Anterior Lumbar Interbody Fusion Using rhBMP-2 With Tapered Interbody Cages

Abstract

In a multicenter, prospective, randomized, nonblinded, 2-year study, 279 patients with degenerative lumbar disc disease were randomly divided into two groups that underwent interbody fusion using two tapered threaded fusion cages. The investigational group (143 patients) received rhBMP-2 on an absorbable collagen sponge, and a control group (136 patients) received autogenous iliac crest bone graft. Plain radiographs and computed tomographic scans were used to evaluate fusion at 6, 12, and 24 months after surgery. Mean operative time (1.6 hours) and blood loss (109.8 mL) were less in the investigational rhBMP-2 group than in the autograft control group (2.0 hours and 153.1 mL). At 24 months the investigational group's fusion rate (94.5%) remained higher than that of the control group (88.7%). New bone formation occurred in all investigational patients. At all intervals, mean postoperative Oswestry, back pain, and leg pain scores and neurologic status improved in both treatment groups with similar outcomes. In the control group, eight adverse events related to the iliac crest graft harvest occurred (5.9%), and at 24 months 32% of patients reported graft site discomfort and 16% were bothered by its appearance. Lumbar fusion using rhBMP-2 and a tapered titanium fusion cage can yield a solid union and eliminate the need for harvesting iliac crest bone graft.

Posterior lumbar interbody fusion using rhBMP-2

“…The culmination of this strategy for spinal fusion surgery involves harvesting bone from the iliac crest. Limitations of this approach include donor site morbidity, increased operative time and increased blood loss, not to mention the economic derivative summed in the separate limitations [3,13].…”

Lessons from the infuse trials: do we need a classification of bias in scientific publications and editorials?

“…The authors of the original industry-sponsored or industry-associated studies of rhBMP-2 all reported the efficacy in applications including both anterior and posterior cervical and lumbar fusion surgery [3][4][5][6][7][8][9][10][11][12][13][14]. Additionally, the authors of these studies stated similar safety profiles with no adverse effects or complications attributable to rhBMP-2 in any study.…”

Substitutos ósseos comparados ao enxerto ósseo autólogo em cirurgia ortopédica: revisão sistemática da literatura

“…Burkus et al (21) 19 Efficacy of calcium sulfate plus decompression bone in lumbar and lumbosacral spinal Alexander et al (22) fusion: preliminary results in 40 patients.…”

“…envolvendo BMP-2 (5)(6)9,15,17,(20)(21) , três utilizando BMP-7 (10)(11)19) , sete envolvendo biocerâmicas, como hidroxiapatita, fosfato tricálcio e sulfato de cálcio (12)(13)(14)16,18,(22)(23) . O substituto ósseo mostrou-se equivalente ao enxerto autólogo em 19 estudos (4)(5)(6)(7)(8)(9)(10)(11)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) e inferior em três (12,(24)(25) .…”

“…O substituto ósseo mostrou-se equivalente ao enxerto autólogo em 19 estudos (4)(5)(6)(7)(8)(9)(10)(11)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) e inferior em três (12,(24)(25) .…”