Evaluations of minimally invasive transforaminal lumbar interbody fusion performed with rhBMP-2
[post]
2019
unpublished
The combination of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and recombinant human bone morphogenetic protein 2 (rhBMP-2) is widely used for its advantage of rapid recovery and improved bone fusion. However, no previous study has reported the synergistic effect of MIS-TLIF with rhBMP-2 in patients with degenerative lumbar disease (DLD). Objective: To investigate the radiographic and patient-reported outcomes (PROs) in patients with DLD who underwent MIS-TLIF with and
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... ithout a low dose of rhBMP-2. Methods: We retrospectively reviewed 48 patients treated with MIS-TLIF from 2013 to 2016. The patients were classified into the rhBMP-2 group (n = 25) and non-rhBMP-2 group (n = 23). Fusion-related parameters were measured before and after the operation. Clinical data included the numeric rating scale (NRS) score, Japanese Orthopedic Association (JOA) scores, and the MOS 36-item short form health survey (SF-36) score, which were documented to evaluate the effect of surgery. Results: In the 48 patients who underwent MIS-TLIF, the operated disc was predominantly at the L4/5 and L5/S1 levels. ADH, MDH, and PDH increased significantly in both groups after surgery (P < 0.05). FH improved in the rhBMP-2 group, but not in the non-rhBMP-2 group. There was no obvious improvement in SA in both groups. Furthermore, the SL showed a significant difference in both groups and a significant improvement over the baseline. The LL showed significant improvement in the two groups at the early follow-up (P < 0.05), but the improvement did not persist. Cage subsidence had no significant effect on different subsidence grades. In addition, no differences in cage subsidence were observed in different types of modic change (MC), except for MC 0 in both groups. There was no difference in PROs even though all clinical outcomes improved significantly during the postoperative follow-up period in both groups. Conclusion: MIS-TLIF with the low doses of rhBMP-2 resulted in an improvement in radiographic and clinical results, but not a longer-Jang et al. suggested that there is a relationship between sagittal parameters, cage subsidence, and clinical outcomes in degenerative cervical disease.[9] However, the radiographic sagittal parameters of MIS-TLIF performed with and without rhBMP-2 in the disk space have not been fully evaluated. In the current study, we reviewed our experience with MIS-TLIF to elucidate the effect of rhBMP on the sagittal parameters, cage subsidence, and MC of the operated segment. We aim to explore potential relationships between use of rhBMP-2 and improvement in radiologic parameters and clinical outcomes. Further, possible correlations of these parameters were investigated. Methods This study identified 48 patients who had complaints of low back pain or neurologic symptoms. Data for age, gender, and operated level were collected from inpatient medical records. Single or two-level MIS-TLIF procedures were performed on all patients from March 2013 to February 2016. This protocol was approved by the ethics committee of the Affiliated People's Hospital with Jiangsu University. All patients gave written informed consent for their information to be stored in the hospital database and used for research. This study was conducted according to the principles expressed in the Declaration ofHelsinki. Our exclusion criteria were as follows: spinal fracture, lumbar infection and tumor, prior history of lumbar surgery, and MIS-TLIF operated on levels above the lumbar spine. A total of 25 patients received additional rhBMP-2 treatment (rhBMP-2 group), while 27 patients did not receive rhBMP-2 treatment (non-rhBMP-2 group). We collected clinical data from inpatient medical records, pre-and postoperative plain radiographs, and postoperative CT or MR images. All patients were contacted by cellphone to collect missing information. Demographics and procedure data listed in Table 1 were recorded prospectively for both groups. * Statistically significant among groups. † Values are presented as means ± SD.
doi:10.21203/rs.2.12544/v1
fatcat:3gxr42d2f5ahjlgwlbu3cso2du