Several artificial bone grafts have been developed but fail to achieve anticipated osteogenesis due to their insufficient neovascularization capacity and periosteum support. This study aimed to develop a vascularized bone-periosteum construct (VBPC) to provide better angiogenesis and osteogenesis for bone regeneration. A total of 24 male New Zealand white rabbits were divided into four groups according to the experimental materials. Allogenic adipose-derived mesenchymal stem cells (AMSCs) were cultured and seeded evenly in the collagen/chitosan sheet to form cell sheet as periosteum. Simultaneously, allogenic AMSCs were seeded onto alginate beads and were cultured to differentiate to endothelial-like cells to form vascularized bone construct (VBC). The cell sheet was wrapped onto VBC to create a vascularized bone-periosteum construct (VBPC). Four different experimental materials – acellular construct, VBC, non-vascularized bone-periosteum construct, and VBPC – were then implanted in bilateral L4-L5 intertransverse space. At 12 weeks post-surgery, the bone-forming capacities were determined by CT, biomechanical testing, histology, and immunohistochemistry staining analyses.Aims
Methods
Since 1982, 21 patients were operated at our hospital including 12 males and 9 females. The average age were 59.4 years, the average duration of HD was 15.5 years, and DSA was in the cervical spine in 14 cases, and the lumbar spine in 7. Symptoms were pain in 21 patients (100%) and neurological deficits in 19 (90%). Histological examination of respected specimen revealed amyloid deposits in all cases. We classified the X-rays changes from DSA in stage 0 (no change) to stage 3 (end stage), and as type A (kyphosics), B (subluxation), C (amyloid deposits in soft tissues), and D (spontaneous fusion). All 21 cases were classified as stage 3. The 14 cervical spine cases belonged to type A or B, but all 7 lumbar spine cases belonged to type C or were combined types. In the 14 cervical spine cases, spinal fusion was done to stabilize the spine (AO plate in 3, Axis plate in 2, Olerud system in 2, and others in 7). In contrast, posterior decompression (laminoplasty with or without spinal fusion) was done in all 7 lumbar spine cases. The results were evaluated from the JOA scores. The score improved from 6.1 to 10.1 points (full score:17) in cervical patients and it improved from 12.2 to 20.2 points (full score:29) in lumbar patients. One patient died 2 days after surgery because of massive blood loss. Twenty-one operations for DSA were investigated. Surgical strategies were decompression, stabilization, or combination. In addition, minimum invasive procedure should be considered for the patients with high-risk and the poor bone quality.
