Lewandrowski Kai-Uwe, Nanson Christopher, Calderon Robert
Center for Advanced Spinal Surgery, 3395 N Campbell Avenue, Tucson, AZ 85719, USA.
Spine J. 2007 Sep-Oct;7(5):609-14. doi: 10.1016/j.spinee.2007.01.011. Epub 2007 May 7.
Recombinant human bone morphogenetic protein 2 (rh-BMP-2) is frequently used in an off-label fashion. Its application for posterior interbody fusion appears intuitive because its use obviates the need for iliac crest bone graft and shows higher fusion rates than with the use of local autologous bone graft. To date, there is no report of adverse outcomes with such use of rh-BMP-2.
To draw attention to this unusual complication of posterior interbody lumbar fusion and to review the relevant literature.
Clinical report of five cases of vertebral osteolysis that developed postoperatively from lumbar transforaminal interbody fusion of the L5/S1 motion segment using cages and rh-BMP-2.
Sixty-eight patients underwent transforaminal lumbar interbody fusion for spondylolisthesis or degenerative disc disease with discogenic back pain. Five of these 68 patients developed vertebral osteolysis within 4 months from their surgery. Their clinical presentation and radiographic findings are presented in this case series.
Each one of these five patients had uneventful surgery and postoperative recovery. Their back and leg pain improved in the immediate postoperative period. However, each patient reported worsening back pain with variable radicular pain as early as 4 weeks and as late as 3 months after the index procedure. Diagnostic workup revealed evidence of vertebral osteolysis typically involving the L5 vertebral body. In all five patients, osteolytic defects filled in spontaneously, and symptoms typically resolved within an additional 3 months of nonoperative care.
Vertebral osteolysis can occur with the use of rh-BMP-2 in posterior lumbar interbody fusions. Violation of the end plate during decortication may be a contributing factor. Symptoms often resolve spontaneously.
重组人骨形态发生蛋白2（rh - BMP - 2）经常被超适应证使用。其用于后路椎间融合术似乎是合理的，因为使用它无需髂嵴骨移植，并且与使用局部自体骨移植相比显示出更高的融合率。迄今为止，尚无关于rh - BMP - 2这种使用方式出现不良后果的报道。
引起对腰椎后路椎间融合术这种不寻常并发症的关注并回顾相关文献。
关于5例椎体骨质溶解病例的临床报告，这些病例是在L5/S1运动节段使用椎间融合器和rh - BMP - 2进行腰椎经椎间孔椎间融合术后发生的。
68例患者因腰椎滑脱或退行性椎间盘疾病伴椎间盘源性背痛接受了经椎间孔腰椎椎间融合术。这68例患者中有5例在术后4个月内发生了椎体骨质溶解。本病例系列展示了他们的临床表现和影像学检查结果。
这5例患者中的每一例手术及术后恢复均顺利。他们的腰腿痛在术后即刻有所改善。然而，每例患者均报告在初次手术后最早4周、最晚3个月出现腰背痛加重，并伴有不同程度的神经根性疼痛。诊断性检查发现了椎体骨质溶解的证据，通常累及L5椎体。在所有5例患者中，骨质溶解缺损均自行填充，并且症状通常在另外3个月的非手术治疗后得到缓解。
在腰椎后路椎间融合术中使用rh - BMP - 2可能会发生椎体骨质溶解。去皮质过程中终板受损可能是一个促成因素。症状通常会自行缓解。
