Top

European Spine Journal

Published in:

01-03-2014 | Original Article

Biological performance of a polycaprolactone-based scaffold plus recombinant human morphogenetic protein-2 (rhBMP-2) in an ovine thoracic interbody fusion model

Authors: Mostyn R N O Yong, Siamak Saifzadeh, Geoffrey N Askin, Robert D Labrom, Dietmar W Hutmacher, Clayton J Adam

Published in: European Spine Journal | Issue 3/2014

Abstract

Purpose

We develop a sheep thoracic spine interbody fusion model to study the suitability of polycaprolactone-based scaffold and recombinant human bone morphogenetic protein-2 (rhBMP-2) as a bone graft substitute within the thoracic spine. The surgical approach is a mini-open thoracotomy with relevance to minimally invasive deformity correction surgery for adolescent idiopathic scoliosis. To date there are no studies examining the use of this biodegradable implant in combination with biologics in a sheep thoracic spine model.

Methods

In the present study, six sheep underwent a 3-level (T6/7, T8/9 and T10/11) discectomy with randomly allocated implantation of a different graft substitute at each of the three levels: (a) calcium phosphate (CaP) coated polycaprolactone-based scaffold plus 0.54 μg rhBMP-2 (b) CaP-coated PCL-based scaffold alone or (c) autograft (mulched rib head). Fusion was assessed at 6 months post-surgery.

Results

Computed Tomographic scanning demonstrated higher fusion grades in the rhBMP-2 plus PCL-based scaffold group in comparison with either PCL-based scaffold alone or autograft. These results were supported by histological evaluations of the respective groups. Biomechanical testing revealed significantly higher stiffness for the rhBMP-2 plus PCL-based scaffold group in all loading directions in comparison with the other two groups.

Conclusion

The results of this study demonstrate that rhBMP-2 plus PCL-based scaffold is a viable bone graft substitute, providing an optimal environment for thoracic interbody spinal fusion in a large animal model.

Available only for authorised users

Dubousset J (2001) Scoliosis and its pathophysiology: do we understand it? Spine 26(9):1001PubMedCrossRef

Newton PO, Wenger DR, Mubarak SJ, Meyer RS (1997) Anterior release and fusion in pediatric spinal deformity. A comparison of early outcome and cost of thoracoscopic and open thoracotomy approaches. Spine 22(12):1398–1406PubMedCrossRef

Picetti GD 3rd, Pang D, Bueff HU (2002) Thoracoscopic techniques for the treatment of scoliosis: early results in procedure development. Neurosurgery 51(4):978–984PubMed

Izatt MT, Harvey JR, Adam CJ, Fender D, Labrom RD, Askin GN (2006) Recovery of pulmonary function following endoscopic anterior scoliosis correction: evaluation at 3, 6, 12 and 24 months after surgery. Spine 31(21):2469–2477PubMedCrossRef

Gatehouse SC, Izatt MT, Adam CJ, Harvey JR, Labrom RD, Askin GN (2007) Perioperative aspects of endoscopic anterior scoliosis surgery: the learning curve for a consecutive series of 100 patients. J Spinal Disord Tech 20(4):317–323PubMedCrossRef

Yong MR, Izatt MT, Adam CJ, Labrom RD, Askin GN (2012) Secondary curve behavior in Lenke type 1C adolescent idiopathic scoliosis after thoracoscopic selective anterior thoracic fusion. Spine 37(23):1965–1974. doi:10.1097/BRS.0b013e3182583421 PubMedCrossRef

Sandhu HS (2000) Anterior lumbar interbody fusion with osteoinductive growth factors. Clin Orthop Relat Res 371:56–60PubMedCrossRef

Abbah SA, Lam CX, Hutmacher DW, Goh JC, Wong HK (2009) Biological performance of a polycaprolactone-based scaffold used as fusion cage device in a large animal model of spinal reconstructive surgery. Biomaterials 30(28):5086–5093. doi:10.1016/j.biomaterials.2009.05.067 PubMedCrossRef

Sawyer AA, Song SJ, Susanto E, Chuan P, Lam CX, Woodruff MA, Hutmacher, Cool SM (2009) The stimulation of healing within a rat calvarial defect by mPCL-TCP/collagen scaffolds loaded with rhBMP-2. Biomaterials 30(13):2479–2488. doi:10.1016/j.biomaterials.2008.12.055 PubMedCrossRef

10.

Panjabi M (1998) Biomechanical evaluation of spinal fixation devices: 1. A conceptual framework. Spine 13(10):1129–1134CrossRef

11.

Karageorgiou V, Kaplan D (2005) Porosity of 3D biomaterial scaffolds and osteogenesis. Biomaterials 26(27):5474–5491PubMedCrossRef

12.

Yang F, Wolke JGC, Jansen JA (2008) Biomimetic calcium phosphate coating on electrospun poly (ε-caprolactone) scaffolds for bone tissue engineering. Chem Eng J 137(1):154–161CrossRef

13.

Patel VV, Zhao L, Wong P, Pradhan BB, Bae HW, Kanim L, Delamarter RB (2006) An in vitro and in vivo analysis of fibrin glue use to control bone morphogenetic protein-stimulated bone growth. Spine J 6(4):397–403PubMedCrossRef

14.

Sucato DJ, Hedequist D, Zhang H, Pierce WA, O’Brien SE, Welch RD (2004) Recombinant human bone morphogenetic protein-2 enhances anterior spinal fusion in a thoracoscopically instrumented animal model. J Bone Joint Surg 86-A(4):752–762PubMed

15.

Melchels FPW, Domingos MAN, Klein TJ, Malda J, Bartolo PJ, Hutmacher DW (2012) Additive manufacturing of tissues and organs. Prog Polym Sci 37(8):1079–1104CrossRef

16.

Goel VK, Panjabi MM, Patwardhan AG, Dooris AP, Hassan S (2006) Test protocols for evaluation of spinal implants. J Bone Joint Surg 88(Suppl. 2):103–109PubMedCrossRef

17.

Urist MR (1965) Bone formation by autoinduction. Science 150:893–899PubMedCrossRef

18.

Burkus JK (2004) Bone morphogenetic protein in anterior lumbar interbody fusion: old techniques and new technologies. Invited submission from the Joint section meeting on disorders of the spine and peripheral nerves. J Neurosurg Spine 1(3):254–260PubMedCrossRef

19.

Carragee EJ, Hurwitz EL, Weiner BK (2011) A critical review of recombinant human bone morphogenetic protein-2 trials in spinal surgery: emerging safety concerns and lessons learned. Spine J 11:471–491PubMedCrossRef

20.

Walker DH, Wright NM (2002) Bone morphogenetic protein and spinal fusion. Neurosug Focus 13(6):article 3

21.

Cunningham BW, Kanayama M, Parker LM, Weis JC, Sefter JC, Fedder IL, McAfee PC (1999) Osteogenic protein versus autologous interbody arthrodesis in the sheep thoracic spine. A comparative endoscopic study using the Bagby and Kuslich interbody fusion device. Spine 24(6):509–518PubMedCrossRef

22.

Hutmacher DW, Schanz JT, Lam CX, Tan KC, Lim TC (2007) State of the art and future directions of scaffold—based bone engineering from a biomaterials perspective. J Tissue Eng Med 1(4):245–260CrossRef

23.

Oda I, Abumi K, Cunningham BW, Kaneda K, McAfee PC (2002) An in vitro human cadaveric study investigating the biomechanical properties of the thoracic spine. Spine 27(3):E64–E70PubMedCrossRef

24.

Yong MR, Saifzadeh S, Askin GN, Labrom RD, Hutmacher DW, Adam CJ (2013) Establishment and characterization of an open mini-thoracotomy surgical approach to an ovine thoracic spine fusion model. Tissue Engineering C. doi:10.1089/ten.TEC.2012.0746

25.

Cunningham BW, Kotani Y, McNulty PS, Cappucino A, Kanayama M, Fedder IL, McAfee PC (1998) Video-assisted thoracoscopic surgery versus open thoracotomy for anterior thoracic spinal fusion. A comparative radiographic, biomechanical, and histological analysis in a sheep model. Spine 23(12):1333–1340PubMedCrossRef

26.

Hecht BP, Fischgrund JS, Herkowitz HN, Penman L, Toth JM, Shirkhoda A (1999) The use of recombinant human bone morphogenetic protein 2 (rhBMP-2) to promote spinal fusion in a nonhuman primate anterior interbody fusion model. Spine 24(7):629–636PubMedCrossRef

Title: Biological performance of a polycaprolactone-based scaffold plus recombinant human morphogenetic protein-2 (rhBMP-2) in an ovine thoracic interbody fusion model
Authors: Mostyn R N O Yong
Siamak Saifzadeh
Geoffrey N Askin
Robert D Labrom
Dietmar W Hutmacher
Clayton J Adam
Publication date: 01-03-2014
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 3/2014
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-013-3085-x

At a glance: The STEP trials

Springer Medicine

Biological performance of a polycaprolactone-based scaffold plus recombinant human morphogenetic protein-2 (rhBMP-2) in an ovine thoracic interbody fusion model

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2014

Does strenuous leisure time physical activity prevent severe back disorders leading to hospitalization?

Reciprocal changes in cervical spine alignment after corrective thoracolumbar deformity surgery

Range of motion of thoracic spine in sagittal plane

Adjacent-level failures after occipito-thoracic fusion for rheumatoid cervical disorders

Inflammatory pain pattern and pain with lumbar extension associated with Modic 1 changes on MRI: a prospective case–control study of 120 patients

Reviewer’s Comment concerning “Multiaxial high modularity spinopelvis (HSMP) fixation device in neuromuscular scoliosis—a comparative study” (ESJO-D-13-00331R1 by Jin-Ho Hwang, Hitesh N. Modi, Seung-Woo Suh, Jae-Hyuk Yang, Jae-Young Hong)