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E-Poster #510 Mineralized Collagen and Bone Marrow Aspirate in Anterior Interbody Carbon Fiber Cages Achieve High Fusion Rates in Multilevel Adult Spinal Deformity Richard Hostin, M.D.; Eric Klineberg, M.D.; Shay Bess, M.D.; Munish Gupta, M.D.; International Spine Study Group

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Presenter: Presenter: Richard Hostin(a,d) DePuy Spine; (e) Axial Biotech Co-Authors: Eric Klineberg(a) OREF; (b) Synthes; (d) DePuy Spine, Stryker, Synthes (e) AO Shay Bess(a,b) DePuy Spine; (b) Allosource; (c) Pioneer Munish Gupta(b) DePuy Spine, Osteotech, Lanx; (c) DePuy Spine, J&J, Pioneer, Proctor & Gamble, Acrotech, Pfizer; (d) AO, Medtronic International Spine Study Group(a) DePuy Spine a.Grants/Research Support b.Consultant c.Stock/Shareholder d.Speakers Bureau e.Other Financial Support 18th International Meeting on Advanced Spine Techniques Authors Disclosure Information E-Poster #510 Mineralized collagen and bone marrow...

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Summary Single-center, blinded radiographic and patient outcome analysis of multilevel anterior spine fusion rates using bone marrow aspirate and mineralized collagen in anterior interbody fusion cages in adult spinal deformity patients. Fusion grades based on published Lenke-Bridwell grading scale 1 Complete fusion 2 Probable fusion with no lucencies 3 an intact graft with lucency at the top or bottom of the graft 4 nonunion with resorption of the graft

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Introduction Many factors can affect success of spine fusion Patient co-morbidities Position of implant Mechanical and/or biological deficiencies Debate continues regarding the proper method of assessing union with bone graft replacements as well as the cost vs benefit of available osteobiologics

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Introduction Surgical exploration and radiographic analysis continue to be acceptable options for evaluating fusion success Purpose: To determine the ability of bone marrow aspirate and mineralized collagen placed in carbon fiber polymer cages to achieve multilevel anterior fusion in adult spinal deformity patients.

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Methods Prospective, consecutive, adult spinal deformity patients who required long fusions to the pelvis underwent multilevel anterior spine fusion using bone marrow aspirate/mineralized collagen and a carbon fiber interbody device, combined with instrumented posterior spinal fusion Radiographic analysis included preop and minimum 1 year postop full length coronal and sagittal radiographs, lumbar flexion/extension radiographs and postop lumbar CT scans

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Methods Anterior spine fusion status at each level (T11-S1) evaluated minimum 1 year postoperatively by 3 independent surgeons using the Bridwell-Lenke grading scale Grades 2.5 classified as not fused Pre and post op HRQOL measures included: VAS, SRS-22, and ODI

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Methods Statistical analysis: Comparison analysis using paired t-tests was performed with minimum of 1 year follow up Changes in ODI scores from preoperative to 1 year postop decreased significantly by an average of 12.53 (p=0.02) Changes in ODI scores from preop to 2 year post op decreased significantly by an average of 10.80 (p=0.02) There was no statistical change in ODI scores between the two post op periods (year 1 to year 2) Similar results were observed for SRS and VAS scores

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Results From 2006-2008, 23 adult spinal deformity patients received 109 anterior spine fusions (mean 4.7 levels/patient) Follow up = 1.6 years 95% of levels were classified as fused on plain radiographs 86% of levels classified as fused on CT Improvement demonstrated for all HRQOL measures No statistically significant differences in outcome measures between patients classified as fused versus non-fused

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Results Pre OP (mean) 1 yr PostOP (mean) P value ODI31.519.20.02 VAS4.92.6