Does Bone Morphogenetic Protein Use Reduce Pseudarthrosis Rates in Single-Level Transforaminal Lumbar Interbody Fusion Surgeries?

Autor:	Zhong J; Department of Orthopedics, Division of Spine, NYU Langone Health, New York, NY, USA., Tareen J; Department of Orthopedics, Division of Spine, NYU Langone Health, New York, NY, USA., Ashayeri K; Department of Orthopedics, Division of Spine, NYU Langone Health, New York, NY, USA., Leon C; Department of Orthopedics, Division of Spine, NYU Langone Health, New York, NY, USA., Balouch E; Department of Orthopedics, Division of Spine, NYU Langone Health, New York, NY, USA., O'Malley N; Department of Orthopedics, Division of Spine, NYU Langone Health, New York, NY, USA., Stickley C; Department of Orthopedics, Division of Spine, NYU Langone Health, New York, NY, USA., Maglaras C, O'Connell B; Department of Orthopedics, Division of Spine, NYU Langone Health, New York, NY, USA., Ayres E; Department of Orthopedics, Division of Spine, NYU Langone Health, New York, NY, USA., Fischer C; Department of Orthopedics, Division of Spine, NYU Langone Health, New York, NY, USA., Kim Y; Department of Orthopedics, Division of Spine, NYU Langone Health, New York, NY, USA., Protopsaltis T; Department of Orthopedics, Division of Spine, NYU Langone Health, New York, NY, USA., Buckland AJ; Department of Orthopedics, Division of Spine, NYU Langone Health, New York, NY, USA aaron.buckland@spineandscoliosis.org.; Melbourne Orthopedic Group, Melbourne, Australia.; Spine and Scoliosis Research Associates Australia, Windsor, Australia.
Jazyk:	angličtina
Zdroj:	International journal of spine surgery [Int J Spine Surg] 2024 May 06; Vol. 18 (2), pp. 207-216. Date of Electronic Publication: 2024 May 06.
DOI:	10.14444/8590
Abstrakt:	Background: Recombinant human bone morphogenetic protein 2 (rhBMP-2, or BMP for short) is a popular biological product used in spine surgeries to promote fusion and avoid the morbidity associated with iliac crest autograft. BMP's effect on pseudarthrosis in transforaminal lumbar interbody fusion (TLIF) remains unknown. Objective: To assess the rates of pseudarthrosis in single-level TLIF with and without concurrent use of BMP. Methods: This was a retrospective cohort study conducted at a single academic institution. Adults undergoing primary single-level TLIF with a minimum of 1 year of clinical and radiographic follow-up were included. BMP use was determined by operative notes at index surgery. Non-BMP cases with iliac crest bone graft were excluded. Pseudarthrosis was determined using radiographic and clinical evaluation. Bivariate differences between groups were assessed by independent t test and χ 2 analyses, and perioperative characteristics were analyzed by multiple logistic regression. Results: One hundred forty-eight single-level TLIF patients were included. The mean age was 59.3 years, and 52.0% were women. There were no demographic differences between patients who received BMP and those who did not. Pseudarthrosis rates in patients treated with BMP were 6.2% vs 7.5% in the no BMP group ( P = 0.756). There was no difference in reoperation for pseudarthrosis between patients who received BMP (3.7%) vs those who did not receive BMP (7.5%, P = 0.314). Patients who underwent revision surgery for pseudarthrosis more commonly had diabetes with end-organ damage (revised 37.5% vs not revised 1.4%, P < 0.001). Multiple logistic regression analysis demonstrated no reduction in reoperation for pseudarthrosis related to BMP use (OR 0.2, 95% CI 0.1-3.7, P = 0.269). Diabetes with end-organ damage (OR 112.6,95% CI 5.7-2225.8, P = 0.002) increased the risk of reoperation for pseudarthrosis. Conclusions: BMP use did not reduce the rate of pseudarthrosis or the number of reoperations for pseudarthrosis in single-level TLIFs. Diabetes with end-organ damage was a significant risk factor for pseudarthrosis. Clinical Relevance: BMP is frequently used "off-label" in transforaminal lumbar interbody fusion; however, little data exists to demonstrate its safety and efficacy in this procedure. Competing Interests: Declaration of Conflicting Interests : A.J.B. is a paid consultant for Nuvasive, K2M-Stryker, Medtronic, Altus Spine, Evolution Spine, and EOS Imaging. Additionally, he reports contracts/grants from Nuvasive (paid to institution); royalties/licenses from Nuvasive, Evolution Spine, and Altus Spine; support for attending meetings/travel from Nuvasive and Medtronic; serving as director and chair of the Spine and Scoliosis Research Associates Australia (nonprofit); and received fellowship support from Nuvasive paid to the institution. T.S.P. is a paid consultant for Globus Medical, Innovasis, K2M-Stryker, Medicrea International, and Nuvasive and owns stocks/stock options with Torus Medical. C.R.F. is a presenter or speaker for Expert Connect; a paid consultant for Stryker and Nuvasive; has received payment/honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Amplify; and has received payment for expert testimony from the departments of Justice in the southern and eastern districts of New York. Y.H.K. receives IP royalties and is a paid consultant of Biomet. The remaining authors have no disclosures. (This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2024 ISASS. To see more or order reprints or permissions, see http://ijssurgery.com.)
Databáze:	MEDLINE
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