Posterior lumbar interbody fusion using rhBMP-2

Abstract

The use of biological technologies for the treatment of degenerative spinal diseases has undergone rapid clinical and scientific development. BMP strategies have gained wide support for an inherent potential to improve the ossification process. It has been extensively studied in combination with various techniques for spinal stabilisation from both anterior and posterior approach. We studied the fusion process after implantation of rhBMP-2 in 17 patients with degenerative lumbar spine diseases in combination with dorsal fixation with pedicle screws and poly-ether-ether-ketone (PEEK) interbody cages. We used 12 mg rhBMP-2 carried by collagen sponge, 6 mg in every cage. Patient follow up consisted of pre-operative radiographic and clinical evaluation. Similar post-operative evaluations were performed at 3 and 6 months. Clinical assessment demonstrated clear improvement in all patients despite evidence of vertebral endplate osteoclastic activity in the 3-month radiographs. The 6-month radiograph, however, confirmed evidence of fusion, and no untoward results or outcomes were noted. While previous studies have shown exclusively positive results in both fusion rates and process, our study demonstrated an intermediate morphology at 3 months during the ossification process using Induct Os in combination with peek-cages using a PLIF-technique. The transient resorption of bone surrounding the peek cage did not result in subsidence, pain or complication, and fusion was reached in all cases within a 6-month-controlled evaluation. Although there was no negative influence on clinical outcome, the potential for osteoclastic or metabolic resorption bears watching during the post-surgical follow up.

A Review of the Clinical Side Effects of Bone Morphogenetic Protein-2

“…Vertebral and nonvertebral bone resorption 41,48,55,60,61,156,[164][165][166][167][168][169][170] Graft subsidence 41,60,61,166,171 Urogenital events Retrograde ejaculation 76,[172][173][174][175] Bladder retention 172,175 Wound complications Hematoma No competing financial interests exist.…”

Growth factors in orthopaedic surgery: demineralized bone matrix versus recombinant bone morphogenetic proteins

“…Bone resorption, osteolysis and implant displacement were observed [49,50]. Other authors reported bone overgrowth into the spinal canal in PLIF and radiculitis, osteolysis and loss of alignment [46,49,[51][52][53].…”

The justification for recombinant human bone morphogenetic protein-2 use in one- or two-level lumbar spine interbody fusions

“…6 Vaidya et al further noted that abdominal contents precluded adequate radiographic visualization in nine patients, and in their author reply, that ''It is our belief that endplate resorption occurs in all patients that undergo rhBMP assisted spinal fusion". 7 Vaidya's belief was confirmed by Meisel et al 8 In 2007 surgeons from Thomas Jefferson reported on 68 TLIF procedures; rhBMP-2 was implanted in 39 of the patients. 9 Patients receiving BMP-2 were eight times more likely to report postoperative radicular pain.…”