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Title: Anterior lumbar interbody fusion using recombinant human bone morphogenetic protein-2: a prospective study of complications.
Epworth Authors: Malham, Gregory
Blecher, Carl
Chow, Fiona
Claydon, Matthew
Other Authors: Parker, Rhiannon
Ellis, Ngaire
Keywords: Lumbar Fusion
Anterior Lumbar Interbody Fusion
Recombinant Human Bone Morphogenetic Protein
Polyetheretherketone Cage
Retrograde Ejaculation
Pain Visual Analog Scale
Complication Rates
Anterior Screw-plate
Clinical Outcomes
Back Pain
Back Surgery
Spinal Fusion
Oswestry Disability Index
Mental Component Summary
Physical Component Summary
Neurosciences Clinical Institute, Epworth HealthCare, Victoria, Australia
Issue Date: Dec-2014
Publisher: American Association of Neurological Surgeons
Citation: J Neurosurg Spine. 2014 Dec;21(6):851-60
Abstract: OBJECT: The use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in anterior lumbar interbody fusion (ALIF) is controversial regarding the reported complication rates and cost. The authors aimed to assess the complication rates of performing ALIF using rhBMP-2. METHODS: This is a prospective study of consecutive patients who underwent ALIF performed by a single spine surgeon and a single vascular surgeon between 2009 and 2012. All patients underwent placement of a polyetheretherketone (PEEK) cage filled with rhBMP-2 and a separate anterior titanium plate. Preoperative clinical data, operative details, postoperative complications, and clinical and radiographic outcomes were recorded for all patients. Clinical outcome measures included back and leg pain visual analog scale scores, Oswestry Disability Index (ODI), and SF-36 Physical and Mental Component Summary (PCS and MCS) scores. Radiographic assessment of fusion was performed using high-definition CT scanning. Male patients were screened pre- and postoperatively regarding sexual dysfunction, specifically retrograde ejaculation (RE). RESULTS: The study comprised 131 patients with a mean age of 45.3 years. There were 67 men (51.1%) and 64 women (48.9%). Of the 131 patients, 117 (89.3%) underwent ALIF at L5-S1, 9 (6.9%) at L4-5, and 5 (3.8%) at both L4-5 and L5-S1. The overall complication rate was 19.1% (25 of 131), with 17 patients (13.0%) experiencing minor complications and 8 (6.1%) experiencing major complications. The mean estimated blood loss per ALIF level was 115 ml. There was 1 incidence (1.5%) of RE. No significant vascular injuries occurred. No prosthesis failure occurred with the PEEK cage and separate anterior screw-plate. Back and leg pain improved 57.2% and 61.8%, respectively. The ODI improved 54.3%, with PCS and MCS scores improving 41.7% and 21.3%, respectively. Solid interbody fusion was observed in 96.9% of patients at 12 months. CONCLUSIONS: Anterior lumbar interbody fusion with a vascular access surgeon and spine surgeon, using a separate cage and anterior screw-plate, provides a very robust and reliable construct with low complication rates, high fusion rates, and positive clinical outcomes, and it is cost-effective. The authors did not experience the high rates of RE reported by other authors using rhBMP-2.
DOI: DOI: 10.3171/2014.8.SPINE13524
PubMed URL:
ISSN: 1547-5654
Journal Title: Journal of Neurosurgery: Spine
Type: Journal Article
Type of Clinical Study or Trial: Prospective Study
Appears in Collections:Diagnostic Services

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