Periosteal cells compared with autologous cancellous bone in lumbar segmental fusion

Object. Despite modern stabilization techniques and the use of autologous cancellous bone, bone consolidation does not occur in 10-15% of spinal fusion operations. There is also considerable donor site morbidity. Therefore, there is a definite need for material that has a larger measure of osteoinductivity, osteoconductivity, and osteogenic potential. Methods. In this study, 24 patients with degenerative spinal disease underwent single-level circumferential lumbar fusion. The patients were randomly placed in 2 groups, each with different cage filling (Group 1, autologous iliac crest cancellous bone; Group 2, autologous periosteal cells in a fibrin/polyalactin-poly-p-dioxanone fleece). After 3, 6, 9, and 12 months, the patients underwent clinical (Oswestry Disability Index, patient satisfaction, willingness to undergo the operation again, visual analog scale for pain) and radiological (plain and flexion/extension radiographic and thin-layer computed tomography [CT]) examinations. Results. The 6-month CT scans and 9-month radiographs obtained in Group 2 patients showed a significantly higher rate of fusion than those in Group 1 patients. Aside from this, there were no further significant differences. After 12 months, radiographic results showed a fusion rate of 80% in Group 1 and 90% in Group 2. No implant- or transplant-related complications were observed. Conclusions. The use of autologous periosteal cells on carrier material with osteoinductive and osteoconductive properties showed comparable results with autologous cancellous bone and better results with regard to consolidation at 6-9 months postoperatively. The shorter consolidation time, as well as lower donor site morbidity, justifies the clinical use and further development of this tissue-engineering strategy.