title: RhBMP-2 use in lumbar fusion surgery is associated with transient immediate post-operative leg pain.
abstract: OBJECTIVE
  Supra-physiological rhBMP loads during spinal fusion may trigger local inflammation and post-operative radiculitis. MRI is an effective tool to detect nerve root compression in severe post-operative leg pain. The aim of this study was to determine if recombinant bone morphogenic protein 2 (rhBMP-2) is associated with immediate post-operative leg pain without evidence of root compression using MRI.
  
  
  METHODS
  All patients undergoing posterolateral and posterior interbody lumbar spinal fusions with rhBMP-2 between July 2007 and January 2009 at a single surgeon practice were retrospectively reviewed for incidence of severe immediate post-operative leg pain. Patients that presented with immediate post-operative leg pain were interviewed and Oswestry Disability Indices calculated.
  
  
  RESULTS
  Sixty-four rhBMP-2 treated patients and 40 controls were included. Pre-operative demographics and diagnoses were similar and inter-body cages were used equally. Immediate post-operative leg pain incidence was 25 and 12.5% in the rhBMP-2 and non-rhBMP-2 groups, respectively. 17.2% of the patients treated with rhBMP-2 had immediate post-operative leg pain without evidence of nerve root compression on MRI versus 7.5% of the patients treated without rhBMP-2. At follow-up, leg pain incidence was 11.6 and 7.6% in rhBMP-2 and non-rhBMP-2 groups, respectively. There was no difference in Oswestry Disability Indices between groups (36.5 ± 31.2 vs. 23.0 ± 25.5).
  
  
  CONCLUSIONS
  RhBMP-2 associated radiculitis presenting as immediate post-operative leg pain without MRI evidence of neuronal compression occurs in 17% of the patients with rhBMP-2 assisted fusion. Patients should be pre-operatively counselled regarding immediate post-operative leg pain with rhBMP-2.
  
  
  METHODS
  III.
authors.affiliation: Department of Orthopaedics and Spinal Surgery, Mater Private Hospital, 69 Eccles St, Dublin 7, Ireland. fiachrarowan@yahoo.com
authors.forename: Fiachra E
authors.initials: FE
authors.lastname: Rowan
authors.forename: Natasha
authors.initials: N
authors.lastname: O'Malley
authors.forename: Ashley
authors.initials: A
authors.lastname: Poynton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055396:Bone Morphogenetic Protein 2 / Q000009:adverse effects* / Q000627:therapeutic use; D016022:Case-Control Studies; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D007866:Leg / Q000473:pathology; D008159:Lumbar Vertebrae / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000139:chemically induced / Q000453:epidemiology* / Q000473:pathology; D011843:Radiculopathy / Q000139:chemically induced / Q000453:epidemiology* / Q000473:pathology; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: C525718:BMP2 protein, human; D055396:Bone Morphogenetic Protein 2; D011994:Recombinant Proteins