Heterotopic bone formation with the use of rhBMP2 in posterior minimal access interbody fusion - A CT analysis
Heterotopic bone formation with the use of rhBMP2 in posterior minimal access interbody fusion - A CT analysis
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DOI：
10.1097/brs.0b013e31815b7596
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发表时间：
2007-12-01
期刊：
影响因子：
3
通讯作者：
Rampersaud, Yoga Raja
中科院分区：
文献类型：
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作者：
Joseph, Vivek;Rampersaud, Yoga Raja
研究设计。具有前瞻性CT分析的观察性研究。目的：探讨应用重组骨形态发生蛋白2(Rh BMP2)和局部自体植骨(Rh BMP2)行小切口椎间融合术(PLIF和TLIF)后硬膜外成骨的发生率和临床后遗症。使用重组人骨形态发生蛋白2进行椎间融合与高融合率相关。然而，对于后路，人们对硬膜外间隙内的异位骨形成提出了担忧。对33例接受微创腰椎融合术(PLIF[n=10]或TLIF[n=23])的患者进行了独立的CT分析。骨形成以离心式方式分级(椎间盘内、环状/ALL/PLL、硬膜外[管/孔]和脊柱外)。在所有的BMP病例中，给予4.2毫克/盘水平的恒定剂量(商业上可获得的最低剂量)。所有病例均采用局部自体移植。对前瞻性收集的结果数据进行回顾和评估。平均临床随访25.0个月，CT(至少6个月)随访7.9个月。BMP组和非BMP组的桥接骨融合发生率分别为100%和90%。使用BMP的硬膜外成骨发生率为20.8%(5个节段：1个椎管，4个椎孔内)，而不使用BMP的硬膜外成骨发生率为8.3%(1个节段：椎管)。仅TLIF组可见孔状骨形成。所有的硬膜外骨形成都是异位的，没有异位骨形成。没有与异位骨形成相关的临床后遗症。术前、术后Oscstry功能障碍指数分别为50.2%(25%~75%)和11.3%(0%~38%)。结论。虽然辅助性使用重组人骨形态发生蛋白2与异位骨的发生率较高有关，但似乎没有任何相关的临床后遗症。
Study Design. Observational study with prospective CT analysis.Objective. To assess the incidence and clinical sequelae of epidural bone formation following the adjunctive use of recombinant bone morphogenetic protein 2 (rhBMP2) with local autogenous bone graft use of (rhBMP2) in minimal access interbody (PLIF and TLIF) fusions.Summary of Background Data. The use of rhBMP2 for interbody fusion is associated with high fusion rates. However, for posterior approaches, concerns regarding heterotopic bone formation within the epidural space have been raised.Methods. An independent CT analysis of 33 consecutive patients following minimal access lumbar fusion (PLIF [n = 10] or TLIF [n = 23]) with [n = 23] and without [ n = 10] rhBMP2 was performed. Bone formation was graded in a centrifugal manner (intradiscal, anular/ALL/PLL, epidural [canal/foramen] and beyond the spine). In all BMP cases, a constant dose of 4.2 mg/disc level was administered (lowest commercially available dose). In all cases, local autograft was used. Review and assessment of prospectively collected outcomes data were performed.Results. Average clinical and CT (minimum 6 months) follow-up was 25.0 and 7.9 months, respectively. Bridging bone (fusion) was seen in 100% of the BMP group and 90% without BMP. Epidural bone formation occurred in 20.8% with the use of BMP (5 levels: n = 1 spinal canal and n = 4 within the foramen) compared with 8.3% (1 level: canal) without BMP. Foraminal bone formation was seen only in the TLIF group. All epidural bone formation was heterotopic, and no ectopic bone formation occurred. There were no clinical sequelae associated with heterotopic bone formation. The mean preoperative and postoperative Oswestry Disability Index was 50.2% ( range, 25%-75%) and 11.3% (range, 0%-38%) respectively. Conclusion. Although the adjunctive use of rhBMP2 is associated with a higher incidence of heterotopic bone, there does not seem to be any associated clinical sequelae.