Cell-based therapies for spinal fusion.
ABSTRACT During spinal fusion procedures, bone grafts are placed to promote bone healing and to provide stability. The autologous graft is the current clinical standard of care due to its ability to initiate bone formation and because it poses no risk of rejection; however, it has drawbacks such as donor site morbidity and limited supply. Due to processing for sterility and storage, allogeneic grafts have reduced osteoinductive properties and thus must be delivered with osteoinductive agents. As a result, bone morphogenetic proteins have been used increasingly to augment bone repair, but in certain locations these proteins can cause complications such as swelling and ectopic bone formation. The drawbacks associated with these treatments have prompted increased investigations into using cells to deliver osteoinductive agents. Clinical studies have demonstrated that when osteoprogenitor cells are combined with osteoconductive materials, fusion rates are comparable to autograft results. Preclinical investigations have achieved superior spinal fusion rates in as little as two weeks using cells genetically modified to deliver osteoinductive agents. Immunoisolation of allogeneic cells by microencapsulation has demonstrated the feasibility of using non-autologous cells, thereby eliminating the need for immunosuppressants. This chapter describes the latest research advances in promoting spinal fusion using these cell-based therapies.
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ABSTRACT: Abstract In the last 25 years of spinal surgery, tremendous improvements have been made. The development of smart technologies with the overall aim of reducing surgical trauma has resulted in the concept of minimally invasive surgical techniques. Enhancements in microsurgery, endoscopy and various percutaneous techniques, as well as improvement of implant materials, have proven to be milestones. The advancement of training of spine surgeons and the integration of image guidance with precise intraoperative imaging, computer- and robot-assisted treatment modalities constitute the era of reducing treatment morbidity in spinal surgery. This progress has led to the present era of preserving spinal function. The promise of the continuing evolution of spinal surgery, the era of restoring spinal function, already appears on the horizon. The current state of minimally invasive spine surgery is the result of a long-lasting and consecutive development of smart technologies, along with stringent surgical training practices and the improvement of instruments and techniques. However, much effort in research and development is still mandatory to establish, maintain and evolve minimally invasive spine surgery. The education and training of the next generation of highly specialized spine surgeons is another key point. This paper will give an overview of surgical techniques and methods of the past 25 years, examine what is in place today, and suggest a projection for spine surgery in the coming 25 years by drawing a connection from the past to the future.Minimally invasive therapy & allied technologies: MITAT: official journal of the Society for Minimally Invasive Therapy 08/2013; 22(4):227-41. DOI:10.3109/13645706.2013.821414 · 1.18 Impact Factor