Asian Spine J.  2019 Aug;13(4):544-555. 10.31616/asj.2018.0277.

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

Affiliations
  • 1Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA. Sebastian.arjun@mayo.edu

Abstract

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.

Keyword

Lumbosacral region; Spinal fusion; Radiculopathy

MeSH Terms

Arthrodesis*
Autografts
Back Pain
Bone Morphogenetic Proteins
Cohort Studies
Follow-Up Studies
Humans
Leg
Lumbosacral Region
Ossification, Heterotopic
Outcome Assessment (Health Care)
Prospective Studies*
Radiculopathy*
Sciatica
Spinal Fusion
Spine*
Visual Analog Scale
Bone Morphogenetic Proteins
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