title: Perioperative and long-term clinical outcomes for bone morphogenetic protein versus iliac crest bone graft for lumbar fusion in degenerative disk disease: systematic review with meta-analysis.
abstract: METHODS
  Systematic review with meta-analysis.
  
  
  OBJECTIVE
  To compare the perioperative and long-term postoperative effectiveness of bone morphogenetic protein (BMP) for lumbar arthrodesis in skeletally mature adults with degenerative disk disease (DDD) to that of the current golden standard treatment, iliac crest autologous bone graft (ICBG).
  
  
  BACKGROUND
  The treatment efficacy of lumbar arthrodesis in DDD is a complex clinical and economic issue for patients and health care providers.
  
  
  METHODS
  Comprehensive electronic literature search was performed using following databases: Ovid MEDLINE; Embase; Cochrane Library; Central Register of Controlled Trials (CENTRAL); Database of Abstracts of Reviews of Effects; Methodology Register; Technology Assessment Database; and Economic Evaluation Database. The full year ranges of each database until May of 2012 were included.
  
  
  RESULTS
  Eight randomized controlled clinical trials of 383 citations were selected. The included studies involved 1138 participants. The pooled 2-year postoperative clinical outcomes were equivalent in BMP and ICBG groups, and exceeded minimum clinically important differences for Oswestry Disability Index, SF-36 (physical scale), and numeric rating scale (back pain). ICBG was associated with increased pain and complications at the donor site (P<0.01). The pooled average operative time was 21 minutes less in BMP versus ICBG (P<0.001). The pooled rate of additional surgical treatment was 2 times less in the BMP than in the ICBG groups (P=0.006). The pooled risk of nonunion at 24-month follow-up was 2 times less in the BMP than in the ICBG groups (P=0.037), however, this effect was likely biased.
  
  
  CONCLUSIONS
  BMP, in particular rhBMP-2, is a good alternative to autogenous bone graft, especially in cases when harvesting of autologous bone is contraindicated or undesirable, operation time is limited, and there are no contraindications for BMP use.However, the current study did not reveal evidence robust enough to develop strong medical recommendations concerning BMP use for lumbar arthrodesis in degenerative disk disease.
authors.affiliation: *Department of Orthopedics †Health Sciences Library, University of Colorado Anschutz Medical Campus, Aurora, CO.
authors.forename: Andriy
authors.initials: A
authors.lastname: Noshchenko
authors.forename: Lilian
authors.initials: L
authors.lastname: Hoffecker
authors.forename: Emily M
authors.initials: EM
authors.lastname: Lindley
authors.forename: Evalina L
authors.initials: EL
authors.lastname: Burger
authors.forename: Christopher M J
authors.initials: CM
authors.lastname: Cain
authors.forename: Vikas V
authors.initials: VV
authors.lastname: Patel
mesh_terms: D000328:Adult; D000368:Aged; D064592:Autografts; D019485:Bone Morphogenetic Proteins / Q000494:pharmacology / Q000627:therapeutic use*; D016025:Bone Transplantation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007085:Ilium / Q000187:drug effects / Q000637:transplantation*; D055959:Intervertebral Disc Degeneration / Q000188:drug therapy* / Q000601:surgery; D008159:Lumbar Vertebrae / Q000187:drug effects / Q000601:surgery*; D008161:Lumbosacral Region / Q000601:surgery; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D019990:Perioperative Care; D011183:Postoperative Complications / Q000209:etiology; D017594:Publication Bias; D011994:Recombinant Proteins / Q000627:therapeutic use; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D011795:Surveys and Questionnaires; D016212:Transforming Growth Factor beta; D016896:Treatment Outcome
chemical_list: D019485:Bone Morphogenetic Proteins; D011994:Recombinant Proteins; D016212:Transforming Growth Factor beta