Predictive factors and rates of fusion in minimally invasive transforaminal lumbar interbody fusion utilizing rhBMP-2 or mesenchymal stem cells

Samuel C. Overley; Steven J. McAnany; Muhammad A. Anwar; Robert K. Merrill; Andrew Lovy; Javier Z. Guzman; Sergey Zhadanov; Amish Doshi; Edward Rothenberg; Avani Vaishnav; Catherine Gang; Sheeraz A. Qureshi

doi:10.14444/6007

Predictive factors and rates of fusion in minimally invasive transforaminal lumbar interbody fusion utilizing rhBMP-2 or mesenchymal stem cells

Samuel C. Overley, Steven J. McAnany, Muhammad A. Anwar, Robert K. Merrill, Andrew Lovy, Javier Z. Guzman, Sergey Zhadanov, Amish Doshi, Edward Rothenberg, Avani Vaishnav, Catherine Gang, Sheeraz A. Qureshi

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12 Scopus citations

Abstract

Background: Several fusion adjuncts exist to enhance fusion rates during minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). The objective of this study was to compare fusion rates in patients undergoing MI-TLIF with either rhBMP-2 or cellularized bone matrix (CBM). Methods: We conducted a single surgeon retrospective cohort study of patients who underwent MI-TLIF with either rhBMP-2 or CBM placed in an interbody cage. Single and multilevel procedures were included. Fusion was assessed on computed tomography scans at 12-month follow-up by an independent, blinded, board-certified neuroradiologist. Fusion rates and rate of revision surgery were compared with a Fisher exact test between the 2 groups. A multivariate regression analysis was performed to identify patient factors that were predictive of radiographic nonunion after MI-TLIF. Results: A total of 93 fusion levels in 78 patients were reviewed. Thirty-nine patients received CBM, and 39 patients received rhBMP-2. The patients receiving rhBMP-2 were older on average (61.4 vs 55.6, P = .03). The overall fusion rate was 68% in the CBM group (32/47 levels) and 78% in the rhBMP-2 group (36/46) (P = .35). Only preoperative hypertension was predictive of radiographic nonunion (odds ratio = 3.5, P = .05). There were 3 smokers in the CBM group and 4 smokers in the BMP group, and 1 in each group experienced radiographic pseudarthrosis. A total of 4 patients, 3 in the CBM group and 1 in the BMP group (P = .61), required revision for symptomatic pseudarthrosis. All of these patients had a single-level index procedure. Conclusions: There were no differences in radiographic fusion and rate of revision surgery in patients who underwent MI-TLIF with either rhBMP-2 or CBM as fusion adjuncts. Level of Evidence: 3 Clinical Relevance: Both rhBMP-2 and CBMs can be used as effective fusion adjuncts without any clear advantage of one over the other.

Original language	English
Pages (from-to)	46-52
Number of pages	7
Journal	International Journal of Spine Surgery
Volume	13
Issue number	1
DOIs	https://doi.org/10.14444/6007
State	Published - 2019

Keywords

Bone morphogenetic protein
Cellularized bone matrix
Lumbar spine fusion
Minimally invasive transforaminal lumbar interbody fusion
RhBMP-2
Stem cells
TLIF

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10.14444/6007

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Overley, S. C., McAnany, S. J., Anwar, M. A., Merrill, R. K., Lovy, A., Guzman, J. Z., Zhadanov, S., Doshi, A., Rothenberg, E., Vaishnav, A., Gang, C., & Qureshi, S. A. (2019). Predictive factors and rates of fusion in minimally invasive transforaminal lumbar interbody fusion utilizing rhBMP-2 or mesenchymal stem cells. International Journal of Spine Surgery, 13(1), 46-52. https://doi.org/10.14444/6007

@article{4e93e750088243d484fa57a25a05614d,

title = "Predictive factors and rates of fusion in minimally invasive transforaminal lumbar interbody fusion utilizing rhBMP-2 or mesenchymal stem cells",

abstract = "Background: Several fusion adjuncts exist to enhance fusion rates during minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). The objective of this study was to compare fusion rates in patients undergoing MI-TLIF with either rhBMP-2 or cellularized bone matrix (CBM). Methods: We conducted a single surgeon retrospective cohort study of patients who underwent MI-TLIF with either rhBMP-2 or CBM placed in an interbody cage. Single and multilevel procedures were included. Fusion was assessed on computed tomography scans at 12-month follow-up by an independent, blinded, board-certified neuroradiologist. Fusion rates and rate of revision surgery were compared with a Fisher exact test between the 2 groups. A multivariate regression analysis was performed to identify patient factors that were predictive of radiographic nonunion after MI-TLIF. Results: A total of 93 fusion levels in 78 patients were reviewed. Thirty-nine patients received CBM, and 39 patients received rhBMP-2. The patients receiving rhBMP-2 were older on average (61.4 vs 55.6, P = .03). The overall fusion rate was 68% in the CBM group (32/47 levels) and 78% in the rhBMP-2 group (36/46) (P = .35). Only preoperative hypertension was predictive of radiographic nonunion (odds ratio = 3.5, P = .05). There were 3 smokers in the CBM group and 4 smokers in the BMP group, and 1 in each group experienced radiographic pseudarthrosis. A total of 4 patients, 3 in the CBM group and 1 in the BMP group (P = .61), required revision for symptomatic pseudarthrosis. All of these patients had a single-level index procedure. Conclusions: There were no differences in radiographic fusion and rate of revision surgery in patients who underwent MI-TLIF with either rhBMP-2 or CBM as fusion adjuncts. Level of Evidence: 3 Clinical Relevance: Both rhBMP-2 and CBMs can be used as effective fusion adjuncts without any clear advantage of one over the other.",

keywords = "Bone morphogenetic protein, Cellularized bone matrix, Lumbar spine fusion, Minimally invasive transforaminal lumbar interbody fusion, RhBMP-2, Stem cells, TLIF",

author = "Overley, {Samuel C.} and McAnany, {Steven J.} and Anwar, {Muhammad A.} and Merrill, {Robert K.} and Andrew Lovy and Guzman, {Javier Z.} and Sergey Zhadanov and Amish Doshi and Edward Rothenberg and Avani Vaishnav and Catherine Gang and Qureshi, {Sheeraz A.}",

note = "Publisher Copyright: {\textcopyright}International Society for the Advancement of Spine Surgery.",

year = "2019",

doi = "10.14444/6007",

language = "English",

volume = "13",

pages = "46--52",

journal = "International Journal of Spine Surgery",

issn = "2211-4599",

publisher = "Elsevier USA",

number = "1",

}

Overley, SC, McAnany, SJ, Anwar, MA, Merrill, RK, Lovy, A, Guzman, JZ, Zhadanov, S, Doshi, A, Rothenberg, E, Vaishnav, A, Gang, C & Qureshi, SA 2019, 'Predictive factors and rates of fusion in minimally invasive transforaminal lumbar interbody fusion utilizing rhBMP-2 or mesenchymal stem cells', International Journal of Spine Surgery, vol. 13, no. 1, pp. 46-52. https://doi.org/10.14444/6007

TY - JOUR

T1 - Predictive factors and rates of fusion in minimally invasive transforaminal lumbar interbody fusion utilizing rhBMP-2 or mesenchymal stem cells

AU - Overley, Samuel C.

AU - McAnany, Steven J.

AU - Anwar, Muhammad A.

AU - Merrill, Robert K.

AU - Lovy, Andrew

AU - Guzman, Javier Z.

AU - Zhadanov, Sergey

AU - Doshi, Amish

AU - Rothenberg, Edward

AU - Vaishnav, Avani

AU - Gang, Catherine

AU - Qureshi, Sheeraz A.

N1 - Publisher Copyright: ©International Society for the Advancement of Spine Surgery.

PY - 2019

Y1 - 2019

N2 - Background: Several fusion adjuncts exist to enhance fusion rates during minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). The objective of this study was to compare fusion rates in patients undergoing MI-TLIF with either rhBMP-2 or cellularized bone matrix (CBM). Methods: We conducted a single surgeon retrospective cohort study of patients who underwent MI-TLIF with either rhBMP-2 or CBM placed in an interbody cage. Single and multilevel procedures were included. Fusion was assessed on computed tomography scans at 12-month follow-up by an independent, blinded, board-certified neuroradiologist. Fusion rates and rate of revision surgery were compared with a Fisher exact test between the 2 groups. A multivariate regression analysis was performed to identify patient factors that were predictive of radiographic nonunion after MI-TLIF. Results: A total of 93 fusion levels in 78 patients were reviewed. Thirty-nine patients received CBM, and 39 patients received rhBMP-2. The patients receiving rhBMP-2 were older on average (61.4 vs 55.6, P = .03). The overall fusion rate was 68% in the CBM group (32/47 levels) and 78% in the rhBMP-2 group (36/46) (P = .35). Only preoperative hypertension was predictive of radiographic nonunion (odds ratio = 3.5, P = .05). There were 3 smokers in the CBM group and 4 smokers in the BMP group, and 1 in each group experienced radiographic pseudarthrosis. A total of 4 patients, 3 in the CBM group and 1 in the BMP group (P = .61), required revision for symptomatic pseudarthrosis. All of these patients had a single-level index procedure. Conclusions: There were no differences in radiographic fusion and rate of revision surgery in patients who underwent MI-TLIF with either rhBMP-2 or CBM as fusion adjuncts. Level of Evidence: 3 Clinical Relevance: Both rhBMP-2 and CBMs can be used as effective fusion adjuncts without any clear advantage of one over the other.

AB - Background: Several fusion adjuncts exist to enhance fusion rates during minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). The objective of this study was to compare fusion rates in patients undergoing MI-TLIF with either rhBMP-2 or cellularized bone matrix (CBM). Methods: We conducted a single surgeon retrospective cohort study of patients who underwent MI-TLIF with either rhBMP-2 or CBM placed in an interbody cage. Single and multilevel procedures were included. Fusion was assessed on computed tomography scans at 12-month follow-up by an independent, blinded, board-certified neuroradiologist. Fusion rates and rate of revision surgery were compared with a Fisher exact test between the 2 groups. A multivariate regression analysis was performed to identify patient factors that were predictive of radiographic nonunion after MI-TLIF. Results: A total of 93 fusion levels in 78 patients were reviewed. Thirty-nine patients received CBM, and 39 patients received rhBMP-2. The patients receiving rhBMP-2 were older on average (61.4 vs 55.6, P = .03). The overall fusion rate was 68% in the CBM group (32/47 levels) and 78% in the rhBMP-2 group (36/46) (P = .35). Only preoperative hypertension was predictive of radiographic nonunion (odds ratio = 3.5, P = .05). There were 3 smokers in the CBM group and 4 smokers in the BMP group, and 1 in each group experienced radiographic pseudarthrosis. A total of 4 patients, 3 in the CBM group and 1 in the BMP group (P = .61), required revision for symptomatic pseudarthrosis. All of these patients had a single-level index procedure. Conclusions: There were no differences in radiographic fusion and rate of revision surgery in patients who underwent MI-TLIF with either rhBMP-2 or CBM as fusion adjuncts. Level of Evidence: 3 Clinical Relevance: Both rhBMP-2 and CBMs can be used as effective fusion adjuncts without any clear advantage of one over the other.

KW - Bone morphogenetic protein

KW - Cellularized bone matrix

KW - Lumbar spine fusion

KW - Minimally invasive transforaminal lumbar interbody fusion

KW - RhBMP-2

KW - Stem cells

KW - TLIF

UR - http://www.scopus.com/inward/record.url?scp=85067298828&partnerID=8YFLogxK

U2 - 10.14444/6007

DO - 10.14444/6007

M3 - Article

AN - SCOPUS:85067298828

SN - 2211-4599

VL - 13

SP - 46

EP - 52

JO - International Journal of Spine Surgery

JF - International Journal of Spine Surgery

IS - 1

ER -

Predictive factors and rates of fusion in minimally invasive transforaminal lumbar interbody fusion utilizing rhBMP-2 or mesenchymal stem cells

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Keywords

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