The effect of platelet-rich plasma and bone marrow on murine posterolateral lumbar spine arthrodesis with bone morphogenetic protein

Raj D. Rao, Krishnaj Gourab, Vaibhav B. Bagaria, Vinod B. Shidham, Umesh Metkar, Brian C. Cooley

Research output: Contribution to journalArticle

Abstract

Background: Recombinant human bone morphogenetic protein-2 (rhBMP-2) has had limited success in stimulating osteogenesis at the site of posterolateral lumbar spine arthrodesis when used at the currently approved human dose for anterior lumbar interbody arthrodesis. The objective of the present study was to investigate the effect of co-administration of fresh harvested autologous bone marrow aspirate and platelet-rich plasma on rhBMP-2-mediated in vivo murine posterolateral lumbar spine arthrodesis. Methods: Forty adult male mice underwent posterolateral intertransverse process arthrodesis from L4 to L6. In three experimental groups, a collagen sponge was placed on each side, overlaying the decorticated transverse processes. Each collagen sponge was presoaked for fifteen minutes with 31 mg of rhBMP-2 in a 100-μL solution containing either saline solution (n = 10), platelet-rich plasma (n = 10), or donor bone-marrow cells (n = 10). Control mice underwent decortication alone (n = 10). The lumbar spine was harvested four weeks after surgery, and spinal fusion was evaluated on the basis of radiographs, computed tomography, and histological analysis. Results: Control mice showed no evidence of spinal fusion. The rate of fusion was radiographically and histologically similar in all three experimental groups. The area, volume, and density of the fusion mass were significantly greater (p <0.05) for the group treated with rhBMP-2 and bone marrow as compared with the group treated with rhBMP-2 alone. The group treated with rhBMP-2 and platelet-rich plasma had intermediate fusion area and density. Histologically, the spines treated with rhBMP-2 alone consistently showed the presence of cortical bone between the two transverse processes but fewer trabeculae within the fusion mass; bone marrow co-augmentation resulted in more trabeculae within the fusion mass and a thicker cortical perimeter. Conclusions: The present study quantitatively confirmed a synergistic effect of bone marrow cells when added to rhBMP-2 in an in vivo mouse posterolateral lumbar spine fusion model. The volume, area, and density of the fusion mass were significantly increased by augmentation with bone marrow cells. Clinical Relevance: Increasing the success of rhBMP-2 augmented posterolateral lumbar spine fusion needs to be further explored in the context of its synergistic mechanisms with other locally available osteoprogenitor cells and growth factors. Additional studies involving higher animals and clinical trials involving humans will be required before this synergistic activity is used clinically.

Original languageEnglish (US)
Pages (from-to)1199-1206
Number of pages8
JournalThe Journal of bone and joint surgery. American volume
Volume91
Issue number5
DOIs
StatePublished - May 1 2009
Externally publishedYes

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Bone Morphogenetic Proteins
Platelet-Rich Plasma
Arthrodesis
Spine
Bone Marrow
Bone Marrow Cells
Spinal Fusion
Porifera
Collagen
recombinant human bone morphogenetic protein-2
Osteogenesis
Sodium Chloride
Intercellular Signaling Peptides and Proteins
Tomography
Clinical Trials

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

The effect of platelet-rich plasma and bone marrow on murine posterolateral lumbar spine arthrodesis with bone morphogenetic protein. / Rao, Raj D.; Gourab, Krishnaj; Bagaria, Vaibhav B.; Shidham, Vinod B.; Metkar, Umesh; Cooley, Brian C.

In: The Journal of bone and joint surgery. American volume, Vol. 91, No. 5, 01.05.2009, p. 1199-1206.

Research output: Contribution to journalArticle

Rao, Raj D. ; Gourab, Krishnaj ; Bagaria, Vaibhav B. ; Shidham, Vinod B. ; Metkar, Umesh ; Cooley, Brian C. / The effect of platelet-rich plasma and bone marrow on murine posterolateral lumbar spine arthrodesis with bone morphogenetic protein. In: The Journal of bone and joint surgery. American volume. 2009 ; Vol. 91, No. 5. pp. 1199-1206.
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AU - Bagaria, Vaibhav B.

AU - Shidham, Vinod B.

AU - Metkar, Umesh

AU - Cooley, Brian C.

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N2 - Background: Recombinant human bone morphogenetic protein-2 (rhBMP-2) has had limited success in stimulating osteogenesis at the site of posterolateral lumbar spine arthrodesis when used at the currently approved human dose for anterior lumbar interbody arthrodesis. The objective of the present study was to investigate the effect of co-administration of fresh harvested autologous bone marrow aspirate and platelet-rich plasma on rhBMP-2-mediated in vivo murine posterolateral lumbar spine arthrodesis. Methods: Forty adult male mice underwent posterolateral intertransverse process arthrodesis from L4 to L6. In three experimental groups, a collagen sponge was placed on each side, overlaying the decorticated transverse processes. Each collagen sponge was presoaked for fifteen minutes with 31 mg of rhBMP-2 in a 100-μL solution containing either saline solution (n = 10), platelet-rich plasma (n = 10), or donor bone-marrow cells (n = 10). Control mice underwent decortication alone (n = 10). The lumbar spine was harvested four weeks after surgery, and spinal fusion was evaluated on the basis of radiographs, computed tomography, and histological analysis. Results: Control mice showed no evidence of spinal fusion. The rate of fusion was radiographically and histologically similar in all three experimental groups. The area, volume, and density of the fusion mass were significantly greater (p <0.05) for the group treated with rhBMP-2 and bone marrow as compared with the group treated with rhBMP-2 alone. The group treated with rhBMP-2 and platelet-rich plasma had intermediate fusion area and density. Histologically, the spines treated with rhBMP-2 alone consistently showed the presence of cortical bone between the two transverse processes but fewer trabeculae within the fusion mass; bone marrow co-augmentation resulted in more trabeculae within the fusion mass and a thicker cortical perimeter. Conclusions: The present study quantitatively confirmed a synergistic effect of bone marrow cells when added to rhBMP-2 in an in vivo mouse posterolateral lumbar spine fusion model. The volume, area, and density of the fusion mass were significantly increased by augmentation with bone marrow cells. Clinical Relevance: Increasing the success of rhBMP-2 augmented posterolateral lumbar spine fusion needs to be further explored in the context of its synergistic mechanisms with other locally available osteoprogenitor cells and growth factors. Additional studies involving higher animals and clinical trials involving humans will be required before this synergistic activity is used clinically.

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