School of Medicine, Kansas City University, Kansas City, Missouri, USA.
Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
World Neurosurg. 2021 Dec;156:e64-e71. doi: 10.1016/j.wneu.2021.08.142. Epub 2021 Sep 13.
Bone morphogenetic protein (BMP) is a growth factor that aids in osteoinduction and promotes bone fusion. There is a lack of literature regarding recombinant human BMP-2 (rhBMP-2) dosage in different spine surgeries. This study aims to investigate the trends in rhBMP-2 dosage and the associated complications in spinal arthrodesis.
A retrospective study was conducted investigating spinal arthrodesis using rhBMP-2. Variables including age, procedure type, rhBMP-2 size, complications, and postoperative imaging were collected. Cases were grouped into the following surgical procedures: anterior lumbar interbody fusion/extreme lateral interbody fusion (ALIF/XLIF), posterior lumbar interbody fusion/transforaminal lumbar interbody fusion (PLIF/TLIF), posterolateral fusion (PLF), anterior cervical discectomy and fusion (ACDF), and posterior cervical fusion (PCF).
A total of 1209 patients who received rhBMP-2 from 2006 to 2020 were studied. Of these, 230 were categorized as ALIF/XLIF, 336 as PLIF/TLIF, 243 as PLF, 203 as ACDF, and 197 as PCF. PCF (P < 0.001), PLIF/TLIF (P < 0.001), and PLF (P < 0.001) demonstrated a significant decrease in the rhBMP-2 dose used per level, with major transitions seen in 2018, 2011, and 2013, respectively. In our sample, 129 complications following spinal arthrodesis were noted. A significant relation between rhBMP-2 size and complication rates (χ= 73.73, P = 0.0029) was noted. rhBMP-2 dosage per level was a predictor of complication following spinal arthrodesis (odds ratio = 1.302 [1.05-1.55], P < 0.001).
BMP is an effective compound in fusing adjacent spine segments. However, it carries some regional complications. We demonstrate a decreasing trend in the dose/vertebral level. A decrease rhBMP-2 dose per level correlated with a decrease in complication rates.
骨形态发生蛋白（BMP）是一种生长因子，有助于成骨诱导并促进骨融合。关于不同脊柱手术中重组人 BMP-2（rhBMP-2）的剂量，文献较少。本研究旨在调查脊柱融合术中 rhBMP-2 剂量的趋势及其相关并发症。
回顾性研究使用 rhBMP-2 进行脊柱融合术。收集的变量包括年龄、手术类型、rhBMP-2 大小、并发症和术后影像学检查。病例分为以下手术程序：前路腰椎椎间融合/极外侧椎间融合术（ALIF/XLIF）、后路腰椎椎间融合/经椎间孔腰椎椎间融合术（PLIF/TLIF）、后外侧融合术（PLF）、前路颈椎间盘切除术和融合术（ACDF）和后路颈椎融合术（PCF）。
共研究了 2006 年至 2020 年间接受 rhBMP-2 治疗的 1209 名患者。其中，230 例归入 ALIF/XLIF 组，336 例归入 PLIF/TLIF 组，243 例归入 PLF 组，203 例归入 ACDF 组，197 例归入 PCF 组。PCF（P<0.001）、PLIF/TLIF（P<0.001）和 PLF（P<0.001）的每节段使用的 rhBMP-2 剂量显著降低，分别于 2018 年、2011 年和 2013 年出现主要转变。在我们的样本中，注意到脊柱融合术后有 129 种并发症。rhBMP-2 大小与并发症发生率之间存在显著关系（χ=73.73，P=0.0029）。rhBMP-2 每节段的剂量是脊柱融合术后并发症的预测因素（优势比=1.302[1.05-1.55]，P<0.001）。
BMP 是一种有效的融合相邻脊柱节段的化合物。然而，它会引起一些区域性并发症。我们发现剂量/椎体水平呈下降趋势。rhBMP-2 剂量的减少与并发症发生率的降低相关。
