Prospective Evaluation of Radiculitis following Bone Morphogenetic Protein-2 Use for Transforaminal Interbody Arthrodesis in Spine Surgery

Arjun S. Sebastian; Nathan R. Wanderman; Bradford L. Currier; Mark A. Pichelmann; Vickie M. Treder; Jeremy L. Fogelson; Michelle J. Clarke; Ahmad N. Nassr

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저자정보: Arjun S. Sebastian (Orthopedic Surgery Mayo Clinic Rochester MN USA) Nathan R. Wanderman (Orthopedic Surgery Mayo Clinic Rochester MN USA) Bradford L. Currier (Orthopedic Surgery Mayo Clinic Rochester MN USA) Mark A. Pichelmann (Orthopedic Surgery Mayo Clinic Rochester MN USA) Vickie M. Treder (Orthopedic Surgery Mayo Clinic Rochester MN USA) Jeremy L. Fogelson (Orthopedic Surgery Mayo Clinic Rochester MN USA) Michelle J. Clarke (Orthopedic Surgery Mayo Clinic Rochester MN USA) Ahmad N. Nassr (Orthopedic Surgery Mayo Clinic Rochester MN USA)

저널정보: 대한척추외과학회 Asian Spine Journal Asian Spine Journal Vol.13 No.4

발행연도: 2019.1

수록면: 544 - 555 (12page)

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Study Design: Prospective observational cohort study. Purpose: This study aims to evaluate the safety and efficacy of bone morphogenetic protein-2 (BMP-2) in transforaminal lumbar interbody fusion (TLIF) with regard to postoperative radiculitis. Overview of Literature: Bone morphogenetic protein (BMP) is being used increasingly as an alternative to iliac crest autograft in spinal arthrodesis. Recently, the use of BMP in TLIF has been examined, but concerns exist that the placement of BMP close to the nerve roots may cause postoperative radiculitis. Furthermore, prospective studies regarding the use of BMP in TLIF are lacking. Methods: This prospective study included 77 patients. The use of BMP-2 was determined individually, and demographic and operative characteristics were recorded. Leg pain was assessed using the Visual Analog Scale (VAS) for pain and the Sciatica Bothersome Index (SBI) with several secondary outcome measures. The outcome data were collected at each follow-up visit. Results: Among the 77 patients, 29 were administered with BMP. Postoperative leg pain significantly improved according to VAS leg and SBI scores for the entire cohort, and no clinically significant differences were observed between the BMP and control groups. The VAS back, Oswestry Disability Index, and Short-Form 36 scores also significantly improved. A significantly increased 6-month fusion rate was noted in the BMP group (82.8% vs. 55.3%), but no significant differences in fusion rate were observed at the 12- and 24-month follow-up. Heterotopic ossification was observed in seven patients: six patients and one patient in the BMP and control groups, respectively (20.7% vs. 2.1%). However, no clinical effect was observed. Conclusions: In this prospective observational trial, the use of BMP in TLIF did not lead to significant postoperative radiculitis, as measured by VAS leg and SBI scores. Back pain and other functional outcome scores also improved, and no differences existed between the BMP and control groups. The careful use of BMP in TLIF appears to be both safe and effective.

#Lumbosacral region #Spinal fusion #Radiculopathy

참고문헌 (30)

참고문헌 신청

Burkus JK / 2002 / Clinical and radiographic outcomes of anterior lumbar interbody fusion using recombinant human bone morphogenetic protein-2 / Spine(Phila Pa 1976) 27:2396~2408

Cahill KS / 2009 / Prevalence, complications, and hospital charges associated with use of bone-morphogenetic proteins in spinal fusion procedures / JAMA 302:58~66

Owens K / 2011 / Perioperative complications with rhBMP-2 in transforaminal lumbar interbody fusion / Eur Spine J 20:612~617

Mummaneni PV / 2004 / Contribution of recombinant human bone morphogenetic protein-2 to the rapid creation of interbody fusion when used in transforaminal lumbar interbody fusion : a preliminary report : invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004 / J Neurosurg Spine 1:19~23

Molinari RW / 2001 / Functional outcomes of instrumented posterior lumbar interbody fusion in active-duty US servicemen : a comparison with nonoperative management / Spine J 1:215~224

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