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首页> 外文期刊>Spine >Recombinant human bone morphogenic protein-2-enhanced anterior spine fusion without bone encroachment into the spinal canal: a histomorphometric study in a thoracoscopically instrumented porcine model.
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Recombinant human bone morphogenic protein-2-enhanced anterior spine fusion without bone encroachment into the spinal canal: a histomorphometric study in a thoracoscopically instrumented porcine model.

机译：重组人骨形态发生蛋白2-增强了无脊柱侵犯骨的前脊柱融合：在胸腔镜仪器化的猪模型中的组织形态计量学研究。

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STUDY DESIGN: A thoracoscopically assisted 5-level anterior spinal fusion and instrumentation model analyzing new bone formation when using recombinant human bone morphogenic protein-2 (rhBMP-2) with a collagen hydroxyapatite-tricalcium phosphate (HA/TCP) composite sponge carrier. OBJECTIVE: To determine whether new bone formation extends beyond the posterior confines of the vertebral body encroaching into the spinal canal when rhBMP-2 is used to enhance anterior fusion. SUMMARY OF BACKGROUND DATA: A possible concern regarding the use of rhBMP-2 to enhance spinal fusion is the risk of unwanted bone formation leading to inadvertent fusion of adjacent levels or compression of neural elements. The safety of rhBMP-2 in one spinal application does not ensure similar results in other applications. Therefore, the expanded use of rhBMP-2 should occur only after carefully monitored preclinical and clinical studies for each new application. METHODS: Eighteen pigs underwent thoracoscopically-assisted instrumentation and fusion of 5 contiguous levels (T5-T10) and randomly assigned to 4 treatment groups: group 1 (n = 6): rh-BMP-2 on a HA/TCP-collagen sponge (Medtronic Sofamor Danek, Memphis, TN); group 2 (n 4): iliac crest autograft; group 3 (n HA/TCP-collagen sponge (Medtronic Sofamor Danek) only. In groups 1 and 4, the HA/TCP collagen sponge was morselized into small granules and pushed through a bone delivery funnel for implantation into the disc. At 4 months after surgery, spines were sectioned longitudinally through the midsagittal plane and underwent undecalcified processing. Bone formation extending beyond the margins of the original discectomy and the confines of vertebral body were evaluated histomorphometrically at each operative level. RESULTS: Recombinant human bone morphogenic protein-2 on a HA/TCP-collagen sponge induced significant new bone formation extending anterior to the confines of the vertebral body compared with the other treatment groups (P < 0.05). In addition, rhBMP-2 on a HA/TCP-collagen sponge induced significant new bone formation extending posterior to the original margins of the discectomy (P < 0.05). However, there was no new bone formation beyond the confines of the posterior vertebral body. The total bone volume in the rhBMP-2-HA/TCP-collagen sponge group was significantly greater compared with all other groups in both the discectomy fusion area and beyond the discectomy area (P < 0.05). CONCLUSIONS: Recombinant human bone morphogenic protein-2 on a HA/TCP-collagen sponge enhanced anterior spinal fusion and induced significant new bone formation extending beyond the margins of the original discectomy and anterior vertebral body, most likely secondary to migration of some morselized carrier fragments from the disc space. However, the new bone formation did not extend beyond the posterior confines of the vertebral body to encroach into the spinal canal because of the intact posterior anulus and/or posterior longitudinal ligament.
机译：研究设计：胸腔镜辅助的5级前路脊柱融合和器械模型分析结合使用重组人骨形态发生蛋白2（rhBMP-2）和胶原羟基磷灰石-磷酸三钙（HA / TCP）复合海绵载体时的新骨形成。目的：确定当使用rhBMP-2增强前路融合时，新的骨形成是否延伸超出椎体的后边界并侵犯到椎管内。背景数据概述：关于使用rhBMP-2增强脊柱融合的可能担心是，形成不需要的骨的风险会导致相邻层的无意融合或神经元受压。在一种脊柱应用中，rhBMP-2的安全性无法确保在其他脊柱应用中获得相似的结果。因此，rhBMP-2的广泛使用应仅在对每种新应用进行仔细监测的临床前和临床研究后进行。方法：18头猪在胸腔镜辅助下进行仪器检查并融合5个连续水平（T5-T10），并随机分为4个治疗组：第1组（n = 6）：在HA / TCP-胶原海绵上的rh-BMP-2（田纳西州孟菲斯市的Medtronic Sofamor Danek）;组2（n 4）：auto自体移植;第3组（仅使用HA / TCP胶原海绵（Medtronic Sofamor Danek）。在第1组和第4组中，将HA / TCP胶原海绵切成小颗粒，并推入骨输送漏斗中植入椎间盘中，四个月。手术后，将脊椎纵向切开穿过矢状中平面，并进行不脱钙的处理;在每个手术水平上，用骨组织形态学方法评估骨形态，超出最初的椎间盘切除术的边缘，并评估椎体的局限性。与其他治疗组相比，HA / TCP-胶原海绵诱导了显着的新骨形成，延伸到椎体的前部（P <0.05）。骨形成向后延伸至椎间盘切除术的原始边缘（P <0.05），但是，没有新的骨形成超出后椎骨的范围ral身体。在椎间盘切除术融合区域内和椎间盘切除术区域之外，rhBMP-2-HA / TCP-胶原海绵组的总骨体积明显高于所有其他组（P <0.05）。结论：HA / TCP-胶原海绵上的重组人骨形态发生蛋白2增强了前脊柱融合并诱导了明显的新骨形成，延伸超出了原始椎间盘切除术和前椎体的边缘，很可能继发于一些杂散的载体片段的迁移从光盘空间。然而，由于完整的后环和/或后纵韧带，新的骨形成并未延伸到椎体的后界限以侵犯到椎管内。

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