Use of autologous growth factors in lumbar spinal fusion

The results of spinal fusion, especially posteriorly above the lumbosacral junction, have been mixed. Autologous growth factor concentrate (AGP) prepa red by ultraconcentration of platelets contains multiple growth factors hav ing a chemotactic and mitogenic effect on mesenchymal stem cells and osteob lasts and may play a role in initiating bone healing, The purpose of this r etrospective study is to review our results with AGF in lumbar spinal fusio ns, To date, AGF has been used in 39 patients having lumbar spinal fusion, The study group consisted of the first 19 consecutive cases to allow at lea st 6 months follow-up, The average follow-up was 13 months (range 6 to 18 m onths). Follow-up compliance was 91%. There were 7 men and 12 women. Averag e age was 52 years (range 30-72 years), Nine patients had prior back surger y. There were 8 smokers. AGF was used in posterior (n = 15) or anterior int radiscal (n = 4) fusions, AGF was used with autograft and coraline hydroxya patite in all posterior fusions, and autograft, coral, and intradiscal spac er (carbon fiber spinal fusion cages or Synthes femoral ring) in intradisca l fusions. Posterior stabilization was used in all cases. Eight cases were single-level fusions, 6 were two-level, and 1 was a three-level fusion, Aut ologous iliac crest bone graft was taken in 14 cases and local autograft us ed in 5 cases, Posteriorly, a total of 23 levels were fused; of these, nine were at L5-S1, eight at L4-L5, five at L3-L4, and one at L2-L3, No impendi ng pseudoarthroses were noted on plain radiographic examination at last fol low-up visit. Solid fusion was confirmed in 3 patients having routine hardw are removal, and in 2 patients who had surgery at an adjacent level, There was one posterior wound infection, which was managed without sequelae, When used as an adjunct to autograft, AGF offers theoretical advantages that ne ed to be examined in controlled studies, Further study is necessary to dete rmine whether coralline hydroxyapatite used as a bone graft extender in lum bar spinal fusion may help to obviate the need for secondary site graft har vesting. (Bone 25: 47S-50S; 1999) (C) 1999 by Elsevier Science Inc. All rig hts reserved.