title: Bone union rate with recombinant human bone morphogenic protein-2 versus autologous iliac bone in PEEK cages for anterior lumbar interbody fusion.
abstract: OBJECTIVE
  Autologous iliac crest bone graft (ICBG) is the gold standard material for spinal fusion. Bone graft substitutes, such as recombinant human bone morphogenic protein 2 (rhBMP-2) have been developed to promote spinal fusion and address morbidity issues related to ICBG harvesting. The objective of this study was to compare bone fusion rates after anterior lumbar interbody fusion (ALIF) between ICBG and rhBMP-2 by examining thin-cut computed tomography (CT) images at the one year follow-up.
  
  
  METHODS
  Fifty one patients (62 levels) who underwent single- or two-level ALIF via the video-assisted minimally invasive anterior approach in our institution were assessed. Radiolucent cages were inserted in all cases. Each cage has a middle beam delimiting two chambers. Grafting was performed as follows: one chamber was filled with autologous ICBG, and the other chamber was filled with 6 mg of rhBMP-2. Thin-cut CT-scan multiplanar reconstruction analyses were performed to assess the rate and quality of bone fusion at one year of follow-up.
  
  
  RESULTS
  Fusion was observed in 55 levels (88.7 %), with significant differences in fusion rates with rhBMP-2 and ICBG (71 % vs. 88.7 %) (P=0.001). Osteogenesis in the rhBMP-2 chamber had a centripetal pattern in all cases, leaving a central void in 97.7 % of cases representing 38.3 % of the surface of its chamber (range 0-80.3 %). In ICBG chambers, graft resorption was present in 44.4 %, representing 9.8 % of the chamber surface (range 0-52.2 %).
  
  
  CONCLUSIONS
  RhBMP-2 was inferior to ICBG in terms of rate and quality of bone fusion in one- or two-level ALIF.
authors.affiliation: Hôpital Henri MONDOR, AP-HP - UPEC, Institut du Rachis - Service de Chirurgie Orthopédique et Traumatologique, 51, avenue du Maréchal de Lattre de Tassigny, 94010, Creteil Cedex, France, charles-henri.flouzat-lachaniette@hmn.aphp.fr.
authors.forename: Charles-Henri
authors.initials: CH
authors.lastname: Flouzat-Lachaniette
authors.forename: Amir
authors.initials: A
authors.lastname: Ghazanfari
authors.forename: Charlie
authors.initials: C
authors.lastname: Bouthors
authors.forename: Alexandre
authors.initials: A
authors.lastname: Poignard
authors.forename: Philippe
authors.initials: P
authors.lastname: Hernigou
authors.forename: Jérôme
authors.initials: J
authors.lastname: Allain
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064592:Autografts; D001577:Benzophenones; D055396:Bone Morphogenetic Protein 2 / Q000494:pharmacology / Q000627:therapeutic use*; D016025:Bone Transplantation / Q000295:instrumentation / Q000379:methods*; D015194:Diffusion Chambers, Culture; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007085:Ilium / Q000637:transplantation*; D007659:Ketones; D008159:Lumbar Vertebrae / Q000187:drug effects / Q000293:injuries* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011092:Polyethylene Glycols; D011108:Polymers; D011994:Recombinant Proteins / Q000494:pharmacology / Q000627:therapeutic use; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods*; D013997:Time Factors; D036542:Tomography, Spiral Computed; D016896:Treatment Outcome; D020535:Video-Assisted Surgery
chemical_list: C525718:BMP2 protein, human; D001577:Benzophenones; D055396:Bone Morphogenetic Protein 2; D007659:Ketones; D011108:Polymers; D011994:Recombinant Proteins; C063834:polyetheretherketone; D011092:Polyethylene Glycols