title: Use of recombinant human bone morphogenetic protein-2 with local bone graft instead of iliac crest bone graft in posterolateral lumbar spine arthrodesis.
abstract: METHODS
  Prospective clinical study.
  
  
  OBJECTIVE
  Compare fusion rates between recombinant human bone morphogenetic protein-2 (rhBMP-2) and iliac crest bone graft (ICBG) with rhBMP-2 and local bone graft (LBG) (±bone graft extenders) in posterolateral fusion.
  
  
  BACKGROUND
  Previous reports have shown higher fusion rates when adding rhBMP-2 to ICBG in lumbar posterolateral fusion, compared with ICBG alone. We compared the fusion success rates between rhBMP-2 delivered with ICBG versus that with LBG.
  
  
  METHODS
  Fusion rates were compared in patients with degenerative spondylolisthesis (1-2 levels) with accompanying lumbar stenosis. RhBMP-2 (INFUSE, Medtronic) was delivered on an absorbable collagen sponge (6 mg/side at 1.5 mg/mL) with ICBG alone or with LBG wrapped inside the sponge. Thin slice computed tomographic scans were assessed at 6, 12, and 24 months.
  
  
  RESULTS
  In a consecutive series, 16 patients (30 levels) received ICBG with rhBMP-2 and 35 patients (49 levels) received LBG with rhBMP-2. For the ICBG cohort, 80.0%, 93.4%, 96.7% of levels were fused at 6, 12, and 24 months. In contrast, for the local bone with rhBMP-2 cohort, 87.7%, 98.0%, and 98.0% were fused at 6, 12, and 24 months. There was no statistically significant difference in fusion success rates between the 2 groups at any time point. As for fusion quality, the fusion mass showed superior quality in ICBG group than in the local bone group at each time point.
  
  
  CONCLUSIONS
  This study validates the high fusion success rates previously reported by adding rhBMP-2 to ICBG and shows that local bone may be safely substituted for ICBG in 1- to 2-level posterolateral fusion. The fusion rates were comparable. The avoidance of ICBG harvest has implications for operative time, blood loss, and morbidity. Lastly, this is the first study that directly compares the fusion success rate and quality using local bone with rhBMP-2 versus ICBG with rhBMP-2 at various times.
  
  
  METHODS
  4.
authors.affiliation: *William Beuamont Hospital Department of Orthopedic Surgery Lahser Road Southfield, MI †Seoul Spine Institute Inje University Sanggye-Paik Hospital, Dongil-ro Nowon-gu, Seoul Korea ‡Upstate Bone and Joint Center Upstate Medical University-SUNY Syracuse, NY; and §Emory University, Executive Park, South Atlanta, GA.
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Park
authors.forename: Sung S
authors.initials: SS
authors.lastname: Kim
authors.forename: Nikhil
authors.initials: N
authors.lastname: Thakur
authors.forename: Scott D
authors.initials: SD
authors.lastname: Boden
mesh_terms: D064592:Autografts; D055396:Bone Morphogenetic Protein 2 / Q000008:administration & dosage*; D016025:Bone Transplantation / Q000379:methods*; D004337:Drug Carriers; D006801:Humans; D007085:Ilium / Q000637:transplantation*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000601:surgery*; D056687:Off-Label Use; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000008:administration & dosage; D013123:Spinal Fusion / Q000379:methods*; D013168:Spondylolisthesis / Q000000981:diagnostic imaging / Q000601:surgery*; D015503:Surgical Sponges; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: C525718:BMP2 protein, human; D055396:Bone Morphogenetic Protein 2; D004337:Drug Carriers; D011994:Recombinant Proteins