Article
Long time follow up after posterior lumbar interbody fusion with bone morphogenetic protein-2
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Authors
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Christian Hohaus
- BG-Kliniken Bergmannstrost, Klinik für Neurochirurgie, Halle
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Hans Jörg Meisel
- BG-Kliniken Bergmannstrost, Klinik für Neurochirurgie, Halle
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Timothey Ganey
- Atlanta Medical Center, Department of Orthopeadic Research, Atlanta, USA
| Published: | March 21, 2014 |
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Outline
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Introduction: The use of biologic technologies for the treatment of degenerative spinal diseases is undergoing rapid clinical and scientific development. Patients with an instability in the spinal motion segment profit from stabilisation by dorsal fixation in combination with interbody fusion. BMP-2 has gained broad acceptance as an adjuvant to spinal fusion when used with interbody fusion device to improve the ossification process.
Material and methods: The clinical and surgical experience of patients treated for degenerative lumbar spine disease has been analysed retrospectively. We included 17 patients with neurological deficits causing by spinal stenosis and instability after degenerative disc disease. All patients underwent a posterior lumbar interbody fusion in combination with BMP-2 filled cages. Over the time from more than 8 years 13 patients were monitored retrospectively with clinical examination, radiographs and CT-scans.
Results: ll patients improved from the operative procedure by reduced pain relief over the follow up time. No further neurological deficits were monitored in the period. No significant adjacent level degeneration was seen in the CT scans over 8 years follow up. Additional operative procedures in lumbar spine was not necessary. Side effects of BMP-2 were not detected.
But there was clear evidence of vertebral endplate osteoclastic activity in the radiographs at 3 months in all patients. None of the patients were clinically symptomatic; events were radiographic findings. All patients showed radiographic evidence of fusion at 6 months follow up. There was no ongoing ossification after the 6 month period. Some ossification was found in the surgical approach and around the pedicle screws. Ectopic ossification was not found over the follow up period of 8 years in CT-scans.
Conclusion: The effects of BMPs seen after 3 month in the CT scans on osteoclast activity have not been widely investigated. To evaluate this phenomenon, dose dependency, osteogenic activity and associated osteoclastic activity attendant with the use of BMP-2 will be studied in a large animal model.
The good results over a long time follow up of our small group of patients received BMP 2 for spinal interbody fusion gives a suggestion that faster fusion might provide an adjacent level degeneration in lumbar spine degeneration.
