Ahn Junyoung, Tabaraee Ehsan, Singh Kern
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
J Spinal Disord Tech. 2015 Jun;28(5):186-8. doi: 10.1097/BSD.0000000000000282.
Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has become a popular alternative to traditional methods of lumbar decompression and fusion. When compared with the open technique, the minimally invasive approach can result in decreased pain and blood loss as well as a shorter length of hospitalization. However, the narrower working channel through the tubular retractor increases the difficulty of decortication and bone grafting. Therefore, recombinant human bone morphogenetic proteins (rhBMP-2) is often utilized (although this is off-label) to create a more favorable interbody fusion environment. Recently, the use of rhBMP-2 has been associated with excessive bone growth in an MIS-TLIF. If this bone growth compresses the neighboring neural structures, patients may present with either new or recurrent radicular pain. Computed tomographic (CT) imaging can demonstrate heterotopic bone growth extending from the disk space into either the ipsilateral neuroforamen or lateral recess, which may result in the compression of the exiting or traversing root, respectively. The purpose of this article and the accompanying video is to demonstrate a technique for defining and resecting rhBMP-2-induced heterotopic bone growth following a previous MIS-TLIF.
微创经椎间孔腰椎椎间融合术（MIS-TLIF）已成为传统腰椎减压融合术的一种流行替代方法。与开放技术相比，微创方法可减少疼痛和失血，并缩短住院时间。然而，通过管状牵开器的工作通道变窄增加了去皮质和植骨的难度。因此，重组人骨形态发生蛋白（rhBMP-2）常被用于（尽管这属于超适应症使用）创造更有利的椎间融合环境。最近，rhBMP-2的使用与MIS-TLIF中过度的骨生长有关。如果这种骨生长压迫相邻神经结构，患者可能会出现新的或复发性神经根性疼痛。计算机断层扫描（CT）成像可显示异位骨生长从椎间盘间隙延伸至同侧神经孔或侧隐窝，这可能分别导致出口神经根或走行神经根受压。本文及随附视频的目的是展示一种用于界定和切除先前MIS-TLIF术后rhBMP-2诱导的异位骨生长的技术。
