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Clinical and radiographic correlation in the use of rhBMP-2 for posterior-lateral lumbar spinal fusion. 2009

General Spine

Joseph G Craig, MB ChB,
Stephen Bartol, MD, Non ASSR Member
Marc Underhill, MD, Non ASSR Member
Nauman Akhtar, MD, Non ASSR Member

Scientific Paper

Mentor Award: No

Institution where work was conducted

Henry Ford Hospital

Affiliation and Department

Radiology Department, Henry Ford Hospital

Address

2799 West Grand Boulevard
Detroit, Michigan
48202
Phone: 313 9169848
Email: josephgcraig@comcast.net

Purpose

To determine the efficiency of rh-BMP (bone morphogenic protein) use in posterior spinal fusion surgery.

Determine rh-BMP2s ability to influence complete fusion rates as determined by radiographic analysis.

Determine risk factors that lead to pseudoarthrosis as determined by radiographic analysis.

Explore the clinical outcomes of patients after posterior lumbar fusion enhanced with rh-BMP2.

Methods & Materials

Retrospective review of prospectively collected outcome data.

Review of 63 consecutive patients whom had undergone posterior lumbar decompression and all with autograft enhanced rh-BMP2. 23 male patients’ age range 34-75, mean 55.4 years of age, 40 female patients age range 34-84, mean 63 years of age.

All underwent lumbar spine posterior decompression and fusion between 2003-
2006.

One to seven levels, all with local autograft enhanced rhBMP2.

Fusion was evaluated primarily on AP radiographs.

Clinical outcome was determined by Owestry scores, back and leg pain scores.

Comorbidities including ASA score, diabetes, swelling and BMI were also evaluated.

Radiographic fusion was determined to be solid if bridging bone with confluent trabeulation was present between vertebra on the AP radiograph.

Results

51 patients had complete fusion, the average time to fusion was 306.24 days. The average time to fusion of individual sides was 283 days.
This was 16.1% faster than without rhBMP2 assuming a 1 year expected fusion rate 2/63 patients’ demonstrated pseudoarthrosis, a 2 level fusion and a 4 level fusion.

Conclusion

1. rhBMP-2 is useful in aiding posterior fusion of the
spine.

2. As the number of levels increase, the average time to fusion also increases.

3. Rate of pseudoarthrosis is different with rh-BMP2 than fusion rates with autograft alone.

4. Oswestry pain and functional scores seem to correlate with radiographic assessment of fusion.

5. Smoking may be a risk factor to pseudoarthrosis, however, not statistically significant in this study.