Perioperative complications with rhBMP-2 in transforaminal lumbar interbody fusion
Perioperative complications with rhBMP-2 in transforaminal lumbar interbody fusion
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DOI：
10.1007/s00586-010-1494-7
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发表时间：
2011-04-01
影响因子：
2.8
通讯作者：
Carreon, Leah Y.
中科院分区：
文献类型：
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作者：
Owens, Kirk;Glassman, Steven D.;Carreon, Leah Y.
骨形态发生蛋白（BMP）通常用作经椎间孔腰椎椎间融合术（TLIF）的ICBG替代品。然而，最近的多份报告引起了对围手术期神经根病发生率的担忧。此外，鉴于颈椎前路BMP使用报告的严重并发症，需要澄清TLIF的肿胀和水肿相关风险。由于使用rhBMP-2的TLIF相关并发症通常在小系列或孤立病例中报告，没有明确的分母，因此实际并发症发生率在很大程度上是未知的。本研究旨在描述使用rhBMP-2进行TLIF手术的大型连续系列的围手术期并发症和并发症发生率。我们审查了2003年至2007年期间接受使用rhBMP-2 TLIF的204例患者[113例女性，91例男性，平均年龄49.3（22-79）岁]的连续系列的住院和门诊病历。根据病因和严重程度对3个月围手术期内观察到的并发症进行分类。伤口问题描述为伤口感染、血肿/血清肿或持续引流/浅表裂开。分析神经功能缺损和神经根病，以确定是否存在明确的病因（螺钉错位），并确定与rhBMP-2使用的任何潜在关系。在3个月的围手术期内，204例患者中有47例（21.6%）出现并发症。严重并发症13例（6.4%），轻微并发症34例（16.7%）。在13例患者（6.4%）中观察到新的或更严重的术后神经系统投诉，其中6例需要额外手术。这些病例包括1例椎弓根螺钉错位和1例硬膜外血肿。在4例患者（2.0%）中，椎间孔区域的局部血清肿/血肿导致神经压迫，需要翻修。在另外一名患者中，椎体骨质溶解引起椎间孔狭窄和神经根病，但在没有进一步手术的情况下消退。在6名患者中观察到影像学检查无明确病因的持续性神经根病。6例患者（2.9%）出现伤口相关问题，分布为伤口感染（3例）、血肿/血清肿（1例）和持续引流/裂开（2例）。总体而言，本研究证明使用rhBMP-2的TLIF的并发症发生率适中。虽然观察到BMP使用特有的围手术期并发症，但它们很少发生。有必要将并发症的发生率与ICBG采集相关的并发症发生率以及获得牢固关节融合术的任何不同受益进行权衡。
Bone morphogenetic protein (BMP) is commonly used as an ICBG substitute for transforaminal lumbar interbody spine fusion (TLIF). However, multiple recent reports have raised concerns regarding a substantial incidence of perioperative radiculopathy. Also, given the serious complications reported with anterior cervical BMP use, risks related to swelling and edema with TLIF need to be clarified. As TLIF related complications with rhBMP-2 have generally been reported in small series or isolated cases, without a clear denominator, actual complication rates are largely unknown. The purpose this study is to characterize perioperative complications and complication rates in a large consecutive series of TLIF procedures with rhBMP-2. We reviewed inpatient and outpatient medical records for a consecutive series of 204 patients [113 females, 91 males, mean age 49.3 (22-79) years] who underwent TLIF using rhBMP-2 between 2003 and 2007. Complications observed within a 3-month perioperative interval were categorized as to etiology and severity. Wound problems were delineated as wound infection, hematoma/seroma or persistent drainage/superficial dehiscence. Neurologic deficits and radiculopathies were analyzed to determine the presence of a clear etiology (screw misplacement) and identify any potential relationship to rhBMP-2 usage. Complications were observed in 47 of 204 patients (21.6%) during the 3-month perioperative period. Major complications occurred in 13 patients (6.4%) and minor complications in 34 patients (16.7%). New or more severe postoperative neurologic complaints were noted in 13 patients (6.4%), 6 of whom required additional surgery. These cases included one malpositioned pedicle screw and one epidural hematoma. In four patients (2.0%), localized seroma/hematoma in the area of the foramen caused neural compression, and required revision. In one additional patient, vertebral osteolysis caused foraminal narrowing and radiculopathy, but resolved without further surgery. Persistent radiculopathy without clear etiology on imaging studies was seen in six patients. Wound related problems were seen in six patients (2.9%), distributed as wound infection (3), hematoma/seroma (1) and persistent drainage/dehiscence (2). Overall, this study demonstrates a modest complication rate for TLIF using rhBMP-2. While perioperative complications which appeared specific to BMP usage were noted, they occurred infrequently. It will be necessary to weigh this incidence of complications against the complication rate associated with ICBG harvest and any differential benefit in obtaining a solid arthrodesis.