Minimally Effective Dose of Bone Morphogenetic Protein in Minimally Invasive Lumbar Interbody Fusions
| Autor: | Lisa Govila, Doris Tong, Matthew Bahoura, Roger Gonda, Evan Lytle, Clifford Houseman, Dejan Slavnic, Teck-Mun Soo |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Radiography Urology Bone morphogenetic protein Logistic regression 03 medical and health sciences 0302 clinical medicine Lumbar Text mining Humans Medicine Orthopedics and Sports Medicine Longitudinal Studies Longitudinal cohort Aged Retrospective Studies Aged 80 and over 030222 orthopedics Lumbar Vertebrae business.industry Lumbosacral Region Retrospective cohort study Middle Aged Effective dose (pharmacology) Logistic Models Spinal Fusion Bone Morphogenetic Proteins Female Neurology (clinical) Tomography X-Ray Computed business 030217 neurology & neurosurgery |
| Zdroj: | Spine. 44:989-995 |
| ISSN: | 1528-1159 0362-2436 |
| Popis: | Study design Retrospective longitudinal cohort. Objective We sought to demonstrate the minimally effective bone morphogenetic protein (BMP) dose to achieve fusion in minimally invasive transforaminal lumbar interbody fusions. Summary of background data Multiple studies have been conducted, which used a wide range of BMP doses for lumbar fusions highlighting associated risks and benefits. There is, however, a paucity in the literature in determining the minimally effective dose. Methods Consecutive patients who underwent transforaminal lumbar interbody fusion from 2009 to 2014 were reviewed. Fusion was determined by a combination of computed tomography and dynamic x-ray by independent radiologists. We used backward stepwise multiple logistic regression with fusion as the dependent variable to determine whether BMP dose/level was a significant predictor for fusion. To determine the minimally effective dose of BMP/level, separate logistic regressions for different BMP dose ranges and sensitivity analyses were used. A P value ≤0.025 was considered significant. Results There were 1102 interspaces among 690 patients. Average BMP dose was 1.28 mg/level. Overall fusion was 95.2% with a mean follow-up of 19 months. BMP dose/level was a significant predictor for fusion. Odds of fusion increased by 2.02 when BMP dose range was increased from (0.16-1 mg/level) to (1.0-2 mg/level), but fusion odds did not increase when BMP dose increased to more than 2 mg/level. Conclusion BMP dose/level was a significant predictor for fusion. There was a significant increase in odds of fusion when BMP dose increased from 0.16 to 1 mg/level to 1.0 to 2 mg/level. No benefit from increasing the dose more than 2 mg/level was found, suggesting 1.0 mg/level to be the minimally effective BMP dose. Level of evidence 3. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|