The diffusion study showed a significant limitation in rhBMP-2 diffusion when encapsulated in fibrin glue. The laminectomy study revealed blockage of bone formation by fibrin glue and protection of the spinal canal.
To read the abstract, click here
This study histologically evaluates bone shavings collected during surgery for bone quantity by percentage and quality for use in spine fusion surgery. This application of bone shavings that would otherwise be wasted in the suction canisters can maximize the collection of local autograft and decrease the need for iliac crest bone graft. This technique is especially applicable in combination with bone graft extenders such as calcium phosphate and bone growth stimulants such at BMP.
Spinal decompression surgery involves careful surgical planning pre-operatively based on MRI and/or CT-myelogram imaging. Unfortunately, in the operating room, there is not yet an ideal method of visualizing the decompression performed. Current methods of evaluation include ultrasound which does not provide good bony anatomy images, palpation which is limited by the skill and experience of the surgeon, and direct visualization which is limited by the decompression; thus surgeons typically decompress more than what is necessary to be sure of an adequate decompression. This leads to larger incisions, longer operating time and greater blood loss. New technology has provided the ability to obtain multiplanar (3D) images in the operating room. This study utilizes the new 3D imaging system in combination with an injection of contrast media to allow visualization of the spinal canal relative to bony and soft tissue surfaces. This allows the surgeon to immediately evaluate the need for additional decompression in the operating room. In the future this technology, once validated, could allow for more minimally invasive procedures for focused decompressions.
Use of rh-BMP2 in the cervical spine has lead to reports of life-threatening complications related to increased soft-tissue swelling. As there is a concern for an increased inflammatory response with use of rh-BMP2, the material is under evaluation for both characterizing the inflammatory response, and using materials such as fibrin glue to limit this inflammation.
Use of rh-BMP-2 in lumbar interbody applications without instrumentation has been reported to result in graft resorption and collapse. This has not been evaluated in a non-human model for time course or amount of resorption. This study evaluates the quality of bone resorption and formation in a sheep model during the first 3 months after implantation with rh-BMP2.
The subjective response to pain stimulus is quite variable among individuals as well as within individuals depending on other physical and psychological stressors. This makes it very difficult to quantify the amount of pain an individual reports. Thus, in an attempt to correlate perceived pain with a pain stimulus, volunteers are subjected to a safe level of pain stimulus of various random intensity levels and the pain responses reported by the subjects are recorded. These collected responses are then correlated with the pain stimulus and with the aggregate data for a more objective interpretation of the subjects perceived pain. These responses are carried out before and after surgery to also evaluate the correlation of pain perception with associated chronic pain.
Anterior plating for spinal fusion is a relatively new technique for stand-alone anterior spinal fusion compared to the standard technique of pedicle screw fixation. This anterior technique allows for less morbidity and quicker recovery, but the biomechanical comparison with the standard pedicle screw technique has yet to be made. This study compares anterior plating with posterior pedicle screw instrumentation in both saw bone and cadaveric spine models using MTS testing.
Stand alone anterior tension band plating with discectomy and graft placement have become clinically available and accepted as a form of lumbar spinal fusion; however, clinical comparisons with standard techniques are not available. This study is a retrospective case control comparison of anterior fusion with plating and standard posterior spinal interbody fusion with pedicle screw instrumentation. Areas of OR time, blood loss, recovery time, and functional outcome are compared.
P-15 is a peptide based on a specific sequence found on the binding site of collagen. This peptide can be adsorbed onto a bone graft substitute carrier such as anorganic bovine bone matrix to provide a synthetic bone graft substitute without the risks of disease transmission or the morbidity of autograft harvest. It has been in used extensively in the dental industry but not in orthopaedic applications. As the environment in the mouth is significantly different from that of the body, this material must be thoroughly tested for it’s ablility to stimulate bone formation and fusion. This first stage of testing involves implantation in sheep and evaluation with histology and micro-CT imaging.
Any center of excellence must continually evaluate and re-evaluate the treatments provided. At the Spine Center, patients undergoing surgical procedures are asked to fill out questionnaires before surgery and at multiple time points after surgery. This database is updated, maintained, and queried for surgical outcomes of the various procedures performed.
V. Patel, S. Hsu, H. Bae, B. Pradhan, T. Hedman, R. Delamarter,“Floating and Fixed Center of Rotation Intervertebral Prostheses: Biomechanical Comparison of Facet Joint Forces for submission to Spine, in process.
V. Patel, Li Xao, P. Wong, H. Bae, B. Pradhan, R. Delamarter, “Controlling BMP Diffusion and BMP-Stimulated Bone Growth Using Fibrin Glue” Accepted in Spine.
V. Patel, Li Xao, P. Wong, H. Bae, B. Pradhan, R. Delamarter “An In-Vitro and In-Vivo Analysis of Fibrin Glue Used to Control BMP Diffusion and BMP-Stimulated Bone Growth” Accepted in The Spine Journal.
V. Patel, C. Andrews, L. Kanim, B. Pradhan, M. Kropf, H. Bae, R. Delamarter “Intervertebral Prosthesis Position Evaluated by Computed Tomography: Relevance to Clinical Outcome” Spine, Vol 31 (8) pp 2006
BB Pradhan, MD MSE; HW Bae, MD; VV Patel, MD; MA Kropf, MD; L Zhao, MD PhD; P Wong, BS; RB Delamarter, MD Leakage of rhBMP-2 from Absorbable Collagen Sponges during use in Anterior Cervical Discectomy and Fusion: Quantification by Assay and Radiographic Follow-up. Submitted for publication.
BB Pradhan, MD MSE; HW Bae, MD; MA Kropf, MD; VV Patel, MD; RB Delamarter, MD
Radiographic Characterization and Outcomes of Anterior Cervical Discectomy and Fusion using Allograft, rhBMP-2, and Plate Fixation Submitted for publication.
BB Pradhan MD MSE, RB Delamarter MD, VV Patel MD, MA Kropf MD, HW Bae MD Kyphoplasty Reduction of Osteoporotic Vertebral Compression Fractures: Correction of Local Kyphotic Deformity versus Overall Sagittal Alignment. Spine. 2006 Feb 15;31(4):435-41.
BB Pradhan MD MSE, RB Delamarter MD, HW Bae MD, VV Patel MD, MA Kropf MD, EG Dawson MD Graft Resorption with the Use of Bone Morphogenetic Protein: Lessons from Anterior Lumbar Interbody Fusion Using Femoral Ring Allografts and Recombinant Human Bone Morphogenetic Protein-2, Spine Vol 31 (10)pp 2006.
BB Pradhan MD MSE, VV Patel MD, HW Bae MD, MA Kropf, RB Delamarter MD Lumbar Disc Degeneration in Women and Advances in Management – Total Disc Replacement
Submitted for publication in: WOMEN’S HEALTH, Orthopaedic Edition
V. Deviren, V. Patel, S. Berven, S. Hu, D. Bradford, “Anterior Instrumentation for Thorocolumbar Scoliosis: Adult vs. Adolescent” Submitted to JBJS