J Korean Neurosurg Soc.  2024 May;67(3):354-363. 10.3340/jkns.2023.0136.

Effect of Mixture of Recombinant Human Bone Morphogenic Protein-2 and Demineralized Bone Matrix in Lateral Lumbar Interbody Fusion

• Son JI
• Lee Ys
• Ko MJ
• Wui SH
• Park SW

• KMID: 2554873
• DOI: http://doi.org/10.3340/jkns.2023.0136

Abstract

Objective
: This study aims to determine the optimal dose of recombinant-human bone morphogenic protein-2 (rhBMP-2) for successful bone fusion in minimally invasive lateral lumbar interbody fusion (MIS LLIF). Previous studies show that rhBMP is an effective alternative to autologous iliac crest bone graft, but the optimal dose remains uncertain. The study analyzes the fusion rates associated with different rhBMP doses to provide a recommendation for the optimal dose in MIS LLIF.
Methods
: Ninety-three patients underwent MIS LLIF using demineralized bone matrix (DBM) or a mixture of rhBMP-2 and DBM as fusion material. The group was divided into the following three groups according to the rhBMP-2 usage : group A, only DBM was used (n=27); group B, 1 mg of rhBMP-2 per 5 mL of DBM paste (n=41); and group C, 2 mg of rhBMP-2 per 5 mL of DBM paste (n=25). Demographic data, clinical outcomes, postoperative complication and fusion were assessed.
Results
: At 12 months post-surgery, the overall fusion rate was 92.3% according to Bridwell fusion grading system. Groups B and C, who received rhBMP-2, had significantly higher fusion rates than group A, who received only DBM. However, there was no significant increase in fusion rate when the rhBMP-2 dosage was increased from group B to group C. The groups B and C showed significant improvement in back pain and Oswestry disability index compared to the group A. The incidence of screw loosening was decreased in groups B and C, but there was no significant difference in the occurrence of other complications.
Conclusion
: Usage of rhBMP-2 in LLIF surgery leads to early and increased final fusion rates, which can result in faster pain relief and return to daily activities for patients. The benefits of using rhBMP-2 were not significantly different between the groups that received 1 mg/5 mL and 2 mg/5 mL of rhBMP-2. Therefore, it is recommended to use 1 mg of rhBMP-2 with 5 mL of DBM, taking both economic and clinical aspects into consideration.

Keyword

Bone morphogenetic protein 2; Spinal fusion; Grafton demineralized bone matrix gel

Figure

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  Fig. 1. Fusion assessment by bridwell grading system. *Post hoc analysis showed a statistically significant difference between group A and group B (p<0.05). **Post hoc analysis showed a statistically significant difference between group A and group C (p<0.05), group B and C showed no statistical difference.

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  Fig. 2. Developed figures to show progressive change at each time point that was assessed. Goal of figures are to show continuity in assessment and comparability in the technique of the assessment. A : A 62-year-old female of group A at 3, 6, and 12 months after surgery. B : A 68-year-old male of group B at 3, 6, and 12 months after operation. C : A 59-year-old male of group C at 3, 6, and 12 months.

Reference

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