The use of RhBMP-2 in single-level transforaminal lumbar interbody fusion: a clinical and radiographic analysis |
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Authors: | Jeffrey A Rihn Junaid Makda Joseph Hong Ravi Patel Alan S Hilibrand David G Anderson Alexander R Vaccaro Todd J Albert |
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Institution: | (1) The Rothman Institute, Thomas Jefferson University Hospital, 925 Chestnut St., Fifth Floor, Philadelphia, PA 19107, USA;(2) Thomas Jefferson Medical College, 1025 Walnut Street, Philadelphia, PA 19107, USA |
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Abstract: | The “off label” use of rhBMP-2 in the transforaminal lumbar interbody fusion (TLIF) procedure has become increasingly popular.
Although several studies have demonstrated the successful use of rhBMP-2 for this indication, uncertainties remain regarding
its safety and efficacy. The purpose of this study is to evaluate the clinical and radiographic outcomes of the single-level
TLIF procedure using rhBMP-2. Patients who underwent a single-level TLIF between January 2004 and May 2006 with rhBMP-2 were
identified. A retrospective evaluation of these patients included operative report(s), pre- and postoperative medical records,
and dynamic and static lumbar radiographs. Patient-reported clinical outcome measures were obtained from a telephone questionnaire
and included a modification of the Odom’s criteria, a patient satisfaction score, and back and leg pain numeric rating scale
scores. Forty-eight patients met the study criteria and were available for follow-up (avg. radiographic and clinical follow-up
of 19.4 and 27.4 months, respectively). Radiographic fusion was achieved in 95.8% of patients. Good to excellent results were
achieved in 71% of patients. On most recent clinical follow-up, 83% of patients reported improvement in their symptoms and
84% reported satisfaction with their surgery. Twenty-nine patients (60.4%) reported that they still had some back pain, with
an average back pain numeric rating score of 2.8. Twenty patients (41.7%) reported that they still had some leg pain, with
an average leg pain numeric rating score was 2.4. Thirteen patients (27.1%) had one or more complications, including transient
postoperative radiculitis (8/48), vertebral osteolysis (3/48), nonunion (2/48), and symptomatic ectopic bone formation (1/48).
The use of rhBMP-2 in the TLIF procedure produces a high rate of fusion, symptomatic improvement and patient satisfaction.
Although its use eliminates the risk of harvesting autograft, rhBMP-2 is associated with other complications that raise concern,
including a high rate of postoperative radiculitis. |
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Keywords: | Transforaminal Lumbar Interbody fusion TLIF Bone morphogenetic protein |
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