Joseph Vivek, Rampersaud Yoga Raja
Divisions of Orthopedic Surgery, Krembil Neuroscience Centre, University Health Network, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
Spine (Phila Pa 1976). 2007 Dec 1;32(25):2885-90. doi: 10.1097/BRS.0b013e31815b7596.
Observational study with prospective CT analysis.
To assess the incidence and clinical sequelae of epidural bone formation following the adjunctive use of recombinant bone morphogenetic protein 2 (rhBMP2) with local autogenous bone graft use of (rhBMP2) in minimal access interbody (PLIF and TLIF) fusions.
The use of rhBMP2 for interbody fusion is associated with high fusion rates. However, for posterior approaches, concerns regarding heterotopic bone formation within the epidural space have been raised.
An independent CT analysis of 33 consecutive patients following minimal access lumbar fusion (PLIF [n = 10] or TLIF [n = 23]) with [n = 23] and without [n = 10] rhBMP2 was performed. Bone formation was graded in a centrifugal manner (intradiscal, anular/ALL/PLL, epidural [canal/foramen] and beyond the spine). In all BMP cases, a constant dose of 4.2 mg/disc level was administered (lowest commercially available dose). In all cases, local autograft was used. Review and assessment of prospectively collected outcomes data were performed.
Average clinical and CT (minimum 6 months) follow-up was 25.0 and 7.9 months, respectively. Bridging bone (fusion) was seen in 100% of the BMP group and 90% without BMP. Epidural bone formation occurred in 20.8% with the use of BMP (5 levels: n = 1 spinal canal and n = 4 within the foramen) compared with 8.3% (1 level: canal) without BMP. Foraminal bone formation was seen only in the TLIF group. All epidural bone formation was heterotopic, and no ectopic bone formation occurred. There were no clinical sequelae associated with heterotopic bone formation. The mean preoperative and postoperative Oswestry Disability Index was 50.2% (range, 25%-75%) and 11.3% (range, 0%-38%) respectively.
Although the adjunctive use of rhBMP2 is associated with a higher incidence of heterotopic bone, there does not seem to be any associated clinical sequelae.
采用前瞻性CT分析的观察性研究。
评估在微创椎间融合术（后路腰椎椎间融合术和经椎间孔腰椎椎间融合术）中联合使用重组骨形态发生蛋白2（rhBMP2）与局部自体骨移植后硬膜外骨形成的发生率及临床后遗症。
rhBMP2用于椎间融合术可获得较高的融合率。然而，对于后路手术，人们对硬膜外间隙内异位骨形成的问题表示担忧。
对33例连续接受微创腰椎融合术（后路腰椎椎间融合术[n = 10]或经椎间孔腰椎椎间融合术[n = 23]）的患者进行独立的CT分析，其中23例使用rhBMP2，10例未使用。骨形成按离心方式分级（椎间盘内、纤维环/前纵韧带/后纵韧带、硬膜外[椎管/椎间孔]及脊柱外）。在所有使用BMP的病例中，均给予4.2 mg/节段的固定剂量（市售最低剂量）。所有病例均使用局部自体骨移植。对前瞻性收集的结果数据进行回顾和评估。
平均临床随访和CT随访（至少6个月）分别为25.0个月和7.9个月。BMP组100%出现骨桥形成（融合），未使用BMP组为90%。使用BMP时硬膜外骨形成发生率为20.8%（5个节段：1个椎管内，4个椎间孔内），未使用BMP时为8.3%（1个节段：椎管内）。椎间孔骨形成仅见于经椎间孔腰椎椎间融合术组。所有硬膜外骨形成均为异位性，未发生异位骨形成。异位骨形成未产生临床后遗症。术前和术后Oswestry功能障碍指数平均分别为50.2%（范围25% - 75%）和11.3%（范围0% - 38%）。
虽然联合使用rhBMP2会导致异位骨形成的发生率较高，但似乎并未产生任何相关的临床后遗症。
