title: In the era of recombinant BMP, does additional anterior stabilization add value to a posterolateral fusion?
abstract: METHODS
  Retrospective cohort study. Clinical question or objective: Is there a benefit to additional transforaminal lumbar interbody fusion (TLIF) if a solid posterolateral (PL) fusion can be achieved with routine bone morphogenetic protein (BMP) use in low-grade spondylolisthesis?
  
  
  METHODS
  We performed a retrospective review of patients who had undergone surgery for grade I or II lumbar spondylolisthesis stratified into two groups. Group 1 had 46 patients who underwent TLIF along with PL instrumented fusion. Group 2 had 40 patients who underwent PL instrumented fusion alone. In both groups, adequate posterior decompression with pedicle screw instrumentation was performed and rhBMP-7 was used. All patients were evaluated clinically using the Oswestry Disability Index (ODI) and by independent radiological examination at 3 and 12 months.
  
  
  RESULTS
  At a minimum follow-up of 12 months, there was no statistically significant difference in the rate of fusion. In addition, there were no differences in the proportion of patients who had a minimal clinically significant difference in their ODI. There was a similar rate of complications between each cohort.
  
  
  CONCLUSIONS
  The use of BMP was associated with a high rate of PL lumbar fusion. In the presence of a PL fusion, there appears to be little clinical benefit to additional anterior TLIF in degenerative spondylolisthesis. [Table: see text].
authors.affiliation: AOSpine Reference Centre, Princess Alexandra Hospital, Brisbane, Australia.
authors.forename: Priyesh
authors.initials: P
authors.lastname: Dhoke
authors.forename: Ben
authors.initials: B
authors.lastname: Goss
authors.forename: Satyen
authors.initials: S
authors.lastname: Mehta
authors.forename: Sanela
authors.initials: S
authors.lastname: Stanojevic
authors.forename: Richard
authors.initials: R
authors.lastname: Williams