Page 15 - HBC Booklet - 2020

Eur Spine J (2011) 20:1791-1795

DOI 10.1007/s00586- 0 l l - 1736-3

ORIGINAL ARTICLE

Autografts for spinal fusion: osteogenic potential of laminectomy

bone chips and bone shavings collected via high speed drill

Claudia Eder• Albert Chavanne • Jochen Meissner•

Wolfgang Bretschneider · Alexander Tuschel ·

Philipp Becker · Michael Ogon

Received: 11 February 2011 / Revised: 16 February 2011 / Accepted: 19 February 2011 /Published online: 6 March 2011

© Springer-Verlag 2011

Abstract In case of revision or minimal invasive spinal obtained from laminectomy bone chips are superior in

surgery, the amount of autograft possibly harvested from terms of cell deli very, cell proliferation and mineralization.

the lamina and the spinous processes is limited. Ekanayake

and Shad (Acta Neurochir 152:651-653, 2010) suggest the Keywords Spinal fusion • Bone graft •

application of bone shavings harvested via high speed burr Osteoregeneration · Bone chips · High speed burr

additionally or instead, but so far no data regarding their

osteogenic potential exist. Aim of the study was to com­

pare the osteogenic potential of bone chips and high speed Introduction

burr shavings, and to evaluate the applicability of bone

shavings as an autograft for spinal fusion. Bone chips and I n order to achieve a solid spinal fusion, the PASS prin­

shavings from 14 patients undergoing spinal decompres­ ciples (Primary wound closure/ Angiogenesis/Space/Stabi­

sion surgery were analyzed using in vitro tissue culture lity) for predictable bone regeneration must be addressed

methods. Osteoblast emigration and proliferation, viability [l]: primary wound closure i s required to ensure undis­

and mineralization were investigated and histological turbed healing. Angiogenesis must take place t o allow

evaluation was performed. Bone chips from all patients connection to the blood supply and attract undifferentiated

showed successful osteoblast emigration after average mesenchymal stem cells to initiate bone regeneration.

5.5 days. In contrast, only 57% of the corresponding bone Space must be maintained or created i n order to facilitate

shavings successfully demonstrated osteoblast emigration osteoblast ingrowth. Stability must be ensured to allow a

within an average time span of 14.8 days. Average osteo­ blood clot formation maintaining growth factors relevant

blast mobilisation was 1.25 x 10 cells per gram from for cell differentiation at the fusion site. For all those
6
bone chips and 1.73 x 1 0 5 cells per gram from the corre­ reasons, stand alone bone grafts or bone grafts combined

sponding bone shavings. No difference was observed with fusion cages are used to promote bone healing and

regarding cell viability, but population doubling times of prevent pseudarthrosis formation.

bone chip cultures were significantly lower (50.5 vs. 121 h) Cancellous bone taken from the iliac crest is still con­

and mineralization was observed in osteoblasts derived sidered a standard in spinal fusion, but is associated with

from bone chips only. Although some authors suggest the complications in up to 20% [2]: complications include

general applicability of laminectomy bone shavings as hematoma formation, neurological injuries and infection as

autografts for spinal fusion, autologous bone grafts well a s acute and chronic pain. Studies report the incidence

o f chronic donor site pain for more than 2 years after

surgery in 31 % of the patients concerned [3]. Additional

C. Eder (121) • A. Chavanne • J. Meissner • W. Bretschneider • operating time and preparation i s required, a n d bone har­

A. Tuschel · P. Becker · M. Ogon vesting may be insufficient [11, 12] Allograft bone is most

3rd Orthopedic Department, frequently used as alternative, but lack of osteogenicity

Orthopedic Hospital Vienna-Speising,

Speisinger Str. 109, 1130 Vienna, Austria may decrease osteoinductance and increase infection rates

e-mail: claudia.eder@oss.at [4]. Various types of synthetic bone grafts are rushing into

� Springer