Browsing by Author "Smith, Micah"

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    Rate of Fusion Using Novel Synthetic Bone Graft Mixed with Allograft Stem Cell Product in Lumbar Interbody Fusions
    (2023-07-28) Bartrom, Sam; Smith, Micah
    Background: Over 400,000 spine fusions are performed in the United States annually with 75% involving the lumbar region.1 It is the indicated treatment of many chronic orthopedic conditions that fail conservative management. There are numerous surgical approaches; however, common to all is the removal of the intervertebral disc and the insertion of a bone graft which promotes arthrodesis. Iliac crest autografts are regarded as the “gold standard” bone graft material for lumbar fusions. SurGenTec has developed an allogeneic graft, Vimax®, that has illustrated similar qualities to autograft material. This study aims to observe how the mixture of Vimax® and OsteoFlo® will affect the rate of arthrodesis in patients undergoing lumbar fusions. Methods: A retrospective chart review on patients that received a lumbar interbody fusion using Vimax® and Osteoflo® between May 2021 to July 2022 was performed. Demographic information was obtained. Pre-operative radiographs were measured in addition to 2-week, 6-week, 3-month, 6-month, and 1-year post-operative radiographs. Post-operative radiographs were also assigned a Bridwell fusion grade. Results: 96 patients receiving 146 fusions were studied. 23.3% of fusions recorded a Bridwell Grade I (complete fusion) at 3-months post-op and 92.8% at 1-year post-op. The comorbidities of heart disease and hypertension displayed delayed arthrodesis at 6 months and 3 months post-op, respectively. However, both had over 90% Bridwell Grade 1 at 1-year post-op. No significant difference was noted for surgical approach or other comorbidities such as diabetes mellitus, osteoporosis, and renal disease. Segmental lordosis, pelvic tilt, pelvic incidence, and PI-LL mismatch had no significant difference post-op compared to pre-op. Anterior and posterior disc height and foraminal height increased significantly while spondylolisthesis decreased significantly post-operatively. Lumbar lordosis displayed a significant decrease at 2-weeks post-op compared to pre-op, but not at any other timepoint. Conclusions: Vimax® and OsteoFlo® demonstrated effectiveness as an iliac crest autograft substitute.
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    Rate of fusion using novel synthetic bone graft mixed with cellular allograft product in lumbar fusions
    (AME, 2025) Bartrom, Samuel; Smith, Micah; Medicine, School of Medicine
    Background: Over 400,000 spine fusions are performed in the United States annually with 75% involving the lumbar region. It is the indicated treatment of many chronic orthopedic conditions that fail conservative management. There are numerous surgical approaches; however, common to all is the removal of the intervertebral disc and the insertion of a bone graft which promotes arthrodesis. Iliac crest autografts are regarded as the "gold standard" bone graft material for lumbar fusions; however, they come with a significant complication rate. Recently developed biologic mixtures, such as the one used in this study, have illustrated similar qualities to autograft material. This study aims to observe how the mixture of a cellular allograft with a fully synthetic bone graft will affect the rate of arthrodesis in patients undergoing lumbar fusions. Methods: A retrospective chart review on patients who received a lumbar interbody fusion using a combination of Vimax® and Osteoflo® between May 26, 2021, to December 31, 2022, was performed. Demographic information was obtained. Pre-operative radiographs were measured in addition to 2-week, 6-week, 3-month, 6-month, and 1-year post-operative radiographs. Post-operative radiographs were examined to assign a Bridwell fusion grade to interbody and lateral mass fusions. Results: A total of 129 patients receiving 211 lateral mass fusions and 199 interbody fusions were studied. A proportion of 3.3% of lateral mass fusions recorded a Bridwell Grade I (complete fusion) at 3 months post-operative and 77.8% at 1 year post-operative. Among interbody fusions, 14.1% were assigned a Bridwell Grade I at 3-month post-operative and 92.0% at the 1-year post-operative timepoint. Non-modifiable risk factors such as age and sex at birth had no impact on arthrodesis rate at 1 year for lateral mass or interbody fusions. Additionally, there was no significant difference in long-term fusions rates at the 1-year post-operative mark between obese and non-obese groups. Comorbidities did not affect the rate of arthrodesis 1-year post-operative apart from depression and hypertension. Patients with depression, and those without hypertension, exhibited significantly reduced lateral mass fusion rates with no difference in interbody fusion rates. While significant variations in rates of fusion were noted amongst surgical approaches at intermediate time points, no difference was observed 1 year post-operatively. Significant improvements in spondylolisthesis, anterior disc height, posterior disc height, and foraminal height were observed at each post-operative period. Conclusions: The cellular allograft and synthetic mixture demonstrated significant arthrodesis rate at 92%, which trends higher than historically reported results for iliac crest autograft. Important to note, the absence of reduced arthrodesis rate in particular at-risk groups, such as the elderly, obese, and those with osteoporosis, suggests this mixture can be used in an extensive patient population and can overcome historically challenging arthrodesis patient cohorts.
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    Successful Arthrodesis Using a Blended Allograft and Autograft Mixture in Lumbar Interbody Fusion: A Retrospective Case Series
    (Springer Nature, 2024-09-15) Fiechter, Jay; Baumann, Anthony N.; Smith, Micah; Orthopaedic Surgery, School of Medicine
    Introduction: Achieving successful arthrodesis after lumbar interbody fusion remains a challenge, especially for minimally invasive surgical approaches that limit the amount of local bone autograft. However, using an allograft blend as an autograft extension mixture may hold promise but requires further research. The purpose of this study is to examine the impact of an allograft blend added to autograft on the quality of arthrodesis after lumbar interbody fusion in adult patients. Methods: This study is a retrospective case series of adult patients (>21 years old) who underwent lumbar interbody fusion between October 2021 and January 2022, performed by a single spine surgeon. The quality of arthrodesis was assessed via the Bridwell grade (I-IV) for up to six months. The impact of surgical technique, age, sex, or amount of allograft utilized during fusion on Bridwell grade was assessed. Results: Patients (n = 18; 27 levels fused) had a mean age of 58.6 (1.9) years and a mean BMI of 32.8 (1.2) kilograms per meter squared (kg/m²). A mean of 18.0 (standard deviation = 2.4) cubic centimeters (cc) (range: 3.4-50.0 cc) of allograft was used per fused level. A Bridwell grade of I (successful arthrodesis) was achieved at three months in 11.1% (3/27) of fusions and at six months in 85.2% (23/27) of fusions. Four fusions remained at a Bridwell grade of II at six months and subsequently achieved complete arthrodesis at 12 months. No patients received a Bridwell grade of IV (lucency with collapse of graft) at three- or six-month follow-up. There was no difference in Bridwell grade when stratified by surgical technique, age, sex, or amount of allograft used. Conclusion: The allograft and autograft blend utilized in this study resulted in successful arthrodesis at all fused levels after one year, irrespective of surgical technique or other patient factors. Prospective studies with larger sample sizes are needed to corroborate the findings of this small case series.