Artikel
rhBMP-2 in lumbar interbody fusion – balancing bone resorption and overzealous bone growth seems to bea question of concentration in the sheep lumbar fusion model
Suche in Medline nach
Autoren
-
Christian Hohaus
- Städtisches Klinikum Dessau, Klinik für Neurochirurgie, Dessau, Deutschland; BG Klinikum Bergmannstrost, Klinik für Neurochirurgie, Halle, Deutschland
-
Gerlinde Susanne Heil
- BG Klinikum Bergmannstrost, Klinik für Neurochirurgie, Halle, Deutschland; Inselspital, Universitätsspital Bern, Abteilung für Plastische und Handchirurgie, Bern, Schweiz
-
Hans Jörg Meisel
- BG Klinikum Bergmannstrost, Klinik für Neurochirurgie, Halle, Deutschland
| Veröffentlicht: | 18. Juni 2018 |
|---|
Gliederung
Text
Objective: Is there a dose- and/or concentration-dependent effect of rhBMP-2 on bone resorption and overzealous bone growth in anterior lumbar interbody fusion (ALIF)?
Methods: Thirty-six Merino sheep underwent right-anterior lumbar interbody fusion at L1-L2 and L3-L4 with the addition of a polyetheretherketone (PEEK) cage either filled with one of four different concentrations/doses of rhBMP-2 (interventional groups: 4.0 mg/ml, total dose of 4.0 mg; 2.0 mg/ml, total dose of 2.0 mg; 1.0 mg/ml, total dose of 1.0 mg; 0.5 mg/ml, total dose of 0.5 mg) or in the control group filled with an absorbable collagen sponge (ACS) or left empty. A pedicle-screw system was implanted in all surgical levels. Thin-cut CT image were taken directly postoperatively, after 3 months, 6 months and 12 months to assess bone resorption, cage subsidence and migration (indirect marker of bone resorption), and overzealous bone growth.
Results: In comparison with the control group, rhBMP-2 groups showed a higher fusion rate at 3 (72% vs. 13%), 6 (90% vs. 30%) and 12 (95% vs. 70%) months CT scans. Overzealous bone growth was detected at the right ventral circumference of the vertebral body as sign of the direct operative access. No ectope ossification was detected in all groups. The incidence of bone resorption as well as cage migration and cage subsidence as indirect marker of bone resorption were higher in the BMP-2 groups.
However, no clear dose-concentration-dependency of these adverse effects could be established. The side effects were less in the BMP-2 group treated with 0.5mg rhBMP-2.
Conclusion: In this animal model the application of rhBMP-2 in different concentrations/doses showed much better fusion rates compared with the control group. These results could be shown in the 0.5mg BMP-2 group with clear reduction of adverse effects. Higher doses of BMP-2 doesn’t cause a benefit in fusion rate but an increase in side effects like cage migration and subsidence as maker of higher bone resorption.
No inflammation reaction or systemic side effects were detected in the BMP-2 group.
