title: Radiographic Appearance of Transforaminal Lumbar Interbody Fusion Performed With and Without Recombinant Human Morphogenetic Protein-2.
abstract: OBJECTIVE
  The purpose of this study is to determine whether recombinant human morphogenetic protein-2 (rhBMP-2) alters the findings on routine radiographs performed after transforaminal lumbar interbody fusion (TLIF).
  
  
  METHODS
  A retrospective review of 256 TLIF procedures in 200 patients was performed over a 4-year period. The rhBMP-2 group included 204 TLIFs in 160 patients, and the control group included 52 TLIFs in 40 patients. Two musculoskeletal radiologists reviewed the postoperative radiographs for endplate resorption, resorption resolution, new bone formation, bridging bone, and allograft migration. Statistical analysis was performed using logistic regression.
  
  
  RESULTS
  The median age was 53 years in the rhBMP-2 group and 54 years in the control group (p = 0.182). The groups were similar with regard to sex (p = 0.517), single or multilevel TLIF (p = 0.921), specific TLIF levels (p = 0.53), and median radiographic follow-up (373 vs 366 days; p = 0.34). Findings that were more common in the rhBMP-2 group than in the control group included endplate resorption (38% [78/204] vs 12% [6/52]; odds ratio [OR], 4.67; 95% CI, 1.99-12.54; p < 0.001), resorption resolution (59% [46/78] vs 0% [0/6]; OR, 8.09; 95% CI, 1.41 to ∞; p = 0.022), new bone formation (84% [171/204] vs 67% [35/52]; OR, 2.51; 95% CI, 1.24-4.99; p = 0.011), bridging bone (55% [112/204] vs 31% [16/52]; OR, 2.73; 95% CI, 1.43-5.34; p = 0.002), and allograft migration (17% [35/204] vs 2% [1/52]; OR, 6.30; 95% CI, 0.91-151.41; p = 0.065).
  
  
  CONCLUSIONS
  A statistically significant higher frequency of endplate resorption, new bone formation, and bone bridging is present in TLIF augmented by rhBMP-2 compared with TLIF performed without rhBMP-2. Endplate resorption resolves without treatment in most cases after rhBMP-2 use.
authors.affiliation: 1 Department of Radiology and Medical Imaging, University of Virginia, 1218 Lee St, Box 800170, Charlottesville, VA 22908.|2 Present address: Mallinckrodt Institute of Radiology, St. Louis, MO.
authors.forename: J Derek
authors.initials: JD
authors.lastname: Stensby
authors.affiliation: 1 Department of Radiology and Medical Imaging, University of Virginia, 1218 Lee St, Box 800170, Charlottesville, VA 22908.|3 Present address: Jefferson Radiology, Hartford, CT.
authors.forename: Ryan W
authors.initials: RW
authors.lastname: Kaliney
authors.affiliation: 1 Department of Radiology and Medical Imaging, University of Virginia, 1218 Lee St, Box 800170, Charlottesville, VA 22908.
authors.forename: Bennett
authors.initials: B
authors.lastname: Alford
authors.affiliation: 4 Department of Orthopedic Surgery, University of Virginia, Charlottesville, VA.
authors.forename: Francis H
authors.initials: FH
authors.lastname: Shen
authors.affiliation: 5 Department of Public Health Sciences, University of Virginia, Charlottesville, VA.
authors.forename: James T
authors.initials: JT
authors.lastname: Patrie
authors.affiliation: 1 Department of Radiology and Medical Imaging, University of Virginia, 1218 Lee St, Box 800170, Charlottesville, VA 22908.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fox
mesh_terms: D055396:Bone Morphogenetic Protein 2 / Q000008:administration & dosage / Q000494:pharmacology*; D016025:Bone Transplantation; D005260:Female; D006133:Growth Substances / Q000008:administration & dosage / Q000494:pharmacology*; D006801:Humans; D007278:Injections, Spinal; D007403:Intervertebral Disc / Q000000981:diagnostic imaging* / Q000187:drug effects / Q000601:surgery; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000187:drug effects / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011859:Radiography; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000494:pharmacology; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods*; D016212:Transforming Growth Factor beta / Q000008:administration & dosage / Q000494:pharmacology*; D016896:Treatment Outcome
chemical_list: D055396:Bone Morphogenetic Protein 2; D006133:Growth Substances; D011994:Recombinant Proteins; D016212:Transforming Growth Factor beta; C499469:recombinant human bone morphogenetic protein-2
keywords: bone resorption; lumbosacral region; osteogenesis; recombinant human bone morphogenetic protein–2; spinal fusion