WO2003066120A1 - Treating degenerative disc disease through transplantation of allograft disc - Google Patents

Treating degenerative disc disease through transplantation of allograft disc Download PDF

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Publication number
WO2003066120A1
WO2003066120A1 PCT/US2002/003123 US0203123W WO03066120A1 WO 2003066120 A1 WO2003066120 A1 WO 2003066120A1 US 0203123 W US0203123 W US 0203123W WO 03066120 A1 WO03066120 A1 WO 03066120A1
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Prior art keywords
disc
cells
donor
disc unit
nucleus pulposus
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PCT/US2002/003123
Other languages
French (fr)
Inventor
Bret A. Ferree
Original Assignee
Ferree Bret A
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Publication date
Application filed by Ferree Bret A filed Critical Ferree Bret A
Priority to PCT/US2002/003123 priority Critical patent/WO2003066120A1/en
Priority to AU2002235518A priority patent/AU2002235518A1/en
Publication of WO2003066120A1 publication Critical patent/WO2003066120A1/en

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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61LMETHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L27/00Materials for grafts or prostheses or for coating grafts or prostheses
    • A61L27/36Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix
    • A61L27/38Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix containing added animal cells
    • A61L27/3804Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix containing added animal cells characterised by specific cells or progenitors thereof, e.g. fibroblasts, connective tissue cells, kidney cells
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61LMETHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L27/00Materials for grafts or prostheses or for coating grafts or prostheses
    • A61L27/36Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix
    • A61L27/3604Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix characterised by the human or animal origin of the biological material, e.g. hair, fascia, fish scales, silk, shellac, pericardium, pleura, renal tissue, amniotic membrane, parenchymal tissue, fetal tissue, muscle tissue, fat tissue, enamel
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61LMETHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L27/00Materials for grafts or prostheses or for coating grafts or prostheses
    • A61L27/36Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix
    • A61L27/3604Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix characterised by the human or animal origin of the biological material, e.g. hair, fascia, fish scales, silk, shellac, pericardium, pleura, renal tissue, amniotic membrane, parenchymal tissue, fetal tissue, muscle tissue, fat tissue, enamel
    • A61L27/3633Extracellular matrix [ECM]
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61LMETHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L27/00Materials for grafts or prostheses or for coating grafts or prostheses
    • A61L27/36Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix
    • A61L27/3641Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix characterised by the site of application in the body
    • A61L27/3645Connective tissue
    • A61L27/3654Cartilage, e.g. meniscus
    • A61L27/3658Intervertebral discs
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61LMETHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L27/00Materials for grafts or prostheses or for coating grafts or prostheses
    • A61L27/36Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix
    • A61L27/3683Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix subjected to a specific treatment prior to implantation, e.g. decellularising, demineralising, grinding, cellular disruption/non-collagenous protein removal, anti-calcification, crosslinking, supercritical fluid extraction, enzyme treatment
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61LMETHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L27/00Materials for grafts or prostheses or for coating grafts or prostheses
    • A61L27/36Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix
    • A61L27/38Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix containing added animal cells
    • A61L27/3839Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix containing added animal cells characterised by the site of application in the body
    • A61L27/3843Connective tissue
    • A61L27/3852Cartilage, e.g. meniscus
    • A61L27/3856Intervertebral discs
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/44Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2/442Intervertebral or spinal discs, e.g. resilient
    • A61F2002/4445Means for culturing intervertebral disc tissue
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/44Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2/442Intervertebral or spinal discs, e.g. resilient
    • A61F2002/445Intervertebral disc tissue harvest sites
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61LMETHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L2430/00Materials or treatment for tissue regeneration
    • A61L2430/38Materials or treatment for tissue regeneration for reconstruction of the spine, vertebrae or intervertebral discs

Definitions

  • This invention relates generally to the treatment of diseased or traumatized intervertebral discs, and more particularly, to the use of engineered disc tissues and endplate materials in conjunction with such treatment.
  • Intervertebral discs provide mobility and a cushion between the vertebrae.
  • the nucleus pulposus which, in the adult human, is composed of cells and an insoluble extracellular matrix which is produced by the nucleus itself.
  • the extracellular matrix is composed of collagen, proteoglycans, water, and noncollagenous proteins.
  • the cells of the nucleus pulposus have chondrocyte-like features. Blood vessels do not course into the nucleus pulposus. Rather, the cells of the nucleus pulposus of the adult human obtain nutrients and eliminate waste by diffusion through blood vessels in the endplates of the vertebrae adjacent to the disc.
  • the nucleus pulposus is surrounded by the annulus fibrosis, which is composed of cells (fibrocyte-like and chondrocyte-like), collagen fibers, and non-fibrillar extracellular matrix.
  • the components of the annulus are arranged in 15-25 lamellae around the nucleus pulposus.
  • Prosthetic disc devices replace nucleus pulposus and/or annulus fibrosis function.
  • nucleus replacing devices rely on the patient's annulus fibrosis to retain the device and perform annulus functions. Unfortunately, injuries to the annulus often accompany nucleus degeneration or trauma. In addition, the degenerated annulus fibrosis may produce pain in patients with nucleus replacement.
  • Total disc replacements rely on attachment of the prosthetic disc to the vertebral endplates. Various methods of attachment have been described including the use of screws, spikes, and porous ingrowth material. The total disc/vertebral interface can loosen. The problems with prosthesis loosening and the revision surgery of the same are well known in prosthetic knee and hip surgery.
  • This invention resides in a method of treating a diseased or traumatized intervertebral disc located between adjacent vertebrae.
  • a disc unit is harvested from a recently deceased human or animal donor.
  • this donor disc unit preferably includes not only an intervertebral disc having an extracellular matrix, but also a portion of the vertebrae on either side of the disc, including the endplates.
  • An affected disc is surgically removing from a patient, including the vertebral endplates and a portion of the vertebra on either side of the disc, thereby creating a void to be filled, and the donor disc unit is positioned within the surgically created void.
  • the spine may be temporarily locally immobilized following placement of the donor disc unit into the surgically created void.
  • the donor disc unit is processed to kills living cells therewithin, while preserve the extracellular matrix.
  • Nucleus pulposus and/or annulus fibrosis cells are harvested from a healthy intervertebral disc, cultured and transplanted into the donor disc unit. Precursors, or cells which differentiate into cells which provide nucleus pulposus and/or annulus fibrosis cell function may alternatively be used. The harvested cells are preferably kept viable until placed into the disc unit.
  • the method of the invention may further include the step of adding one or more therapeutic substances to the donor disc unit, the transplanted cells, or both prior to transplantation. Such therapeutic substances could include culture media, growth factors, differentiation factors, hydrogels, polymers, antibiotics, anti-inflammatory medications, immunosuppressive medications, or any useful combination thereof.
  • a donor disc unit comprising an intervertebral disc and a portion of adjacent vertebrae, is obtained from a recently deceased human or animal donor, and used to restore disc function and eliminate pain in patients with degenerative disc disease.
  • Autograft nucleus pulposus cells and annulus fibrosis cells are harvested from one or more healthy discs of a patient, preferably the same patient suffering from the disc disease, though any appropriate alternative source may be used, including fetal tissue or human sources, preferably having a familial relationship to minimize or avoid the need for immunosuppressive substances.
  • the harvested cells are cultured then added to nucleus pulposus and annulus fibrosis extracellular matrix, preferably obtained from recently deceased humans or animals, and added to the donor disc unit.
  • the donor disc unit preferably includes a portion of vertebra on either side of the disc.
  • Guidelines for tissue procurement including surgical technique of removal, number of hours between death of the donor and tissue procurement, and testing of the donor for infectious disease, are well described in open literature.
  • tissue is processed to kill the living cells, though care is taken to preserve the extracellular matrix.
  • Guidelines for processing the harvested disc as described are also well known to those skilled in the art. For example, such tissue may be frozen and thawed.
  • the disc being replaced including the vertebral endplates and a portion of the vertebra on either side of the disc are removed from the affected patient. Surgical techniques to remove the disc and a portion of the vertebrae are well known to spine surgeons.
  • the donor disc unit is then placed into the surgically created defect.
  • the replacement disc could be held in position with screws, plates, and/or rods attached between the donor bone and the host vertebrae.
  • the plates or other rigid method of fixation may temporarily extend across the disc, such devices must ultimately removed, or not used at all, or else disc function would not be preserved.
  • synthetic or natural fibers are employed to extend across the disc space and attach to the host vertebrae. Appropriate fibers allow vertebral motion while helping to hold the grafted disc replacement in position.
  • pedicle screws and rods or plates may be used.
  • the screws may be placed percutanously to allow easy removal after the vertebrae have healed.
  • bio-resorbable screws may be used. Growth of the host vertebrae to the donor vertebrae may also be encouraged using growth factors such as bone morphogenetic proteins.
  • Cultured disc cells are added to the donor disc unit a few weeks or months following its transplantation.
  • living disc cells are harvested from a normal disc of the patient with the degenerative disc disease.
  • the living disc cells from the nucleus pulposus and annulus fibrosis are added to the donor nucleus and annulus respectively.
  • the delayed insertion of the cells would allow vascularization of the donor vertebrae prior to cell insertion. Vertebrae vascularization is important for diffusion to and from the transplanted disc cells.
  • the cultured disc cells could be added to the donor disc before transplantation or at the time of transplantation. Culture media could be added to the disc with the transplanted cells.
  • Autologous nucleus pulposus chondrocyte- like cells may be obtained by aspiration or biopsy of healthy discs of the patient.
  • the harvested nucleus pulposus cells are isolated and cultured using standard techniques.
  • the harvested sterile nucleus pulposus is morselized and washed with phosphate buffered saline.
  • the cells are released from the extracellular matrix with 0.2% clostridial collagenase (Worthington CLS II, 140u/mg) and agitated. See
  • the filtered solution is then centrifuged at 1800 rpm to remove the cells.
  • the supernatant above the cells is removed with a micropipette until the cell concentration reaches 5.times.l0.sup.7 cells/cc.
  • the harvested cells are grown in Hamm's F-12 culture media, 10% fetal calf serum, L-glutamine (292.mu.g/cc), penicillin (lOOu/cc), streptomycin
  • Precursor cells of nucleus pulposus cells or annulus fibrosis cells, chondrocytes, or other living cells that could function like nucleus pulposus cells or annulus fibrosis cells or that could differentiate into cells to build a functional nucleus pulposus or annulus fibrosis could also be used.
  • the cultured cells are added to the donor disc through multiple small holes drilled through the annulus fibrosis into the nucleus pulposus.
  • resorbable culture medium tissue growth or differentiation factors (recombinant generated morphogenetic proteins, PDGF, TGF- ⁇ , EGF/TGF- ⁇ , IGF-I, ⁇ FGF), hydrogels, resorbable or nonresorbable synthetic or natural polymers (collagen, fibrin, polyglycolic acid, polylactic acid, polytetrafluoroethylene, etc.), antibiotics, anti-inflammatory medication, immunosuppressive medications, etc. may be beneficial.

Abstract

The intervertebral disc and a portion of adjacent vertebrae obtained from recently deceased human or animal donors are used to restore disc function and eliminate pain in patients with disc disease. Cells harvested and cultured from the nucleus pulpsus and/or the annulus fibrosis of a normal disc are added to the donor disc. Additional therapeutic substances like culture medium, growth factors, differentiation factors, hydrogels polymers, antibiotics, anti-inflammatory medications, or immunosuppressive medications may also be added to the transplanted disc unit.

Description

TREATING DEGENERATIVE DISC DISEASE THROUGH TRANSPLANTATION OF ALLOGRAFT DISC
Field of the Invention
This invention relates generally to the treatment of diseased or traumatized intervertebral discs, and more particularly, to the use of engineered disc tissues and endplate materials in conjunction with such treatment.
Background of the Invention
Intervertebral discs provide mobility and a cushion between the vertebrae. At the center of each disc is the nucleus pulposus which, in the adult human, is composed of cells and an insoluble extracellular matrix which is produced by the nucleus itself. The extracellular matrix is composed of collagen, proteoglycans, water, and noncollagenous proteins.
The cells of the nucleus pulposus have chondrocyte-like features. Blood vessels do not course into the nucleus pulposus. Rather, the cells of the nucleus pulposus of the adult human obtain nutrients and eliminate waste by diffusion through blood vessels in the endplates of the vertebrae adjacent to the disc. The nucleus pulposus is surrounded by the annulus fibrosis, which is composed of cells (fibrocyte-like and chondrocyte-like), collagen fibers, and non-fibrillar extracellular matrix. The components of the annulus are arranged in 15-25 lamellae around the nucleus pulposus.
To date, the treatment of degenerative disc disease has relied for the most part on eliminating the defective disc or disc function. This may be accomplished by fusing the vertebra on either side of the disc. In terms of replacement, most prior-art techniques use synthetic materials to replace the entire disc or a portion thereof.
Prosthetic disc devices replace nucleus pulposus and/or annulus fibrosis function.
Nucleus replacing devices rely on the patient's annulus fibrosis to retain the device and perform annulus functions. Unfortunately, injuries to the annulus often accompany nucleus degeneration or trauma. In addition, the degenerated annulus fibrosis may produce pain in patients with nucleus replacement.
Devices that replace nucleus and annulus functions (total disc replacement) also exhibit certain weaknesses. Total disc replacements rely on attachment of the prosthetic disc to the vertebral endplates. Various methods of attachment have been described including the use of screws, spikes, and porous ingrowth material. The total disc/vertebral interface can loosen. The problems with prosthesis loosening and the revision surgery of the same are well known in prosthetic knee and hip surgery.
The future of treating degenerative disc disease therefore lies in treatments which preserve disc function. If disc function could be restored with biologic replacement or augmentation, the risk of premature wear out would be minimized, if not eliminated.
Summary of the Invention
This invention resides in a method of treating a diseased or traumatized intervertebral disc located between adjacent vertebrae. According to the method, a disc unit is harvested from a recently deceased human or animal donor. As defined herein, this donor disc unit preferably includes not only an intervertebral disc having an extracellular matrix, but also a portion of the vertebrae on either side of the disc, including the endplates.
An affected disc is surgically removing from a patient, including the vertebral endplates and a portion of the vertebra on either side of the disc, thereby creating a void to be filled, and the donor disc unit is positioned within the surgically created void. The spine may be temporarily locally immobilized following placement of the donor disc unit into the surgically created void.
In the preferred embodiment, the donor disc unit is processed to kills living cells therewithin, while preserve the extracellular matrix. Nucleus pulposus and/or annulus fibrosis cells are harvested from a healthy intervertebral disc, cultured and transplanted into the donor disc unit. Precursors, or cells which differentiate into cells which provide nucleus pulposus and/or annulus fibrosis cell function may alternatively be used. The harvested cells are preferably kept viable until placed into the disc unit. The method of the invention may further include the step of adding one or more therapeutic substances to the donor disc unit, the transplanted cells, or both prior to transplantation. Such therapeutic substances could include culture media, growth factors, differentiation factors, hydrogels, polymers, antibiotics, anti-inflammatory medications, immunosuppressive medications, or any useful combination thereof.
Detailed Description of the Invention
Broadly according to this invention, a donor disc unit comprising an intervertebral disc and a portion of adjacent vertebrae, is obtained from a recently deceased human or animal donor, and used to restore disc function and eliminate pain in patients with degenerative disc disease. Autograft nucleus pulposus cells and annulus fibrosis cells are harvested from one or more healthy discs of a patient, preferably the same patient suffering from the disc disease, though any appropriate alternative source may be used, including fetal tissue or human sources, preferably having a familial relationship to minimize or avoid the need for immunosuppressive substances. The harvested cells are cultured then added to nucleus pulposus and annulus fibrosis extracellular matrix, preferably obtained from recently deceased humans or animals, and added to the donor disc unit.
The donor disc unit preferably includes a portion of vertebra on either side of the disc. Guidelines for tissue procurement including surgical technique of removal, number of hours between death of the donor and tissue procurement, and testing of the donor for infectious disease, are well described in open literature.
Following disc harvest, the tissue is processed to kill the living cells, though care is taken to preserve the extracellular matrix. Guidelines for processing the harvested disc as described are also well known to those skilled in the art. For example, such tissue may be frozen and thawed.
The disc being replaced, including the vertebral endplates and a portion of the vertebra on either side of the disc are removed from the affected patient. Surgical techniques to remove the disc and a portion of the vertebrae are well known to spine surgeons. The donor disc unit is then placed into the surgically created defect. The replacement disc could be held in position with screws, plates, and/or rods attached between the donor bone and the host vertebrae. Although the plates or other rigid method of fixation may temporarily extend across the disc, such devices must ultimately removed, or not used at all, or else disc function would not be preserved. Preferably, then, synthetic or natural fibers are employed to extend across the disc space and attach to the host vertebrae. Appropriate fibers allow vertebral motion while helping to hold the grafted disc replacement in position.
If temporary local immobilization of the spine is necessary to assist bone growth form the host vertebrae to the donor vertebrae, surgically implanted pedicle screws and rods or plates may be used. The screws may be placed percutanously to allow easy removal after the vertebrae have healed. Alternatively, bio-resorbable screws may be used. Growth of the host vertebrae to the donor vertebrae may also be encouraged using growth factors such as bone morphogenetic proteins.
Cultured disc cells are added to the donor disc unit a few weeks or months following its transplantation. In the preferred embodiment, living disc cells are harvested from a normal disc of the patient with the degenerative disc disease. The living disc cells from the nucleus pulposus and annulus fibrosis are added to the donor nucleus and annulus respectively.
The delayed insertion of the cells would allow vascularization of the donor vertebrae prior to cell insertion. Vertebrae vascularization is important for diffusion to and from the transplanted disc cells. Alternatively, the cultured disc cells could be added to the donor disc before transplantation or at the time of transplantation. Culture media could be added to the disc with the transplanted cells.
Autologous nucleus pulposus chondrocyte- like cells may be obtained by aspiration or biopsy of healthy discs of the patient. The harvested nucleus pulposus cells are isolated and cultured using standard techniques. The harvested sterile nucleus pulposus is morselized and washed with phosphate buffered saline. The cells are released from the extracellular matrix with 0.2% clostridial collagenase (Worthington CLS II, 140u/mg) and agitated. See
Klagsburn, "Methods in Enzvmology, Vol. VII. The resulting suspension is filtered with a
153.mu.g nylon sieve (Tetko, Elmford, N.Y.). The filtered solution is then centrifuged at 1800 rpm to remove the cells. The supernatant above the cells is removed with a micropipette until the cell concentration reaches 5.times.l0.sup.7 cells/cc. The harvested cells are grown in Hamm's F-12 culture media, 10% fetal calf serum, L-glutamine (292.mu.g/cc), penicillin (lOOu/cc), streptomycin
(lOO.mu.g/cc), and ascorbic acid (5.mu.g/cc) at 37. degrees C. The above method is described in detail in 6,060,053. The cells of the annulus fibrosis are harvested and cultured using similar techniques.
Precursor cells of nucleus pulposus cells or annulus fibrosis cells, chondrocytes, or other living cells that could function like nucleus pulposus cells or annulus fibrosis cells or that could differentiate into cells to build a functional nucleus pulposus or annulus fibrosis could also be used. The cultured cells are added to the donor disc through multiple small holes drilled through the annulus fibrosis into the nucleus pulposus.
Additional therapeutic substances could be added to the transplanted nucleus. For example, resorbable culture medium, tissue growth or differentiation factors (recombinant generated morphogenetic proteins, PDGF, TGF-β, EGF/TGF-α, IGF-I, βFGF), hydrogels, resorbable or nonresorbable synthetic or natural polymers (collagen, fibrin, polyglycolic acid, polylactic acid, polytetrafluoroethylene, etc.), antibiotics, anti-inflammatory medication, immunosuppressive medications, etc. may be beneficial.

Claims

What is claimed is:
1. A method of treating a diseased or traumatized intervertebral disc located between adjacent vertebrae, comprising the steps of: harvesting a disc unit from a recently deceased human or animal donor, the donor disc unit including: an intervertebral disc having an extracellular matrix, and a portion of the vertebrae on either side of the disc, including the endplates; surgically removing an affected disc from a patient, including the vertebral endplates and a portion of the vertebra on either side of the disc, thereby creating a void to be filled; and placing the donor disc unit into the surgically created void.
2. The method of claim 1, further including the step of processing the donor disc unit to kills living cells therewithin while preserve the extracellular matrix thereof.
3. The method of claim 1 , further including the steps of: harvesting cells from the nucleus pulposus, annulus fibrosis, or both the nucleus pulposus and annulus fibrosis of a healthy intervertebral disc; culturing the cells; and transplanting the cells into the donor disc unit.
4. The method of claim 3, including the step of keeping the harvested cells viable until placed into the disc unit.
5. The method of claim 1, further including the step of temporarily immobilizing the spine following placement of the donor disc unit into the surgically created void.
6. The method of claim 1, further including the step of adding one or more therapeutic substances to the donor disc unit.
7. The method of claim 6, wherein the therapeutic substances include one or more of the following: culture media, growth factors, differentiation factors, hydrogels, polymers, antibiotics, anti-inflammatory medications, or immunosuppressive medications.
8. A method of treating a diseased or traumatized intervertebral disc located between adjacent vertebrae, comprising the steps of: harvesting: a) cells that differentiate into nucleus pulposus like cells, or live cells that function like cells of the nucleus pulposus, b) cells that differentiate into annulus fibrosis like cells, or live cells that function like cells of the annulus fibrosis, or a) and b); harvesting a disc unit from a recently deceased human or animal donor, the donor disc unit including: an intervertebral disc having an extracellular matrix, and a portion of the vertebrae on either side of the disc, including the endplates; combining the harvested cells with disc unit; and transplanting the disc unit into the disc being treated.
9. The method of claim 8, further including the step of adding one or more therapeutic substances to the engineered nucleus pulposus.
10. The method of claim 9, wherein the therapeutic substances include one or more of the following: culture media, growth factors, differentiation factors, hydrogels, polymers, antibiotics, anti-inflammatory medications, or immunosuppressive medications.
11. The method of claim 8, further including the step of keeping the harvested cells viable until placed into the disc unit.
12. A method of preparing a donor intervertebral disc unit, comprising the steps
of: harvesting a disc unit from a recently deceased human or animal donor, the donor disc unit including: an intervertebral disc having an extracellular matrix, and a portion of the vertebrae on either side of the disc, including the endplates; and keeping the harvested disc unit viable until transplantation.
13. A donor disc unit prepared according to the method of claim 12.
14. The donor disc unit of claim 13, wherein living cells are killed to preserve the extracellular matrix.
15. The method of claim 12, further including the steps of: harvesting cells from the nucleus pulposus, annulus fibrosis, or both the nucleus pulposus and annulus fibrosis of a healthy intervertebral disc; culturing the cells; and transplanting the cells into the donor disc unit.
16. A donor disc unit prepared according to the method of claim 15.
17. The donor disc unit of claim 16, further including one or more therapeutic substances.
18. The donor disc unit of claim 17, wherein the therapeutic substances include one or more of the following: culture media, growth factors, differentiation factors, hydrogels, polymers, antibiotics, anti-inflammatory medications, or immunosuppressive medications.
19. A method of preparing a donor intervertebral disc unit, comprising the steps of: harvesting: a) cells that differentiate into nucleus pulposus like cells, or live cells that function like cells of the nucleus pulposus, b) cells that differentiate into annulus fibrosis like cells, or live cells that function like cells of the annulus fibrosis, or a) and b); harvesting a disc unit from a recently deceased human or animal donor, the donor disc unit including: an intervertebral disc having an extracellular matrix, and a portion of the vertebrae on either side of the disc, including the endplates; combining the harvested cells with disc unit; and keeping the disc unit viable until transplantation.
20. A donor disc unit prepared according to the method of claim 19.
21. The donor disc unit of claim 20, wherein the engineered nucleus pulposus includes one or more therapeutic substances.
22. The donor disc unit of claim 21, wherein the therapeutic substances include one or more of the following: culture media, growth factors, differentiation factors, hydrogels, polymers, antibiotics, anti-inflammatory medications, or immunosuppressive medications.
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WO2005023156A1 (en) * 2003-08-21 2005-03-17 Sdgi Holdings, Inc. Allogenic/xenogenic implants and methods for augmenting or repairing intervertebral discs
US8118779B2 (en) 2006-06-30 2012-02-21 Warsaw Orthopedic, Inc. Collagen delivery device
US8399619B2 (en) 2006-06-30 2013-03-19 Warsaw Orthopedic, Inc. Injectable collagen material
US8435943B2 (en) 2006-12-14 2013-05-07 Advanced Technogies And Regenerative Medicine, Llc Protein stabilization formulations
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US8058237B2 (en) 2007-08-07 2011-11-15 Advanced Technologies & Regenerative Medicine, LLC Stable composition of GDF-5 and method of storage
US7947649B2 (en) 2008-04-14 2011-05-24 Advanced Technologies And Regenerative Medicine, Llc Liquid buffered GDF-5 formulations
US8419739B2 (en) 2009-08-24 2013-04-16 Amir A. Jamali Method and apparatus for allograft disc transplantation

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