Experience With Recombinant Human Bone Morphogenetic Protein-2 in Posterior Lumbar Interbody Fusion: A Retrospective Review of 1019 Procedures

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Figure 1
The author’s current technique for preparing Infuse, per single level. (1) 2.1 mg of recombinant human bone morphogenetic protein-2 is added to a single absorbable collagen sponge, which is then diced. (2, 3) The diced “Infuse” is mixed in with morcellized local bone. (4) ~5 to 8 ccs of bone marrow aspirate from iliac crests is then added to form the final graft material.
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Figure 2
Visual analog scale (VAS) back and leg pain scores over time.
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Figure 3
Oswestry Disability Index (ODI) scores over time.
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Figure 4
The 36-Item Short Form Health Survey (SF-36) physical component score (PCS) and SF-36 mental component score (MCS) over time.
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Figure 5
(A) Sagittal and coronal views of computed tomography images of a patient 3 months after an L4-L5 posterior lumbar interbody fusion showing satisfactory position of hardware but demonstrating osteolysis, particularly at the inferior L4 endplate.
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Figure 6
T2-weighted magnetic resonance imaging, axial views, demonstrating the formation of bilateral epidural cysts 2.5 mo after an L4-S1 posterior lumbar interbody fusion.

Table 1

Patient demographics.

Demographics	N = 1019
Age at surgery, y, mean (SD) (range)	68.1 (12.2) (16–96)
Women, n (%)	644 (63.2)
Rheumatoid arthritis, n/N (%)^{^a}	53/1007 (5.3)
Osteoporosis, n/N (%)^{^a}	126/1007 (12.5)
Smoking, n/N (%)^{^b}	43/789 (5.4)
Body mass index, mean (SD) (range)	27.5 (5.1) (16.2–52)
Previous lumbar surgery, mean (SD) (range)	0.8 (1.1) (0–8)
Duration of follow-up, mo, mean (SD) (range)	51.7 (30.0) (18–172)

Table 2

Surgical demographics.

Characteristic	Frequency, n (%)
Indication for fusion^{^a}
Instability	585 (57.4)
Foramen stenosis	486 (47.7)
Adjacent segment disease	161 (15.8)
Correct painful deformity	195 (19.1)
Nonunion	19 (1.9)
Large, painful, or recurrent disc	2 (0.2)
Discogenic back pain	9 (0.9)
Failed back surgery syndrome	50 (4.9)
Missing or not recorded	24 (2.4)
Number of levels fused^{^b}
1 Level	711 (69.8)
2 Levels	209 (20.5)
3 Levels	52 (5.1)
4 Levels	35 (3.4)
5 Levels	12 (1.2)
Levels fused
L5-S1	396 (38.9)
L4-L5	591 (58.0)
L3-L4	291 (28.6)
L2-L3	150 (14.7)
L1-L2	57 (5.6)

↵a Many cases had more than 1 indication for fusion.
↵b Indicates number of levels that underwent posterior interbody fusion, case by case.

Table 3

Mean (SD) PROM scores.

Abbreviation: MCS, mental component score; ODI, Oswestry Disability Index; PCS, physical component score; PROM, patient-reported outcome measure; SF-36, 36-Item Short Form Health Survey; VAS, visual analog scale.
↵a P value for all timepoints compared with preoperative measures, with repeated measures of analysis of variance.