Bone Fractures – Non-Union
	Osteonecrosis (Avascular Necrosis)
	Spinal Fusion

The Apollo Bramwell Stem Cell Therapy Program offers stem cell therapy alone or in conjunction with traditional surgical interventions for non-union bone fractures, osteonecrosis and spinal fusion.

A fracture is a broken bone. After a fracture occurs, new bone tissue forms to connect the broken pieces. A broken bone that fails to heal is called a non-union. For bone healing to occur, the bone needs adequate stability and blood supply. Blood brings the components for healing to the fracture site. These include oxygen, healing cells, and the body's own chemicals necessary for healing (growth factors). [1][2]    

Avascular necrosis (osteonecrosis) is the death of bone tissue due to a lack of blood supply. Also called osteonecrosis, avascular necrosis can lead to tiny breaks in the bone and the bone's eventual collapse. The blood flow to a section of bone can be interrupted if the bone is fractured or the joint becomes dislocated. The most common joint affected by avascular necrosis is the hip. Avascular necrosis worsens with time. [3] 

Spinal fusion is surgery to join together two bones (vertebrae) in the spine. Fusing permanently joins two bones together so there is no longer movement between them. Spinal fusion is usually done along with other surgical procedures of the spine. Spinal fusion involves placing extra bone (bone graft) to fill the space between two spinal vertebrae. Once the bone graft heals, the vertebrae are permanently connected. [4][5] 

Autologous Mononuclear Stem Cell Therapy for Bone Non-union Fractures, Osteonecrosis (Avascular Necrosis) and Spinal Fusion

Bone marrow stromal cells (also known as mesenchymal stem cells) are known to form bone, cartilage, fibrous connective tissue and fat. [6] Angiogenesis (the growth of new blood vessels from pre-existing vessels) plays a critical role in bone development and fracture repair. Studies have proven that bone marrow cell transplantation has been shown to induce angiogenesis. 

Bone marrow aspirated from the iliac crest contains mononucleated cells. These cells can be used to obtain bone healing of non-unions. Percutaneous autologous bone-marrow grafting has shown to be an effective and safe method for the treatment of an atrophic tibial diaphyseal nonunion. In one study, sixty patients with an established nonunion of the tibial shaft were treated with bone marrow derived stem cells at the same center between 1990 and 2000. Bone union was obtained in fifty-three patients, a 88.3% success rate. [7] 

In another study, in patients with stage-I or II osteonecrosis of the femoral head, implantation of bone-marrow cells decreased the pain and other joint symptoms caused by the osteonecrosis and delayed the progression of the disease to the point of subchondral fracture (stage III) during a twenty-four-month follow-up period. Implantation of autologous bone-marrow mononuclear cells appears to be a safe and effective treatment for early stages of osteonecrosis of the femoral head. [8]

Autologous Mononuclear Stem Cell Therapy for Bone Non-union Fractures, Osteonecrosis (Avascular Necrosis) and Spinal Fusion at the Apollo Bramwell Hospital

Upon registration, the doctor performing the SCT will give you a physical examination and your medical records will be reviewed once again. Your doctor may order additional testing, such as blood tests or radiological testing. The following day one of our specialists will harvest bone marrow from the hip. This procedure normally takes 30-60 minutes. You are then given sedative medications and local anesthesia is administered to the area of the skin where a small incision is made to aspirate the bone marrow. A special bone marrow needle will be used to collect 120 ml of bone marrow, which will be processed in a special machine to separate the mononuclear cells from the rest of the bone marrow. 

In non-union procedures, the orthopedic surgeon will administer the bone marrow concentrate either percutaneously or preoperatively (i.e. by open surgery) as required by the type and nature of the fracture and non-union. 

In cases of avascular femoral head necrosis, the orthopedic surgeon will inject the bone marrow concentrate through a percutaneous transtrocanteric approach under fluoroscopic guidance. 

The bone graft material used for spinal fusion (either autologous bone or hydroxyapatite) during surgery is enriched (pre-treated) with bone marrow derived stems cells before the graft is administered. 

The medical team will monitor you for 2 to 24 hours after the administration of the therapy. Generally, a stay of two days or longer is required in the hospital, depending on the condition of the individual patient. 

Medical Records Required for Patient Evaluation 

The medical records required by the Apollo Bramwell Hospital to determine your eligibility for stem cell therapy for bone non-union fractures, osteonecrosis (avascular necrosis) and spinal fusion are: 

• Reports of consultations with the specialist pertaining to the current condition;
• The list of medications that the patient is currently on (generic and brand names of prescribed drugs);
• Lab reports (biochemical and blood investigations);
• MRI;
• CT scan;
• X-ray;
• Full blood test.

Please note that the medical records supplied need to be no older than three months. 

About Stem Cell Therapy 

Stem cell therapy for bone non-union fractures, osteonecrosis (avascular necrosis) and spinal fusion should be considered for patients who have exhausted all traditional medicinal and surgical interventions. Autologous mononuclear stem cell therapy has provided evidence-based medicine to prove safety and efficacy in treating these diseases. There is however, no guarantee of treatment efficacy and treatment results will vary on a patient by patient basis. Some patients may experience no improvement in their condition after receiving stem cell therapy whilst other patients may experience significant improvements.

The information, content and links to third party websites and studies contained in this website should not be substituted for professional medical advice, diagnosis or treatment. We recommend consulting with your doctor before making a decision regarding stem cell therapy. Every individual patient and his or her records will be fully evaluated by the Apollo Bramwell Hospital’s Medical Review Board to ascertain the patient’s eligibility for stem cell therapy. Individual consultations are available between you, your doctor and the Apollo Bramwell physicians through the Hospital's telemedicine facilities.

For patients wishing to apply for stem cell therapy now, please fill in our Patient Application Form.

References - Orthopedics [1] - [8]