Interbody fusion in degenerative lumbar spinal stenosis with additional posterolateral fusion using Escherichia coli-derived bone morphogenetic protein-2

Abstract

This case series investigated the efficacy and optimal dose of Escherichia coli-derived bone morphogenetic protein-2 (E.BMP-2) as a bone graft substitute for additional posterolateral spinal fusion, accompanying interbody fusion procedures, for treating lumbar degenerative spinal stenosis. This study focused on the optimal dose for each segment and the efficacy of E.BMP-2 as a substitute for autogenous iliac bone graft. Ten patients were enrolled from January 2015 to December 2015, and underwent an additional posterolateral fusion procedure, with 2.5 mg of E.BMP-2 followed by decompression, transpedicular fixation, and interbody fusion. The mean follow-up period was 13.9 months, and regular radiological examinations were performed in every case. Clinical outcomes were measured with a visual analog scale for back pain (VAS-BP), and leg pain (VAS-LP) and the Korean Oswestry Disability Index (K-ODI). All parameters were assessed preoperatively and postoperatively at 12 months. All 18 segments treated with E.BMP-2 completely fused in 6 months as observed on both simple radiography and computed tomography. The mean fusion period was 4.5 months on simple radiography. At 12 months follow-up, VAS-BP, VAS-LP, and K-ODI scores (1.9 ± 1.5, 1.9 ± 1.9, 11.0 ± 6.6, respectively) had improved significantly compared to preoperative scores (5.5 ± 1.9, 6.5 ± 1.9, and 49.9 ± 11.5, respectively, P < .05). There were no postoperative wound infections, neurological symptoms, or complications associated with the use of E.BMP-2 during the follow-up period. E.BMP-2 could be used to enhance the outcomes in posterolateral spinal fusion following interbody fusion surgery. In the present study, 2.5 mg of the E.BMP-2 per segment was sufficient to obtain bony union in posterolateral fusion surgery. Further large-scale trials with long-term follow-up are necessary to evaluate the various complications related to the use of E.BMP-2.

Anterior Cervical Discectomy and Fusion Using Escherichia coli-Derived Recombinant Human Bone Morphogenetic Protein-2: A Pilot Study

“…In previous studies using BMP-2 in spine fusion surgery, a solid union was observed within a relatively short follow-up period after surgery. 10 11 12 22) Likewise, 15 of 21 segments (71.4%) showed solid fusion at 3 months after surgery and 19 of 21 segments (90.4%) at 6 months after surgery in the present study. This is considered to be a great advantage of BMP-2.…”

“…In a clinical study by Cho et al, 11) lumbar posterolateral fusion (PLF) using 6 mg of E.BMP-2 per level bilaterally showed a 100% fusion rate 24 weeks after surgery. Choi et al 10) reported a 100% PLF rate using 2.5 mg of E.BMP-2 per level unilaterally in addition to lumbar interbody fusion, and a solid fusion was observed at a mean of 4.5 months after surgery. Son et al 12) compared grafting autologous IBG and E.BMP-2 when performing lumbar interbody fusion and an additional one-sided PLF.…”

“… 9) Several studies have reported the efficacy and appropriate dose of E.BMP-2 in lumbar spinal surgery to increase fusion rates. 10 11 12) It can be speculated that a risk of prevertebral soft-tissue swelling after ACDF using E.BMP-2 with hydroxyapatite (HA) as a carrier may be lower than with a collagen carrier. Due to its high affinity for E.BMP-2, HA may be able to prevent the initial burst release of E.BMP-2, which can lead to prevertebral swelling.…”

Effectiveness and Feasibility of Injectable Escherichia coli‐Derived Recombinant Human Bone Morphogenetic Protein‐2 for Anterior Lumbar Interbody Fusion at the Lumbosacral Junction in Adult Spinal Deformity Surgery: A Clinical Pilot Study

“…Absorbable collagen sponge (ACS), hydroxyapatite (HA), or beta‐tricalcium phosphate (β‐TCP) can be used as carriers. Among them, HA carrier used with E‐rhBMP‐2 for posterolateral fusion achieved 100% fusion rate within 6 months 20,21 . HA has good osteoconductivity and biocompatibility, but the absorption rate is low and has difficulty in further bone remodeling 22 .…”

“…Among them, HA carrier used with E‐rhBMP‐2 for posterolateral fusion achieved 100% fusion rate within 6 months. 20 , 21 HA has good osteoconductivity and biocompatibility, but the absorption rate is low and has difficulty in further bone remodeling. 22 In contrast, β‐TCP is completely resorbable and has high affinity to rhBMP‐2.…”