Evaluation of autologous platelet concentrate for intertransverse lumbar fusion.

INTRODUCTION: The aim of the study was to analyze if the adding of autologous platelet concentrate (APC) to a mixture of local autograft plus tricalcium phosphate and hidroxiapatite (TCP/HA) would improve the fusion rate in posterolateral lumbar fusion. MATERIALS AND METHODS: A prospective, controlled, blinded, non-randomized clinical trial was carried out in 107 patients affected by degenerative lumbar pathology. The study group consisted of 67 patients, in which autologous platelet concentration was added to a mixture of autologous local bone graft and TCP/HA. A control group of 40 patients with same pathology and surgical technique but without APC addition was used to compare the fusion mass obtained. By means of plain X-rays, a blinded evaluation of the intertransverse fusion mass quality at twelve and twenty-four months was made according to type A (bilateral uniform mass), type B (unilateral uniform mass) and type C (irregular or lack bilateral mass). Patients with type C were regarded as pseudoarthrosis. RESULTS: In the study group 17 patients had lack or irregular fusion mass (25.4%) versus three patients in the control group (7.5%), which was statistically significant. CONCLUSIONS: This study shows that the adding of autologous platelet concentration to a mixture of autologous bone graft plus TCP/HA has decreased our rates of posterolateral lumbar fusion.

Primary giant cell tumor of soft tissue: fluid-fluid levels at MRI (2010:3b).

PURPOSE: Giant cell tumor of soft tissue (GCT-ST) is an extremely rare lesion with an unpredictable behavior. The histological appearance closely resembles that of giant cell tumor of bone and, as such, has been characterized as the soft-tissue equivalent. MATERIALS AND METHODS: We describe the clinical, histological and radiological features of an unusual magnetic resonance imaging (MRI) and deep intramuscular location of GCT-ST with fluid-fluid levels (FFLs) simulating other soft tissue tumors or a hydatid cyst in a 52-year-old man. The lesion was resected. RESULTS: Neither metastasis nor recurrence has occurred in the 6-month period since resection. A review of the literature did not reveal any similar description of intramuscular GCT-ST. CONCLUSION: GCT-ST should be included in the differential diagnosis of soft tissue tumors with FFLs.

Radiographic analysis of fusion mass using fresh autologous bone marrow with ceramic composites as an alternative to autologous bone graft.

OBJECTIVE: To determine whether a biphasic calcium phosphate (BCP) ceramic supplemented with fresh autologous bone marrow (BMA) can give rise to adequate bone to achieve a vertebral fusion mass. MATERIALS AND METHODS: A prospective nonrandomized, radiographic study on 35 patients with posterolateral fusion using rigid transpedicular instrumentation for degenerative lumbar disease. At least 2-year follow-up. On the left side: autologous bone graft obtained from decompression. On the right side: a mixture of BCP and fresh autogenous bone marrow from the right iliac crest. Single-level fusion in 22 patients and two or more levels in 13. Patients assessed with x-rays and computed tomography by an orthopedic surgeon and an independent radiologist. Fusion mass was considered "good" when there was a continuous block of bone without radiolucent areas. No intersegmental bony bridging fusion was considered "poor" mass. McNemar, Fisher, and kappa tests were used for statistical analysis. RESULTS: The interobserver agreement (kappa) had an average of 0.75 for the fusion masses. The interobserver average in the radiologic evaluation of ceramic resorption was 0.68. No differences between smokers and nonsmokers were found. Plain radiography findings: good left fusion masses (autologous bone) in 31 patients and poor in 4; good right masses (BMA plus BCP) in 31 patients and poor in 4 (P > 0.05). Computed tomography evaluation: good left fusion masses in 28 patients and poor in 7; good right fusion masses in 31 patients and poor in 4 (P > 0.05). One patient was reoperated, allowing biopsies to be performed: compact bone tissue was observed around hydroxyapatite in the right fusion mass. CONCLUSIONS: The differences detected between right-side and left-side masses are not statistically significant. This indicates that, BMA and BCP, when mixed, behave like composite grafts and are able to generate sufficient bone mass for arthrodesis when a rigid instrumentation is used. However, a larger number of cases and longer follow-up are needed to generalize the indication.