Posterior lumbar interbody fusion using rhBMP-2.
The use of biological technologies for the treatment of degenerative spinal diseases has undergone rapid clinical and scientific development. BMP strategies have gained wide support for an inherent potential to improve the ossification process. It has been extensively studied in combination with various techniques for spinal stabilisation from both anterior and posterior approach. We studied the fusion process after implantation of rhBMP-2 in 17 patients with degenerative lumbar spine diseases in combination with dorsal fixation with pedicle screws and poly-ether-ether-ketone (PEEK) interbody cages. We used 12 mg rhBMP-2 carried by collagen sponge, 6 mg in every cage. Patient follow up consisted of pre-operative radiographic and clinical evaluation. Similar post-operative evaluations were performed at 3 and 6 months. Clinical assessment demonstrated clear improvement in all patients despite evidence of vertebral endplate osteoclastic activity in the 3-month radiographs. The 6-month radiograph, however, confirmed evidence of fusion, and no untoward results or outcomes were noted. While previous studies have shown exclusively positive results in both fusion rates and process, our study demonstrated an intermediate morphology at 3 months during the ossification process using Induct Os in combination with peek-cages using a PLIF-technique. The transient resorption of bone surrounding the peek cage did not result in subsidence, pain or complication, and fusion was reached in all cases within a 6-month-controlled evaluation. Although there was no negative influence on clinical outcome, the potential for osteoclastic or metabolic resorption bears watching during the post-surgical follow up.
Department of Neurosurgery, BG-Clinic Bergmannstrost, Merseburger Str. 165, 06112, Halle, Germany. meisel@bergmannstrost.com
Hans Jörg
HJ
Meisel
Mark
M
Schnöring
Christian
C
Hohaus
Yvonne
Y
Minkus
Andre
A
Beier
Timothy
T
Ganey
Ulrich
U
Mansmann
D000368:Aged; D001577:Benzophenones; D001672:Biocompatible Materials / Q000627:therapeutic use; D055396:Bone Morphogenetic Protein 2; D019485:Bone Morphogenetic Proteins / Q000008:administration & dosage*; D001861:Bone Regeneration / Q000187:drug effects* / Q000502:physiology; D001862:Bone Resorption / Q000188:drug therapy / Q000503:physiopathology / Q000517:prevention & control; D001863:Bone Screws; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D007659:Ketones / Q000627:therapeutic use; D008159:Lumbar Vertebrae / Q000187:drug effects* / Q000378:metabolism / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010010:Osteoclasts / Q000187:drug effects / Q000502:physiology; D017063:Outcome Assessment, Health Care; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011108:Polymers; D011182:Postoperative Care; D011183:Postoperative Complications / Q000188:drug therapy / Q000503:physiopathology / Q000517:prevention & control; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000008:administration & dosage*; D013123:Spinal Fusion / Q000379:methods*; D015503:Surgical Sponges; D016212:Transforming Growth Factor beta / Q000008:administration & dosage*; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects* / Q000502:physiology
D001577:Benzophenones; D001672:Biocompatible Materials; D055396:Bone Morphogenetic Protein 2; D019485:Bone Morphogenetic Proteins; D007659:Ketones; D011108:Polymers; D011994:Recombinant Proteins; D016212:Transforming Growth Factor beta; C499469:recombinant human bone morphogenetic protein-2; C063834:polyetheretherketone; D011092:Polyethylene Glycols