Formation of Painful Seroma and Edema After the Use of Recombinant Human Bone Morphogenetic Protein-2 in Posterolateral Lumbar Spine Fusions
Formation of Painful Seroma and Edema After the Use of Recombinant Human Bone Morphogenetic Protein-2 in Posterolateral Lumbar Spine Fusions
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DOI：
10.1227/01.neu.0000369517.21018.f2
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发表时间：
2010-06-01
期刊：
影响因子：
4.8
通讯作者：
Sonntag, Volker K. H.
中科院分区：
文献类型：
--
作者：
Garrett, Mark P.;Kakarla, Udaya K.;Sonntag, Volker K. H.
背景：近年来，骨形态发生蛋白在脊柱手术中用于融合增强的应用显著增加。关于这些化合物的有效性和安全性的信息不断涌现。目的：我们注意到在使用重组人骨形成蛋白-2(rhBMP-2)进行腰椎后外侧融合术后，无菌血清形成和痛性水肿的发生率增加。方法：我们回顾了腰椎后外侧植骨融合术加用重组人骨形态发生蛋白-2的手术报告。我们确定了所有需要手术探查术后无菌血清肿块的患者。结果：130例接受腰椎后外侧植骨融合术的患者中，6例(4.6%)返回手术室探查无菌血清肿块。每个患者向后外侧间隙输送的重组人骨形态发生蛋白-2总量为2.1~14.7 mg，平均为8.4 mg。术后5~13天(平均7.7天)返回手术室，术中培养排除感染。结论：腰椎后外侧植骨融合术后，无菌浆液性肿块和痛性水肿的发生率明显增加。这份报告以及其他强调骨形态发生蛋白潜在并发症的系列报告建议，在使用这些化合物时应该更加谨慎。需要进一步的研究来更好地确定在脊柱手术中使用骨形态发生蛋白的风险和好处。
BACKGROUND: The use of bone morphogenetic proteins for fusion augmentation in spine surgery has increased dramatically in recent years. Information is continually emerging regarding the effectiveness and safety profile of these compounds.OBJECTIVE: We have noted an increased incidence in sterile seroma formation and painful edema after the use of recombinant human bone morphogenetic protein-2 (rhBMP-2) for posterolateral lumbar fusion. We present a retrospective review to determine the incidence of seroma formation and to discuss its clinical implications.METHODS: We retrospectively reviewed the operative reports of patients who underwent posterolateral lumbar fusion with the addition of rhBMP-2. We identified all patients who required surgical exploration of a postoperative sterile seroma. RESULTS: Of the 130 patients who underwent posterolateral lumbar fusion with rhBMP-2, 6 (4.6%) were returned to the operating room for exploration of a sterile seroma. The total amount of rhBMP-2 delivered to the posterolateral space per patient was 2.1 to 14.7 mg (mean, 8.4 mg per patient). The patients were returned to the operating room 5 to 13 days (mean, 7.7 days) after their initial surgery, and infection was ruled out in all cases by intraoperative cultures.CONCLUSION: There seems to be an increased incidence of formation of sterile seroma and painful edema in the lumbar region after posterolateral fusion with rhBMP-2. This report, along with other series highlighting the potential complications of bone morphogenetic proteins, suggests that more caution should be used when these compounds are used. Further studies are required to better define the risks and benefits of using bone morphogenetic proteins for spine surgery.