NASTASJA RITTLING Tissue Engineering: Spinal Fusion

What is spinal fusion? Surgical technique used to join two or more vertebrae Bone tissue is either grafted from the patient or from a donor

The Process Surgeons approach it either anteriorly or posteriorly depending on the location of the problem Incision is made, lamina is removed. If there is a bone present that causes pain, it is also removed A bone graft is placed between the vertebrae that need to be fused Supplemental hardware may be used to support the bone grafts until they heal: rods and screws for example Using bone grafts from a bone bank is less painful because another incision in the patient doesn’t have to be made 3-4 days in the hospital post-surgery

Bone Grafting from Iliac Crest

Problems being solved Most commonly treated area is the lumbar region Treats: Degenerative disk disease Spinal disk herniation Discogenic pain Spinal tumor Vertebral fracture Scoliosis Kyphosis Posterior Rami Syndrome

History Spinal disorders and deformities were noted as far back as 3500 B.C 1700’s- People tried to fix spinal issues with large, bulky braces

History 1800’s- First surgical attempts to correct spinal curvatures Lewis Sayre- made plaster casts popular in Europe X-rays helped determine where in the spine the issue was

History  First formal spinal fusion performed by Robert Hibbs. He used a patient with tuberculosis and corrected spinal curvature using traction jackets, steel rods, and autographic bone segments  1950’s- More advancements in spinal fusion technique  1960’s and 1970’s- Use of Harrington rods increased  Cortrel and Dubousset created the segmental instrumentation system  21 st century- With breakthrough of tissue engineering, doctors can use bone grafts and small rods to fix spinal issues

Limitations Possibility for additional bone surgery after the spinal fusion surgery During the surgery, parts of the vertebra may be exposed, meaning the muscles have to be dissected in order to complete the procedure Inflammations can occur from the surgery Hardware may irritate the patient Leg weakness “Adjacent segment syndrome”-rigid segment may cause mobile segment stress

Future Bone morphogenetic proteins will become foundation for spinal fusion Posterior interspinous, decompressive devices Pedicle screw based motion preservation devices Minimally invasive fusion

Sources Ogiela, Dennis. "Spinal Fusion." Medline Plus. A.D.A.M., Inc, Web.. Lewandrowski, Kai-Uwe. Advances in Spinal Fusion:Molecular Science, Biomechanics, and Clinical Management. New York: Marcel Dekker, Inc, Print. Fairview Health Services,. Your Guide to Spinal Fusion. Minneapolis: Fairview Press, Print. Szpalski, Marek. Instrumented Fusion of the Degenerative Lumbar Spine. Lippincott Williams and Wilkins, Print.