Evaluation of Heterotopic Ossification After Using Recombinant Human Bone Morphogenetic Protein-2 in Transforaminal Lumbar Interbody Fusion: A Computed Tomography Review of 996 Disc Levels

• Type of Material: Article
• Authors: Shuo Niu, Emory University; Albert T. Anastasio, Emory University; Razan R. Faraj, Emory University; John Rhee, Emory University
• Language: English
• Date: 2019-05-01
• Publisher: SAGE Publications Ltd.
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2019.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1177/2192568219846074
• Title of Journal or Parent Work: Global Spine Journal
• Volume: 10
• Issue: 3
• Start Page: 280
• End Page: 285
• Grant/Funding Information: The author(s) received no financial support for the research, authorship, and/or publication of this article.
• Keywords: recombinant human bone morphogenetic protein-2; Ectopic bone; Complications; Life Sciences & Biomedicine; Off-label use; Clinical Neurology; Orthopedics; Neurosciences & Neurology; complications; Spine; Science & Technology; transforaminal lumbar interbody fusion; heterotopic ossification
• Research Categories: Engineering, Biomedical; Biology, Neuroscience; Health Sciences, Medicine and Surgery

Abstract

Study Design: Retrospective cohort study. Objectives: Reported incidences and complications of heterotopic ossification (HO) after using recombinant human bone morphogenetic protein–2 (rhBMP-2) in transforaminal lumbar interbody fusion (TLIF) have been inconclusive. This study was designed to evaluate both incidences of radiologic and symptomatic HO in a large series of TLIFs using rhBMP-2. Methods: A total of 996 disc levels in 927 consecutive TLIF patients were retrospectively evaluated at 6-month postoperative follow-up in a single surgical practice. Subjects were separated into the BMP group and the control group. Operative reports, pre- and postoperative medical records were reviewed. Computed tomography (CT) scans were analyzed and graded independently for ossification at each disc level of TLIF. Results: A total of 933 disc levels were in the BMP group, and 63 were in the control group. Six-month fusion rate of interbody was 92.5% in the BMP group, which was significantly higher in contrast to 71.4% in the control group (P <.001). The incidence of radiologic HO in the BMP group was 13.5%, which was significantly higher than 1.6% in the control group (P =.006). After controlling for basic demographics and comorbidities, the presence of radiologic HO was significantly associated with the use of rhBMP-2 (P =.026). However, only one case in the BMP group (0.11%) developed a symptomatic HO (mild-medium left buttock pain, treated nonsurgically) involving left foramen of L5-S1. Conclusions: rhBMP-2 can be safely used in TLIF with regard to HO. There was a low rate of radiologic HO and minimal symptomatic HO, with high fusion rates at 6 months postoperative.