RT Journal Article
SR Electronic
T1 Biologics and Minimally Invasive Approach to TLIFs: What Is the Risk of Radiculitis?
JF International Journal of Spine Surgery
JO Int J Spine Surg
FD International Society for the Advancement of Spine Surgery
SP 804
OP 810
DO 10.14444/7114
VO 14
IS 5
A1 ERIK WANG
A1 CAROLYN STICKLEY
A1 JORDAN MANNING
A1 CHRISTOPHER G. VARLOTTA
A1 DAINN WOO
A1 ETHAN AYRES
A1 EDEM ABOTSI
A1 DENNIS VASQUEZ-MONTES
A1 CHARLA R. FISCHER
A1 JONATHAN STIEBER
A1 MARTIN QUIRNO
A1 THEMISTOCLES S. PROTOPSALTIS
A1 PETER G. PASSIAS
A1 AARON J. BUCKLAND
YR 2020
UL http://ijssurgery.com//content/14/5/804.abstract
AB Background: Bone morphogenetic protein (BMP) and allograft containing mesenchymal stem cells (live cell) are popular biologic substitutes for iliac crest autograft used in transforaminal lumbar interbody fusion (TLIF). Use of these agents in the pathogenesis of postoperative radiculitis remains controversial. Recent studies have independently linked minimally invasive (MIS) TLIF with increased radiculitis risk compared to open TLIF. The purpose of this study was to assess the rate of postoperative radiculitis in open and MIS TLIF patients along with its relationship to concurrent biologic adjuvant use.Methods: Patients ≥18 years undergoing single-level TLIF from June 2012 to December 2018 with minimum 1-year follow-up were included. Outcome measures were rate of radiculitis, intra- and postoperative complications, revision surgery; length of stay (LOS), and estimated blood loss (EBL).Results: There were 397 patients: 223 with open TLIFs, 174 with MIS TLIFs. One hundred and fifty-nine surgeries used bone morphogenetic protein (BMP), 26 live cell, 212 neither. Open TLIF: higher mean EBL, LOS, and Charlson Comorbidity Index (CCI) than MIS. Postoperative radiculitis in 37 patients (9.32% overall): 16 cases MIS BMP (15.69% of their cohort), 6 MIS without BMP (8.33%), 5 open BMP (8.77%), 10 open without BMP (6.02%). MIS TLIF versus open TLIF: no differences in 1-year reoperation rates, infection/wound complication, pseudarthrosis, or postoperative complication rate. BMP versus non-BMP: no differences in reoperation rates, infection/wound complication, pseudarthrosis, or postoperative complication rate. Multivariate logistic regression found that neither BMP (P = .109) nor MIS (P = .314) was an independent predictor for postoperative radiculitis when controlled for age, gender, body mass index, and CCI. Using paired open and MIS groups (N = 168 each) with propensity score matching, these variables were still not independently associated with radiculitis (P = .174 BMP, P = .398 MIS). However, the combination of MIS with BMP was associated with increased radiculitis risk in both the entire patient cohort (odds ratio [OR]: 2.259 [1.117–4.569], P = .023, N = 397) and PSM cohorts (OR: 2.196 [1.045–4.616], P = .038, N = 336) compared to other combinations of surgical approach and biologic use.Conclusion: Neither the MIS approach nor BMP use is an independent risk factor for post-TLIF radiculitis. However, risk of radiculitis significantly increases when they are used in tandem. This should be considered when selecting biological adjuvants for MIS TLIF.Level of Evidence: 3