Asian Spine J.  2016 Dec;10(6):1091-1099. 10.4184/asj.2016.10.6.1091.

Bone Morphogenic Protein Is a Viable Adjunct for Fusion in Minimally Invasive Transforaminal Lumbar Interbody Fusion

Affiliations
  • 1Department of Orthopaedic Surgery, Singapore General Hospital, Singapore. yuewm@singnet.com.sg
  • 2Orthopaedic Diagnostic Centre, Singapore General Hospital, Singapore.

Abstract

STUDY DESIGN: Comparison of prospectively collected data of patients undergoing minimally invasive surgery transforaminal lumbar interbody fusion (MIS-TLIF) with and without recombinant human bone morphogenic protein 2 (BMP). PURPOSE: To compare the clinical, radiological outcome and complications of patients undergoing MIS-TLIF with and without BMP. OVERVIEW OF LITERATURE: BMP is an effective fusion enhancer with potential complications. Direct comparison of MIS-TLIF with and without BMP is limited to retrospective studies with short follow-up.
METHODS
From June 2005 to February 2011, consecutive cases of MIS-TLIF performed by a single surgeon were included. North American Spine Society (NASS) score, Oswestry disability index (ODI), Short Form-36 (SF-36), and visual analogue score (VAS) were assessed preoperatively and at 6 and 24 months postoperatively. Fusion rates and complications were noted.
RESULTS
The 252 cases comprised 104 non-BMP and 148 BMP cases. The BMP group was significantly older (mean age, 60.2 vs. 53.9; p<0.01). Preoperative scores were similar. Immediate postoperative morphine usage was significantly lower in the BMP group (12.4 mg vs. 20.1 mg, p<0.01). At 6 months, the BMP group had lower VAS back and leg pain scores (p<0.01). At 2 years, the BMP group had better leg pain scores (p<0.01), ODI (15.4 vs. 20.3, p=0.04) and NASS scores (8.8 vs. 15.8, p<0.01). Both groups showed significant clinical improvement compared to their preoperative levels. The BMP group attained a significantly higher rate of fusion at 6 months follow-up (88.4% vs. 76.8%, p=0.016) with no difference at 2 years. The non-BMP and BMP group had 12 (11.5%) and 9 (6.1%) complications and 5 (4.8%) and 2 (1.4%) reoperations, respectively.
CONCLUSIONS
The use of BMP to augment fusion in MIS-TLIF is an acceptable alternative that has potential benefits of less pain in early and intermediate postoperative follow-up.

Keyword

Lumbar spine; Degenerative; Transforaminal interbody fusion; Bone morphogenic protein; TLIF BMP

MeSH Terms

Follow-Up Studies
Humans
Leg
Minimally Invasive Surgical Procedures
Morphine
Prospective Studies
Retrospective Studies
Spine
Morphine
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