Spinal Fusion Properties of Mechanically-Reinforced, Osteomodulatory Chitosan Hydrogels

Abstract: Lower back pain is a considerable medical problem that will impact 80% of the U.S. population at some point in their life. For the most severe cases, surgical repair is necessary and is associated with costs upwards of $10.2 billion annually in the United States. To alleviate back pain, spine fusions are a common treatment in which two or more vertebrae are biologically fused together often through the use of a graft material. Unfortunately, iliac crest bone autograft, the current gold standard graft material, can yield insufficient fusion and is associated with considerable donor site morbidity and pain as well as limited supply. Therefore, new materials need to be developed in order to better coordinate healing and new bone growth in the affected area to reduce unnecessary patient burden. In order to address this issue, the incorporation of allograft and one of two types of cellulose (i.e., 0CNCs and CNFs) into a dual-crosslinked chitosan hydrogel loaded with bioactive calcium phosphate was investigated. Hydrogels were then tested for both their material and biological properties. Specifically, hydrogel swelling ratio, mass loss, ion release profile, compressive strength, in vitro biocompatibility and osteoinduction as well as in vivo biocompatibility, and effectiveness in a spine fusion model were determined. Cellulose and allograft incorporation significantly improved hydrogel compressive strength and biocompatibility and CNFs were found to be a significantly more biocompatible form of cellulose than 0CNCs. Additionally, through the controlled delivery of osteoinductive simple signaling molecules (i.e., calcium and phosphate ions), DCF-loaded CNF/Chitosan hydrogels were able to induce osteoblast-like activity in murine mesenchymal stem cells. When evaluated in vivo, these hydrogels were found to be non-toxic though the subacute phase (14 days). A 6-week rabbit spine fusion found these materials to achieve near complete fusion when assessed radiographically. This research provides considerable support for the utility of our novel material for spine fusion procedures as well as other future bone applications.