title: Adjacent vertebral body osteolysis with bone morphogenetic protein use in transforaminal lumbar interbody fusion.
abstract: BACKGROUND
  Recent studies have demonstrated cases of adjacent vertebral body osteolysis when assessing the effect of bone morphogenetic protein (BMP) on fusion rates. However, no study to date has evaluated the course of osteolysis at different periods.
  
  
  OBJECTIVE
  To determine the incidence and resolution of osteolysis associated with BMP used in transforaminal lumbar interbody fusions (TLIF).
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  All TLIF cases using BMP performed at one institution with routine postoperative computed tomography (CT) scans at defined intervals.
  
  
  METHODS
  Area of osteolysis and fusion as determined by CT scan.
  
  
  METHODS
  We performed a retrospective analysis of all patients at our facility who underwent TLIF with BMP. Included were all patients who had obtained a CT scan within 48 hours of surgery, 3 to 6 months postoperatively, and 1 to 2 years postoperatively. Areas of osteolysis were defined as lucency within the vertebral body communicating with the interbody spacer that was not present on the immediately postoperative CT scan. Areas of osteolysis were measured in all three planes and the volume used for comparison of the 3 to 6 months CT scans with the greater than 1 year CT scan.
  
  
  RESULTS
  Twenty-three patients who underwent TLIF with BMP had obtained CT scans at all time periods required for evaluation. Seventy-eight vertebral bodies/end plates were assessed for osteolysis (39 levels). The incidence of osteolysis 3 to 6 months postoperatively in the adjacent vertebral bodies was 54% compared with 41% at 1 to 2 years. The mean volume of osteolysis was at 0.216 cm(3) at 1 to 2 years compared with 0.306 cm(3) at 3 to 6 months (p=.082). The area/rate of osteolysis did not appear to significantly affect the rate of fusion or final outcome with an overall union rate of 83%.
  
  
  CONCLUSIONS
  The rate of osteolysis decreased at 1 year compared with 3 to 6 months, but only 24% of the vertebral bodies with evidence of osteolysis at 3 to 6 months completely resolved by 1 year.
authors: Integrated Department of Orthopaedics and Rehabilitation, Walter Reed Army Medical Center, Washington, DC 20307, USA.
authors: Melvin D
authors: MD
authors: Helgeson
authors: Ronald A
authors: RA
authors: Lehman
authors: Jeanne C
authors: JC
authors: Patzkowski
authors: Anton E
authors: AE
authors: Dmitriev
authors: Michael K
authors: MK
authors: Rosner
authors: Andrew W
authors: AW
authors: Mack
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055396:Bone Morphogenetic Protein 2 / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010014:Osteolysis / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000453:epidemiology; D011183:Postoperative Complications / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology; D011994:Recombinant Proteins / Q000009:adverse effects; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods; D014057:Tomography, X-Ray Computed; D016212:Transforming Growth Factor beta / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D055396:Bone Morphogenetic Protein 2; D011994:Recombinant Proteins; D016212:Transforming Growth Factor beta; C499469:recombinant human bone morphogenetic protein-2