Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA.
Spine (Phila Pa 1976). 2013 Jul 15;38(16):E1020-7. doi: 10.1097/BRS.0b013e3182982f8e.
Systematic review.
The objectives of this review are to examine the spectrum of complications that have been reported in the literature after posterior interbody fusions of the lumbar spine augmented with bone morphogenetic proteins (BMPs) and discuss potential methods for their prevention.
The use of BMPs for spinal arthrodesis procedures has increased dramatically during the past decade. These products are commonly used in "off-label" fashion in posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) constructs. Recently, a number of adverse events have been attributed to the use of BMP for PLIF and TLIF surgical procedure, including heterotopic ossification within the epidural space or neuroforamina, postoperative radiculitis, and endplate osteolysis with interbody device subsidence.
A computer aided literature search was performed on the electronic databases PubMed, MEDLINE, EMBASE, CINAHL, and Cochrane Database of Systematic Reviews. Key words of interest included BMPs, PLIF, TLIF, complications, heterotopic ossification, radiculitis, and osteolysis. All articles, in the English language, between 1990 and 2011 were considered relating to the use of BMPs in PLIF and TLIF constructs.
Seventeen articles discussing the use and potential complications of BMPs in PLIF and TLIF constructs were identified and reviewed. The studies were in the range of a level I prospective randomized trial to case reports of complications. There is a wide variation of published complications associated with BMP-augmented PLIF and TLIF constructs.
Despite high fusion rates there is a growing body of evidence that the use of BMP in PLIF and TLIF constructs does not come without potential complication. There are appreciable rates of BMP-specific complications, which include heterotopic ossification within the epidural space or neuroforamina, postoperative radiculitis, and endplate osteolysis with interbody device subsidence.
系统评价。
本综述旨在检查文献中报道的在使用骨形态发生蛋白（BMPs）增强后路腰椎椎间融合术（PLIF）和经椎间孔腰椎椎间融合术（TLIF）治疗后出现的并发症谱，并讨论潜在的预防方法。
在过去十年中，BMP 用于脊柱融合术的应用显著增加。这些产品通常以“超适应证”的方式用于 PLIF 和 TLIF 构建中。最近，许多不良事件归因于 BMP 在 PLIF 和 TLIF 手术中的使用，包括硬膜外间隙或神经孔内异位骨化、术后神经根炎和椎间置器沉降导致的终板骨溶解。
使用计算机辅助文献检索在电子数据库 PubMed、MEDLINE、EMBASE、CINAHL 和 Cochrane 系统评价数据库中进行。感兴趣的关键词包括 BMPs、PLIF、TLIF、并发症、异位骨化、神经根炎和骨溶解。所有在 1990 年至 2011 年间发表的、与 BMP 在 PLIF 和 TLIF 构建中使用相关的英文文章均被认为与研究相关。
确定并回顾了 17 篇讨论 BMP 在 PLIF 和 TLIF 构建中使用和潜在并发症的文章。这些研究的范围从 I 级前瞻性随机试验到并发症的病例报告。与 BMP 增强型 PLIF 和 TLIF 构建相关的并发症发表情况差异很大。
尽管融合率很高，但越来越多的证据表明，在 PLIF 和 TLIF 构建中使用 BMP 并非没有潜在的并发症。存在相当比例的 BMP 特异性并发症，包括硬膜外间隙或神经孔内异位骨化、术后神经根炎和椎间置器沉降导致的终板骨溶解。
