Allogenic Stem Cells in Spinal Fusion: A Systematic Review

Abstract

Study Design: Systematic review. Objectives: To review, critically appraise, and synthesize evidence on the use of allogenic stem cell products for spine fusion compared with other bone graft materials. Methods: Systematic searches of PubMed/MEDLINE, through October 31, 2018 and of EMBASE and ClinicalTrials.gov through April 13, 2018 were conducted for literature comparing allogenic stem cell sources for fusion in the lumbar or cervical spine with other fusion methods. In the absence of comparative studies, case series of !10 patients were considered. Results: From 382 potentially relevant citations identified, 6 publications on lumbar fusion and 5 on cervical fusion met the inclusion criteria. For lumbar arthrodesis, mean Oswestry Disability Index (ODI), visual analogue scale (VAS) pain score, and fusion rates were similar for anterior lumbar interbody fusion (ALIF) using allogenic multipotent adult progenitor cells (Map3) versus recombinant human bone morphogenetic protein-2 (rhBMP-2) in the one comparative lumbar study (90% vs 92%). Across case series of allogenic stem cell products, function and pain were improved relative to baseline and fusion occurred in !90% of patients at !12 months. For cervical arthrodesis across case series, stem cell products improved function and pain compared with baseline at various time frames. In a retrospective cohort study fusion rates were not statistically different for Osteocel compared with Vertigraft allograft (88% vs 95%). Fusion rates varied across time frames and intervention products in case series. Conclusions: The overall quality (strength) of evidence of effectiveness and safety of allogenic stem cells products for lumbar and cervical arthrodesis was very low, meaning that we have very little confidence that the effects seen are reflective of the true effects.

Cellular allograft for multilevel stand-alone anterior cervical discectomy and fusion

“…24 However, the current evidence regarding the efficacy and safety of cellular allografts for cervical arthrodesis is limited, with no published studies comparing cellular allograft with other grafting materials. 25 In this research, we aimed to explore the utility of cellular allograft in the promotion of successful arthrodesis and postoperative clinical outcomes, comparing patients who underwent multilevel ACDF augmented with cellular allograft with patients who underwent ACDF supplemented with decellularized allograft. The primary outcome was construct fusion at the 1-year follow-up as observed on CT.…”

Arthroscopic Contribution of Synthetic Graft in Tibiotalocalcaneal Arthroscopic Fusions

“…The use of cellular based allografts is an alternate treatment option which has reported promising results in foot and ankle arthrodesis. However, evidence remains limited for these regenerative therapies involving multipotent adult progenitor cells [ 3 , 17 ]. Demineralized bone matrices (DBMs) and the allografts present osteo-conductive and osteo-inductive properties.…”

Investigating the efficacy of allograft cellular bone matrix for spinal fusion: a systematic review of the literature

“…We compared cancellous bone versus various DBMs versus various ACBMs in terms of product cost per cubic centimeter. On average (across various manufacturers), cancellous bone products cost $17 per cm 3 , DBM products cost $151 per cm 3 , and ACBM products cost $525 per cm 3 (Table 4). Thus, ACBMs are being sold at a premium in comparison to other bone graft substitutes.…”

“…1,2 The inability to achieve solid arthrodesis after performing spinal fusion frequently results in poor clinical outcomes, instrumentation failures, increased rates of revision surgery, and escalation of treatment costs. 3 In addition to rigid spinal fixation with instrumentation, an essential component for solid arthrodesis is the bridging of bone surfaces, either with collected autograft or with commercial allograft products. The ideal graft material for spinal fusion must possess three critical physiological properties for achieving solid arthrodesis: osteogenesis, osteoinduction, and osteoconduction.…”