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Ortho Solutions

Spinal Cord Injury

Spinal cord injuries cause myelopathy or damage to white matter or myelinated fiber tracts that carry signals to and from the brain. It also damages gray matter in the central part of the spine, causing segmental losses of inter neurons and motor neurons. Atleast a part of functional deficits after SCI is attributable to chronic progressive demyelination. Typical common causes of damage to the spinal cord are trauma or disease. The resulting damage to the spinal cord is known as a lesion, and the paralysis is known as Quadriplegia or Tetraplegia if the injury is in the cervical region or as Paraplegia if the injury is in the Thoracic, Lumbar or Sacral region.

The adult central nervous system has a very limited capacity to regenerate and thus cell transplantation will have a major role in treating spinal cord injury patients in the future. It must be remembered that loss of function and inability to regain function post injury are due to neuronal and glial cell injuries; unlike other cellular transplantation techniques stem cell transplantation is unique as stem cells have the potential to differentiate into both neurons and glial cells. Transplanted stem/progenitor cells can also contribute to promoting axonal regeneration by functioning as cellular scaffolds for growing axons.

“Autologous adult stem cells employed to facilitate spinal fusion instead of using bone harvested from a patient’s pelvis, may alleviate two potential problems: (1) graft site morbidity (including bleeding, infection, and chronic pain at the donor site); and (2) failure to fuse.” Johnson: Neurosurgical Assoc., San Antonio TX, USA 2007

Non Unions

A high concentration of autologous adult stem cells can be added to an autograft or allograft bone matrix in essentially every surgical indication where autograft or allograft bone matrix would normally be selected as a bone void fill or bone growth stimulator. Including concentrated autologous adult stem cells provides all three essential bone growth properties: osteogenic cells, osteoinductive signals, and an osteoconductive scaffold. The number and concentration of local MSCs determines the capacity for bone formation at the operative site. Therefore, direct delivery of MSCs may result in more rapid, reliable and uniform bone formation.

“Percutaneous bone marrow grafting is safe and effective for treating atrophic tibial diaphyseal non-union efficacy appears to be related to the number of progenitors delivered.” Hernigou: JBJS 87:1430-1437, 2005

Avascular Necrosis – femur / knee

Osteonecrosis is associated with a decrease in progenitor cells in the proximal femur. Intramedullary vascularity is altered and this may be a predisposing factor for osteonecrosis. The lack of osteogenic cells can also influence the bone repair which occurs after osteonecrosis. With the addition of autologous bone marrow along with core decompression, better results have been obtained.

This effectiveness of bone marrow mononuclear cells may be related to the availability of stem cells endowed with osteogenic properties arising from an increase in the supply of such cells to the femoral head through bone-marrow implantation. Mesenchymal stem cells (MSC) from adult bone marrow are multipotent that can differentiate into fibroblastic, osteogenic, myogenic, adipogenic and reticular cells. Another possible explanation for the therapeutic effect of bone-marrow implantation is that injected marrow stromal cells secrete angiogenic cytokines, resulting in increased angiogenesis and subsequent improvement in osteogenesis.

“Implantation of autologous bone marrow cells appears to be a safe and effective treatment for early stages of osteonecrosis of the femoral head.”

Ghangi: JBJS 87:106-112, 2005 & Hernigou: Clin Orth & Rel Res No. 405: 14-23, 2002

Cartilage regeneration

The limited intrinsic healing potential of articular cartilage is attributed to the presence of few and specialized cells with a low mitotic activity, to the lack of vessels and of undifferentiated cells that can promote tissue repair. Therefore, once injury occurs, surgical intervention is necessary to achieve repair of the articular surface. However, recent studies demonstrated that MSCs secrete bioactive molecules that stimulate angiogenesis and mitosis of tissue specific and intrinsic progenitors, reduce T cells surveillance and inflammation and some authors have also recognized that the presence of other nucleated cells are able to restore the damaged tissue. This recently revealed capacity of MSCs to secrete bioactive factors that are both immunomodulatory and regenerative paves the way to strategies that mimic natural tissue repair. According to this paradigm, cell selection and cultivation in the laboratory may not be necessary with a significant reduction to the cost of the total procedure allowing the development of one step surgical procedures.

“One step arthroscopic procedure with use of stem cells, demonstrated to regenerate hyaline cartilage, with advantages of reduced surgical time, lower cost, and lower morbidity.”

Giannini: ICRS Meeting Warsaw, Oct 2007

References - Orthopedic - General

Muschler, G, et al, Age- and Gender-Related Changes in the Cellularity of Human Bone Marrow and the Prevalence of Osteoblastic Progenitors, Journal of Orthopaedic Research, 2001: 19;117-125

Romih, M, et al, The Vertebral Interbody Grafting Site’s Low Concentration in Osteogenic Progenitors can Greatly Benefit from Addition of Illiac Crest Bone Marrow, European Spine Journal, 2005: 14;645-648.

Bodke, D, et al, Bone Grafts Prepared with Selective Cell Retention Technology Heal Canine Segmental Defects as Effectively as Autografts, Journal of Orthopaedic Research, 2006: 14;857-866

Dallari, D, et al, In Vivo Study on the Healing of Bone Defects Treated with Bone Marrow Stromal Cells, Platelet-Rich Plasma, and Freeze-Dried Bone Allografts, Alone and in Combination, Journal of Orthopaedic Research, 2006: 24;887-888

References - Orthopedic - Joints

Steinberg, M, et al, Core Decompression with Bone Grafting for Osteonecrosis of the Femoral Head, Clinical Orthopaedics and Related Research, 2001; 386:71-78

Hernigou, P, et al, Treatment of Osteonecrosis with Autologous Bone Marrow Grafting, Clinical Orthopaedics and Related Research, 2002; 405:14-23

Gangji, V, et al, Treatment of Osteonecrosis of the Femoral Head with Implantation of Autologous Bone-Marrow Cells: A Pilot Study, Journal of Bone and Joint Surgery, 2004; 86-A:1153-1160

References - Orthopedic - Spine

Muschler, G.F., et al, Spine Fusion Using Cell Matrix Composites Enriched in Bone Marrow-Derived Cells, Clinical Orthopaedics and Related Research, 2003;407:102-118.

Shen, F, et al, Cell Technologies for Spinal Fusion, The Spine Journal, 2005: 5;231S-239S.

Brodke, D, et al, Bone Grafts Prepared with Selective Cell Retention Technology Heal Canine Segmental Defects as Effectively as Autograft, Journal of Orthopaedic Research, 2006: 24;857-866

References - Orthopedic - Trauma

Connolly, J, Development of an Osteogenic Bone-Marrow Preparation, Journal of Bone and Joint Surgery, June 1989; 684-691

Connolly, J, Autologous Marrow Injection as a Substitute for Operative Grafting of Tibial Nonunions, Clinical Orthopaedics and Related Research, 1991; 266;259-270

Connolly, J, Clinical Use of Marrow Osteoprogenitor Cells to Stimulate Osteogenesis, Clinical Orthopaedics and Related Research, 1998; 355S:S257-S266

Hernigou, P., et al, Percutaneous Autlogous Bone-Marrow Grafting for Nonuions: Influence of the Number and Concentration of Progenitor Cells, Journal of Bone and Joint Surgery, 2005; 87-A; 1430-1437

Hernigou, P., et al, Percutaneous Autlogous Bone-Marrow Grafting for Nonuions: Surgical Technique, Journal of Bone and Joint Surgery, 2006; 88;322-327

Neiman, R., Treatment of Tibial Nonunion and Delayed Union by Percutaneous Injection of Concentrated Autologous Stem Cells: An Alternative to Surgical Repair - A Case Report, February 2007

Leal, L, Adult Stem Cell Treatment Strategy for Jones Fracture and Nonunion of the Proximal Fifth Metatarsal – A Case Report, October, 2007

Brief, A, Less Invasive Osteochondral Defect Repair of the Talus Using Percutaneous Delivery of Concentrated Autologous Adult Stem Cells – A Case Report, October, 2007

References - Orthopedic/Podiatric - Foot & Ankle

Barett, S, Growth Factors for Chronic Plantar Fasciitis?, Podiatry Today, 2004, 17:36-42

Coetzee, J, et al, The Use of Autologous Concentrated Growth Factors to Promote Syndesmosis Fusion in the Agility Total Ankle Replacement. A Preliminary Study, Foot & Ankle International, 2005; 26:840-846

Barrow, C, et al, Enhancement of Syndesmotic Fusion in Total Ankle Arthroplasty with the use of Autologous Platelet Concentrate, Foot & Ankle International, 2005; 26:458-461

Fox, H, et al, Autologous Platelet Concentrate (APC+); An Exciting and Effective New Modality for Foot and Ankle Surgeons, May 7, 2005

Bibo, C, et al, Union Rates Using Autologous Platelet Concentrate Alone and with Bone Graft in High-Risk Foot and Ankle Surgery Patients, Journal of Surgical Orthopaedic Advances, 2005; 14:17-22

Bielecki, T, et al, Percutaneous Injection of Autogenous Growth Factors in Patient with Nonunion of the Humerus. A Case Report, Journal of Orthopaedics, 2006; 3:e15

References - Orthopedic - Joints

Gardner, M, et al, The Efficacy of Autologous Platelet Gel in Pain Control and Blood Loss in Total Knee Arthroplasty, International Orthopaedics, July 1, 2006

Everts, P, et al, Platelet Gel and Fibrin Sealant Reduce Allogeneic Blood Transfusions in Total Knee Arthroplasty, Journal of Extracorporeal Technology, 2006; 50:593-599

Klayman, M, et al, Autologous Platelet Concentrate and Vacuum-Assisted Closure Device Use in a Nonhealing Total Knee Replacement, Journal of Extracorporeal Technology, 2006; 38:44-47

Floryan, K, et al, Intraoperative Use of Autologous Platelet-Rich and Platelet-Poor Plasma for Orthopedic Surgery Patients, AORN Journal, 2004; 80:688-674

Wrotniak, M, et al, Current Opinion About Using Platelet-Rich Gel in Orthopaedics and Trauma Surgery, Ortop Traumatol Rehabil, 2007; 9:227-238

Everts, P, et al, Autologous Platelet Gel and Fibrin Sealant Enhance the Efficacy of Total Knee Arthroplasty: Improved Range of Motion, Decreased Length of Stay and a Reduced Incidence of Arthrofibrosis, Knee Surg Sports Traumatol Arthrosc, 2007; 15:888-894

Kazakos, K, et al, The Use of Autologous PRP Gel as an Aid in the Management of Acute Trauma Wounds, Injury - International Journal of the Care of the Injured, 2008; May

References - Orthopedic - Spine

Lowery, G, et al, Use of Autologous Growth Factors in Lumbar Spinal Fusion, Bone, 1999; 25:47S-50S

Bose, B, et al, Bone Graft Gel: Autologous Growth Factors Used with Autograft Bone for Lumbar Spine Fusions, Advances in Therapy, 2002; 19:170-175

Hee, H, et al, Do Autologous Growth Factors Enhance Transforaminal Lumbar Interbody Fusion?, European Spine Journal, 2003; 12:400-407

Kurica K, et al; "Autologous Growth Factors and Resorbable Porous Ceramic Without Bone Graft for Instrumented Posterolateral Lumbar Fusion", World Spine II Congress Podium Presentation, August, 2003

Walsh, W, et al, Spinal Fusion Using an Autologous Growth Factor Gel and Porous Resorbable Ceramic, European Spine Journal, 2004; 13:359-366

Jenis, L, et al, A Prospective Study of Autologous Growth Factors in Lumbar Interbody Fusion, The Spine Journal, 2006; 6:14-20

Akeda, K, et al, Platelet-Rich Plasma Stimulates Porcine Articular Chondrocyte Proliferation and Matrix Biosynthesis, OsteoArthritis and Cartilage, 2006; 1-9

Akeda, K, et al, Platelet-Rich Plasma (PRP) Stimulates the Extracellular Matrix Metabolism of Porcine Nucleus Pulposus and Anulus Fibrosus Cells Cultured in Alginate Beads, Spine, 2006; 9:959-966

Cillo, J, et al, Evaluation of Autologous Platelet-Poor Plasma Gel as a Hemostatic Adjunct After Posterior Iliac Crest Bone Harvest, Journal of Oral Maxillofacial Surgery, 2007; 65:1734-1738

Tomoyasu, A, et al, Platelet-Rich Plasma Stimulates Osteoblastic Differentiation in the Presence of BMPs, Biochemical and Biophysical Research Communications, 2007; 361:62-67