RT Journal Article
SR Electronic
T1 Does Bone Morphogenetic Protein Use Reduce Pseudarthrosis Rates in Single-Level Transforaminal Lumbar Interbody Fusion Surgeries?
JF International Journal of Spine Surgery
JO Int J Spine Surg
FD International Society for the Advancement of Spine Surgery
SP 8590
DO 10.14444/8590
A1 Jack Zhong
A1 Jarid Tareen
A1 Kimberly Ashayeri
A1 Carlos Leon
A1 Eaman Balouch
A1 Nicholas O'Malley
A1 Carolyn Stickley
A1 Constance Maglaras
A1 Brooke O’Connell
A1 Ethan Ayres
A1 Charla Fischer
A1 Yong Kim
A1 Themistocles Protopsaltis
A1 Aaron J. Buckland
YR 2024
UL http://ijssurgery.com//content/early/2024/04/03/8590.abstract
AB Background Recombinant human bone morphogenetic protein 2 (rhBMP-2, or BMP for short) is a popular biological product used in spine surgeries to promote fusion and avoid the morbidity associated with iliac crest autograft. BMP’s effect on pseudarthrosis in transforaminal lumbar interbody fusion (TLIF) remains unknown.Objective To assess the rates of pseudarthrosis in single-level TLIF with and without concurrent use of BMP.Methods This was a retrospective cohort study conducted at a single academic institution. Adults undergoing primary single-level TLIF with a minimum of 1 year of clinical and radiographic follow-up were included. BMP use was determined by operative notes at index surgery. Non-BMP cases with iliac crest bone graft were excluded. Pseudarthrosis was determined using radiographic and clinical evaluation. Bivariate differences between groups were assessed by independent t test and χ 2 analyses, and perioperative characteristics were analyzed by multiple logistic regression.Results One hundred forty-eight single-level TLIF patients were included. The mean age was 59.3 years, and 52.0% were women. There were no demographic differences between patients who received BMP and those who did not. Pseudarthrosis rates in patients treated with BMP were 6.2% vs 7.5% in the no BMP group (P = 0.756). There was no difference in reoperation for pseudarthrosis between patients who received BMP (3.7%) vs those who did not receive BMP (7.5%, P = 0.314). Patients who underwent revision surgery for pseudarthrosis more commonly had diabetes with end-organ damage (revised 37.5% vs not revised 1.4%, P < 0.001). Multiple logistic regression analysis demonstrated no reduction in reoperation for pseudarthrosis related to BMP use (OR 0.2, 95% CI 0.1–3.7, P = 0.269). Diabetes with end-organ damage (OR 112.6,95% CI 5.7–2225.8, P = 0.002) increased the risk of reoperation for pseudarthrosis.Conclusions BMP use did not reduce the rate of pseudarthrosis or the number of reoperations for pseudarthrosis in single-level TLIFs. Diabetes with end-organ damage was a significant risk factor for pseudarthrosis.Clinical Relevance BMP is frequently used “off-label” in transforaminal lumbar interbody fusion; however, little data exists to demonstrate its safety and efficacy in this procedure.Level of Evidence 3.