Neurosurgeon University Medical Center Freiburg Baden Wuerttemberg, Germany
Introduction: “Sticky Bone” in maxillofacial surgery describes a combination of fibrin with bone matrix which is utilized to augment areas with severe bone loss. Autologous sticky bone (aSB) is filled with platelet derived growth factors that stimulate the bone matrix and promote regeneration.
A major challenge in instrumented spinal surgery remains the augmentation of bone fusion, which is widely affected by a variety of coexisting pathologies or patient idiosyncrasies.
This study introduces a novel approach where autologous platelet rich fibrin (PRF) and bone collected during minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), augment fusion of the operated segment.
Methods: We applied the aSB as an add-on fusion promoter in a series of 11 patients where single-level MIS-TLIF was indicated.
During MIS-TLIF, a tubular retractor is placed over the targeted facet joint. Under microscopic visualization, the joint is removed by drilling, while a sterile collection tube is adapted to the suction system and collects the removed bone. In parallel 60-80 ml of patient’s peripheral blood is centrifuged for 8 min to prepare the autologous PRF in a semifluid phase. The collected bone debris and PRF are then intermixed. Then PRF gradually polymerizes and encapsulates the bone fragments in a gelatinous matrix (aSB). Prior to its implantation, the hollow core of the intervertebral titan Cage is filled with aSB. The residual aSB is placed next to the cage in the intervertebral space.
Results: In all cases, bone fusion of the operated segment was verified in the 8-month CT-scan follow-up and no complications associated with aSB application were recorded.
Conclusion : Autologous sticky bone can be easily created in the operating theater by combining PRF with bone fragments from the operating corridor and support fusion during MIS-TLIF surgery.
