Autologous iliac crest bone marrow mononuclear cells in bone fusion

Introduction: Autologous iliac bone harvesting is associated with significant drawbacks and low fusion rates are noted in conditions such as osteoporosis. Bone Marrow Aspirate (BMA) is relatively inexpensive and contains mononuclear cells which can be utilised. Aim: To document the efficacy of concentrated Bone Marrow Mononuclear Cells (BM-MNC) in bone fusion and compare fusion rates with autologous Iliac Crest Bone Graft (ICBG) alone versus combined ICBG and BM-MNC. Materials and Methods: This prospective, non randomised study included study group and age matched control group (of previously operated craniovertebral junction anomalies) with 15 patients in each group. Combined autologous ICBG+BM-MNC (study group) was compared with autologous ICBG alone (control group). The BMA was processed in stem-cell laboratory to procure mononuclear cells. Morcelised graft pieces mixed with BM-MNC were applied over fusion site after instrumentation. Patients were assessed for fusion and neurological outcome. Qualitative data analysis was done using Fisher exact test. Results: Mean age, surgical procedures and complications were similar in both groups. Average duration for procurement of cells was 98 minutes. Average of 40.6 million cells were utilised. Higher fusion rates were noted in the study group both at three and six months which, however, was not statistically significant (p-value 0.06 and 0.26 respectively). Conclusion: To the best of our knowledge, this is the first study of its kind to utilise concentrated mononuclear cells combined with iliac graft which lead to higher proportion of fusion and was effective in all surgical procedures. It seems economical and might be suitable for patients who cannot afford expensive graft substitutes and with conditions like osteoporosis. Further prospective studies in larger numbers are needed to confirm these findings.