Nabizadeh Naveed, Glassman Steven D, Djurasovic Mladen, Crawford Charles H, Gum Jeffrey L, Carreon Leah
Orthopaedics, Norton Leatherman Spine Center, Norton Healthcare, Louisville, USA.
Orthopaedic Surgery, University of Louisville, Louisville, USA.
Cureus. 2021 Sep 17;13(9):e18055. doi: 10.7759/cureus.18055. eCollection 2021 Sep.
Background In 2011, studies suggested that complications and cancer rates associated with bone morphogenetic protein (BMP) were greater than previously reported. However, later studies reported complication rates similar to prior literature and no increased cancer rate. We evaluated the pattern of clinical utilization of BMP in posteriorly based lumbar fusion by comparing two periods: 2002-2004 and 2017-2019. Methods Patients who received BMP from 2002-2004 (Early) and 2017-2019 (Late) from a single multi-surgeon institution who had a lumbar fusion were identified. One hundred patients from each cohort were randomly selected. Mean total BMP used at each level and the proportion of BMP placed in the interbody space versus posterolateral gutters were evaluated. Results In the transforaminal lumbar intebody fusion (TLIF) cohort, the total BMP dose in the Late group (6.15 mg) was nearly half of that used in the Early group (12.04 mg, p<0.000). The amount of BMP used in the posterolateral gutters remained similar (Early: 4.01 mg vs Late: 3.38 mg, p=0.222). The amount of BMP used in the interbody space was less in the Late group (2.76 mg) compared to the Early group (8.03 mg, p<0.000). In the posterior spinal fusion (PSF) cohort, the total BMP dose remained similar between the Early (11.96 mg) and the Late groups (10.82 mg, p=0.007). Conclusion Change in the use of BMP in TLIF cases was driven by the complications reported in the literature with no change in outcome. A similar impetus was not seen for PSF.
背景 2011 年，有研究表明与骨形态发生蛋白（BMP）相关的并发症和癌症发生率高于先前报道。然而，后来的研究报告的并发症发生率与先前文献相似，且癌症发生率并未增加。我们通过比较两个时期（2002 - 2004 年和 2017 - 2019 年）来评估 BMP 在腰椎后路融合术中的临床应用模式。方法 确定在一个多外科医生机构中于 2002 - 2004 年（早期）和 2017 - 2019 年（晚期）接受 BMP 进行腰椎融合的患者。从每个队列中随机选择 100 名患者。评估每个节段使用的 BMP 总量以及置于椎间间隙与后外侧沟中的 BMP 比例。结果 在经椎间孔腰椎椎间融合术（TLIF）队列中，晚期组（6.15 毫克）的 BMP 总剂量几乎是早期组（12.04 毫克，p<0.000）的一半。后外侧沟中使用的 BMP 量保持相似（早期：4.01 毫克 vs 晚期：3.38 毫克，p = 0.222）。与早期组（8.03 毫克，p<0.000）相比，晚期组在椎间间隙中使用的 BMP 量较少（2.76 毫克）。在后路脊柱融合术（PSF）队列中，早期组（11.96 毫克）和晚期组（10.82 毫克，p = 0.007）的 BMP 总剂量保持相似。结论 TLIF 病例中 BMP 使用的变化是由文献报道的并发症驱动的，而结果没有变化。PSF 则未看到类似的推动因素。
