Division of Neurosurgery, Department of Surgery, Armed Forces Kaohsiung General Hospital, Kaohsiung, Taiwan.
J Neurosurg Spine. 2010 Jan;12(1):40-6. doi: 10.3171/2009.4.SPINE0876.
Recombinant human bone morphogenetic protein-2 (rhBMP-2) has been approved for use in the lumbar spine in conjunction with the lumbar tapered cage. However, off-label use of this osteoinductive agent is observed with anterior fusion applications as well as with both posterior lumbar interbody fusion and transforaminal lumbar interbody fusion (TLIF). Complications using rhBMP-2 in the cervical spine have been reported. Although radiographic evidence of ectopic bone in the lumbar spine has been described following rhBMP-2 use, this finding was not previously believed to be of clinical relevance.
This study was a retrospective review of 4 patients who underwent minimally invasive spinal TLIF (MIS-TLIF) in which bone fusion was augmented with rhBMP-2 applied to an absorbable collagen sponge. Case presentations, operative findings, imaging data, and follow-up findings were reviewed.
Four cases with delayed symptomatic neural compression following the off-label use of rhBMP-2 with MIS-TLIF were identified.
Although previously believed to be only a radiographic finding, the development of ectopic bone following rhBMP-2 use in lumbar fusion can be clinically significant. This paper describes 4 cases of delayed neural compression following MIS-TLIF. The reader should be aware of this potential complication following the off-label use of rhBMP-2 in the lumbar spine.
重组人骨形态发生蛋白-2（rhBMP-2）已获准与腰椎锥形融合笼一起用于腰椎。然而，这种具有成骨作用的药物也被用于前融合应用，以及后路腰椎间融合术（PLIF）和经椎间孔腰椎间融合术（TLIF）。颈椎使用 rhBMP-2 已报道有并发症。尽管在使用 rhBMP-2 后腰椎的异位骨的放射学证据已经描述过，但之前认为这种发现与临床无关。
这是一项对 4 名接受微创经椎间孔腰椎间融合术（MIS-TLIF）的患者进行的回顾性研究，在该手术中，rhBMP-2 被应用于可吸收胶原海绵以增强骨融合。对病例介绍、手术发现、影像学数据和随访发现进行了回顾。
在非适应证使用 rhBMP-2 联合 MIS-TLIF 后，发现了 4 例迟发性症状性神经压迫病例。
尽管之前认为只是一种放射学发现，但 rhBMP-2 用于腰椎融合后异位骨的形成可能具有临床意义。本文描述了 4 例在 MIS-TLIF 后发生迟发性神经压迫的病例。读者应该意识到在腰椎非适应证使用 rhBMP-2 后可能会出现这种潜在并发症。
