ABSTRACT
OBJECTIVE@#To investigate the effect of modified alternate negative pressure drainage on postoperative outcomes after posterior lumbar interbody fusion (PLIF) surgery.@*METHODS@#This was a prospective study involving 84 patients who underwent PLIF surgery between January 2019 and June 2020. Of these patients, 22 had single-segment surgery and 62 had two-segment surgery. Patients were grouped by surgical segment and admission sequence:the observation group included patients with a single-segment surgery, and the control group included patients with a two-segment surgery. Natural pressure drainage was given to 42 patients in the observation group (modified alternate negative pressure drainage group) after surgery, which was then changed to negative pressure drainage after 24 hours. In the control group, 42 patients were given negative pressure drainage after surgery, which was then changed to natural pressure drainage after 24 hours. The total drainage volume, drainage time, maximum body temperature at 24 hours and 1 week after surgery, and drainage-related complications were observed and compared between the two groups.@*RESULTS@#There was no significant difference in operative time and intraoperative blood loss between the two groups. The postoperative total drainage volume was significantly lower in the observation group (456.69±124.50) ml than in control group (572.36±117.75) ml, and the drainage time was significantly shorter in the observation group (4.95±1.31) days than in the control group (4.00±1.17) days. Maximum body temperature at 24 hours after surgery was similar in both groups (37.09±0.31)°C in the observation group and (37.03±0.33)°C in the control group, while on the 1st week after surgery, it was slightly higher in the observation group (37.05±0.32)°C than in the control group (36.94±0.33)°C, but the difference was not significant. There were no significant differences in drainage-related complications, with one case(2.38%) of superficial wound infection in the observation group and two cases(4.76%) in control group.@*CONCLUSION@#Modified alternate negative pressure drainage after posterior lumbar fusion can reduce the drainage volume and shorten the drainage time without increasing the risk of drainage-related complications.
Subject(s)
Humans , Retrospective Studies , Prospective Studies , Spinal Fusion , Lumbar Vertebrae/surgery , Drainage , Treatment OutcomeABSTRACT
Objective:To analyze the postoperative paravertebral muscle degeneration and its correlations with health related quality of life (HRQL) in patients undergoing minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF).Methods:The clinical data of the 50 patients were retrospectively analyzed who had undergone single-segmental MIS-TLIF at Department of Spinal Cord Surgery, The People's Hospital of Henan Province from January 2019 to December 2021. The relative volumes of lumbar posterior muscle (LM), the relative volumes of the psoas major (PM), and the rates of fatty degeneration (FD) of the fused segment and its adjacent segments were compared respectively between preoperation, 6 and 12 months postoperation. The correlations were analyzed between the HRQL scores [visual analog scale (VAS) for pain and Oswestry disability index (ODI)] and the relative LM volumes, the relative PM volumes, and the FD rates of the fused segment and its adjacent segments at 12 months postoperation.Results:Compared with the preoperative values, the relative LM volumes and the relative PM volumes of the fused segment and its adjacent segments at 6 and 12 months postoperation were significantly reduced while the FD rates significantly increased. However, the FD rate of the fused segment at 12 months postoperation (20.6% ± 6.1%) was significantly lower than that at 6 months postoperation (29.7% ± 8.2%) ( P < 0.05). The VAS score was strongly negatively or positively correlated with the relative LM volume ( r = -0.819, P < 0.001) and the FD rate ( r = 0.86, P < 0.001) of the fused segment, and moderately negatively correlated with the relative PM volume ( r = -0.435, P = 0.016). The ODI index was moderately negatively correlated with the relative LM volume ( r = -0.512, P = 0.004) and the relative PM volume ( r = -0.402, P = 0.020) of the fused segment, but moderately positively correlated with the FD rate of the fused segment ( r = 0.565, P = 0.001). There was a moderate negative correlation between the ODI index and the relative LM volume of the adjacent segments ( r = -0.478, P = 0.012). Conclusions:After MIS-TLIF, the volume of the paravertebral muscles decreases and the dorsal muscles develop fatty degeneration. The improvement of LM fatty degeneration may be observed by 12-month follow-up in the fused segment, but not in the adjacent segments. The LM volume and the FD rate of the fused segment are the most closely related to the postoperative HRQL.
ABSTRACT
ObjectiveTo observe the effects of Internet plus continuous rehabilitation nursing on older patients after lumbar fusion. MethodsFrom January, 2018 to August, 2021, 157 older patients after transforaminal lumbar interbody fusion (TLIF) in Department of Orthopedics, Chongqing General Hospital were retrospectively studied. A total of 66 patients accepting routine continuous rehabilitation nursing care were as control group, and 91 patients accepting internet plus continuous rehabilitation nursing care were as intervention group. They were assessed with Visual Analog Scale for pain (VAS), Oswestry Disability Index (ODI), Huaxi Emotional-distress Index (HEI) and Adult Health Self-management Skill Rating Scale (AHSMSRS) before, and one and three months after intervention. The compliance and nursing satisfaction were investigated with self-made questionnaire three months after intervention, and the postoperative complications were recorded. ResultsA total of 148 patients finished follow-up of three months, including 61 patients for the control group and 87 patients for the intervention group. The VAS, ODI, HEI and AHSMSRS scores improved in both groups one and three months after intervention (F > 85.4, P < 0.001), and improved more in the intervention group than in the control group (|t| > 3.645, P < 0.001). Both the compliance and nursing satisfaction were better in the intervention group than in the control group (χ2 > 5.478, P < 0.05), and no postoperative complication was observed in both groups. ConclusionInternet plus continuous rehabilitation nursing can promote the recovery of function, pain and psychological emotion, ability of self-management, compliance, and nursing satisfaction.
ABSTRACT
BACKGROUND: Hemorrhage control has been an important issue in spine surgery. The widely used gelatin sponge is limited by its long-time bleeding control and poor hemorrhage control. Therefore, new techniques are needed to control bleeding in spine surgery. OBJRCTIVE: To compare the hemostatic effect of fluid gelatin Surgiflo™ with absorbable gelatin sponge in single level posterior lumbar fusion surgery. METHODS: Ninety-eight patients consisting of 52 males and 46 females, aged 54. 32 years who received treatment between September 2017 and December 2017 in Xijing Hospital of The Fourth Military Medical University were included in this study. All patients underwent single-level L4/5 lumbar fusion. Among them, 48 patients received intraoperative hemostasis with fluid gelatin SurgifloTM and 50 patients received intraoperative hemostasis with conventional gelatin sponge. Intraoperative bleeding volume, postoperative drainage volume, success rate of hemostasis in 3 minutes and changes of hemoglobin levels in perioperative period were compared between the two groups. RESULTS AND CONCLUSIONS: The operation time in the Surgiflo™group was significantly shorter than that in the gelatin sponge group [(105±26) vs. (118±32) min, P < 0. 05]. The amount of intraoperative blood loss and total amount of drainage were (156±57) mL and (106±42) mL in the Surgiflo™group which were significantly lower than those in the gelatin sponge group [(204±62) mL, (148±35) mL, P < 0. 05]. The success rate of hemostasis within 3 minutes in the Surgiflo™ group was significantly higher than that in the gelatin sponge group (94% vs. 80%, P < 0. 05). The change in hemoglobin level during the perioperative period relative to pre-surgery level was significantly higher in the Surgiflo™ group was significantly lower than that in the gelatin sponge group [(12. 3±3. 6) vs. (22. 8±4. 3) g/L, P < 0. 05]. No complications such as anaphylaxis, immune rejection, or delayed hematoma occurred in both groups. These results suggest that fluid gelatin Surgiflo™ can significantly reduce intraoperative blood loss and postoperative drainage volume in single-level lumbar fusion surgery and exhibit better hemostatic effects.
ABSTRACT
BACKGROUND: Whether knotless barbed suture applied in lumbar posterior fusion can shorten the suturing time and reduce incision complication has not been confirmed in clinical practice. OBJECTIVE: To explore whether knotless barbed suture has advantages in shortening the suturing time and reducing incision complication in lumbar posterior fusion. METHODS: Sixty-two patients with lumbar degenerative disease at Dongzhimen Hospital, Beijing University of Chinese Medicine from January to December 2018 were selected, and all received lumbar posterior fusion. The patients were randomly divided Into trial group (n=33, the deep lumbar fascia was sutured using knotless barbed suture) and control group (n=29, the deep lumbar fascia was sutured using absorbable suture). The incision length, and the suturing time of deep fascia and subcutaneous tissue were compared between two groups. The suture quality was analyzed by leakage test. The Incision healing and complications were observed and recorded. The Visual Analogue Scale scores and Oswestry Dysfunction Index at baseline and 2 and 6 weeks, and 3 months after surgery were detected. The trial was approved by the Ethics Committee of Dongzhimen Hospital, Beijing University of Chinese Medicine (approval No. DZMEC-KY-2018-11). RESULTS AND CONCLUSION: (1) The Incision length and subcutaneous tissue suture time showed no significant difference (P > 0.05). The suture time of deep fascia in the trial group was shorter than that in the control group [(8.0±0.9) vs. (11.6±1.7) minutes, P 0.05). (4) These results Indicate that the knotless barbed suture can reduce suturing time and Incidence of incision complications in posterior lumbar fusion.
ABSTRACT
Objective@#We aimed to compare the clinical and radiological outcomes of midline lumbar fusion (MIDLF) versus minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) in patients with degenerative spondylolisthesis and/or stenosis in L4-L5 two years after surgery.@*Methods@#Consecutively treated patients with lumbar pathology who underwent MIDLF ( @*Results@#The mean operative time and hematocrit (HCT, Day 1) were significantly shorter and lower in MIDLF cases (174 min @*Conclusion@#MIDLF is comparable to MI-TLIF at L4-5 in clinical outcomes and fusion rates, and the results verified the meaningful advantage of using MIDLF for the elderly with osteoporosis.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Lumbar Vertebrae/surgery , Retrospective Studies , Spinal Fusion/methods , Treatment OutcomeABSTRACT
Background: Many different treatment modalities have been advocated by different authors from time to time for lumbarspondylolisthesis. Many cases, the condition can be treated conservatively. However, when the symptoms persist, surgeryneeds to be performed. The principle of underlying surgery includes stabilization of the slipping vertebrae. Various operativemethods encompassing this principle include stabilization with pedicle screw fixation and fusion which can either posterolateralor interbody fusion, anterior lumbar interbody fusion, posterior lumbar interbody fusion, or transforaminal lumbar interbodyfusion. The objective of this study was to compare the surgical efficacy in terms of stability and fusion achieved using pediclescrew-rod instrumentation with posterolateral fusion and pedicle screw-rod instrumentation with interbody fusion in lumbarspondylolisthesis and to study THE functional and clinical recovery using the Revised Oswestry Disability Index score.Materials and Methods: A prospective study was carried out to compare the clinical and radiological outcomes between Pediclescrew-rod instrumentation with either posterolateral fusion and interbody fusion after adequate decompression in patient oflumbar spondylolisthesis. All patients as per the inclusion criteria were admitted, underwent surgery between March 2010 andMarch 2012, and were included in the study.Results: The total of 50 patients was included in our study. Both male and female patients were equally distributed in both thegroups, wherein postreolateral fusion had 13 female patients and those with interbody fusion had 13 male patients. Our studyshows marked improvement in Revised Oswestry Disability score postoperatively with good-to-excellent results in both thegroups. We achieved good solid radiological fusion earliest on the 3rd month in both the groups with good stability.Conclusion: Our results showed similar clinical and functional outcome in both the groups with no significant statistical differencefound. However, we conclude that in cases where reduction is required and there is instability affecting the three column ofspine interbody fusions with pedicle screws-rod instrumentation provide a more solid mechanical construct.
ABSTRACT
Objective To analyze the correlation between adjacent segment disease (ASDis) after lumbar fusion and spinopelvic sagittal parameters, and to explore the risk factors. Methods From Jan. 2013 to Oct. 2017, the patients undergoing revision surgery for ASDis after lumbar fusion in Changhai Hospital of Naval Medical University (Second Military Medical University) were enrolled as ASDis group, and the patients who did not have ASDis after lumbar fusion during the same follow-up period were taken as controls. The clinical data of the patients in the two groups were retrospectively analyzed. The differences of the general data (age, gender, body mass index [BMI], follow-up time and the etiology of the first operation) and the spinopelvic sagittal parameters (thoracic kyphosis [TK], sagittal vertical axis [SVA], lumbar lordosis [LL], segmental lumbar lordosis [sLL], pelvic incidence [PI], pelvic tilt [PT] and sacral slope [SS]) were compared between the two groups. Results There were 25 patients in the ASDis group and 50 patients in the control group. There were no significant differences in the age, gender, BMI, follow-up time or the etiology of the first operation between the two groups (all P>0.05). Compared with the control group, the LL, sLL and SS were significantly lower in the ASDis group (36.00°±5.44°vs 43.88°±10.62°, 17.80°±5.79°vs 27.62°±6.74°, 27.50°±5.30°vs 31.06°±7.48° all P0.05). Meantime, the proportion of patients with SVA>50 mm, the difference of PT and LL (PT-LL)=10°, and the ratio of sLL to LL (RL)<60% were significantly higher in the ASDis group than those in the control group (18/25 vs 21/50, 16/25 vs 11/50, 21/25 vs 17/50; all P<0.05). Conclusion The sagittal imbalance after lumbar fusion is closely associated with ASDis, and compensatory kyphosis of adjacent lumbar segments due to surgical segmental lordosis may be one of the causes of ASDis after lumbar fusion.
ABSTRACT
Objective To compare the effects of preserving the posterior ligament complex (PLC) with torque loading and displacement loading on the biomechanical properties of the adjacent segments after lumbar decompression and fusion. Methods Six fresh male cadaver lumbar specimens of T12-S2 were tested in the sequence of intact, L4-5 laminotomy (preserving the PLC) with fixation and L4-5 laminectomy (destructing the PLC) with fixation, by applying both displacement loading and torque loading, respectively. Ranges-of-motions (ROMs) of the adjacent segments were measured under a noncontact photographic recording system. Results In displacement-loading mode, the flexion ROM in laminectomy group was significantly higher than that in laminotomy group, and no obvious ROM differences were found in the laminectomy and laminotomy groups under extension, lateral bending, and rotation movement. Conclusions Torque loading and displacement loading have different biomechanical effects on the adjacent segments after lumbar decompression and fusion. Compared with the laminotomy method, in which the PLC is preserved, the laminectomy method in which PLC structures are damaged can obviously lead to an increment of flexion ROMs at the adjacent segments, and also increase the ROMs of the adjacent segments under extension, lateral bending, and rotation movements, which might increase the risk of further instability of the fused adjacent segments.
ABSTRACT
The research progress of finite element method (FEM) applied in biomechanics of lumbar fusion and artificial lumbar disc replacement was reviewed and its prospect was forecasted. The main research directions of FEM are optimal selection of operation plans before the surgery, performance evaluation of implanted devices and prediction of postoperative outcomes. Based on the recent research progress, the application prospects of FEM in simulation of personalized surgery, evaluation of elastic implants and postoperative prediction of novel operation method were discussed. By reviewing and prospecting the application of FEM in biomechanical research of lumbar fusion and artificial lumbar disc replacement, the purpose of this paper is to provide theoretical references and practical guidance for the treatment of lumbar diseases in clinic.
ABSTRACT
Objective To analyze the effectiveness of laminectomy decompression compared with vertebral lamina decompression combined with lumbar fusion in Degree I spondylolisthesis and spinal canal stenosis. Methods PubMed, Science Direct Online, Springer, CNKI, Wan Fang and VIP were retrieved to collect relevant randomized controlled trials( RCT) . According to inclusion and exclusion criteria,two researchers screened literatures, extracted data and evaluated quality. RevMan5. 0 software was used for Meta analysis. A total of 11 RCT were included,with a total of 1684 patients. Meta analysis showed that compared with the simple laminectomy group,the VAS score of lumbar pain in the lumbar fusion group at 1 years after operation decreased ( MD and 95％CI:-1. 20(-1. 57--0. 83) ,P<0. 05) ,and the VAS score of the 1 year postoperative leg pain in the lumbar fusion group decreased(MD and 95％CI:-0. 88(-1. 32- -0. 44),P<0. 05),the excellent rate of lumbar fusion group at 2 years after operation was higher( OR and 95％CI:1. 65( 1. 13-2. 41) ,P<0. 05) . There was no significant difference in postoperative complications and lumbar spondylolisthesis at 1 years after operation. Conclusion In long term, compared with decompression alone, vertebral lamina decompression combined with lumbar fusion has more ideal effectiveness in the treatment.
ABSTRACT
STUDY DESIGN: Retrospective cohort design. PURPOSE: This study aimed to determine whether recombinant human bone morphogenic protein 2 (rhBMP-2) reduces total perioperative blood loss during lumbar and thoracic fusion. OVERVIEW OF LITERATURE: Previous studies on rhBMP-2 versus iliac crest bone grafting in thoracic and lumbar fusions have yielded mixed results regarding reductions in blood loss and have largely neglected the postoperative period when analyzing total blood loss. Additionally, these studies have been limited by heterogeneity and sample size. METHODS: We analyzed the blood loss patterns of 617 consecutive adult patients undergoing lumbar and/or thoracic fusions requiring subfascial drain placement at a single institution from January 2009 to December 2016. Patients were divided into BMP and non-BMP cohorts, and a propensity score analysis was conducted to account for the differences between cohorts. RESULTS: At a per-level fused basis, the BMP group exhibited a significant reduction in the intraoperative (66.1 mL per-level fused basis; 95% confidence interval [CI], 127.9 to 4.25 mL; p=0.036) and total perioperative blood loss (100.7 mL per-level fused basis; 95% CI, 200.9 to 0.5 mL; p=0.049). However, no significant differences were observed in an analysis when not controlling for the number of levels or when examining the postoperative drain output. CONCLUSION: RhBMP-2 appears to reduce both intraoperative and total blood loss during lumbar and thoracic fusions on a per-level fused basis. This total reduction in blood loss was achieved via intraoperative effects because RhBMP-2 had no significant effect on the postoperative drain output.
Subject(s)
Adult , Humans , Bone Transplantation , Cohort Studies , Population Characteristics , Postoperative Period , Propensity Score , Retrospective Studies , Sample Size , Spinal FusionABSTRACT
Objective To investigate the risk factors of proximal junctional kyphosis (PJK) after posterior long segmental lumbar fusion for degenerative lumbar disease. Methods From October, 2012 to July, 2014, 118 degenerative lumbar disease patients who accepted posteri-or long segmental fusion and followed up at least 1.5 years were reviewed. All the PJK were evaluated with X-ray. Results Sixty-six pa-tients completed the follow-up (mean of 3.2 years), in which 12 patients with PJK (PJK group), and the others without (non-PJK group, n=54). There was significant difference in body mass index, bone density and the last Oswestry Disability Index scores (t>2.194, P3.862, P10° (OR=5.789, 95%CI:1.075~31.183) were the independent risk factors of PJK. Conclusion Osteoporosis, UIV located in the thoracolumbar segment (T11-L1) and the pre-surgery PJK angle>10° are risk factors of PJK af-ter posterior long segmental lumbar fusion.
ABSTRACT
OBJECTIVE:To observe analgesic efficacy of oxycodone acetaminophen after posterior lumbar fusion,and to opti-mize spinal postoperative analgesia plan. METHODS:In retrospective study,120 patients underwent posterior lumbar fusion were selected from the Affiliated People's Hospital of Hubei Medical College during Jun. 2013-Jun. 2014,and then divided into observa-tion group and control group according to therapy plan,with 60 cases in each group. Observation group was given oxycodone acet-aminophen 330 mg orally 6 h after surgery,and then 330 mg orally on 1st,2nd day after surgery,tid. Control group was given celecoxib 200 mg 6 h after surgery,and then 200 mg on 1st,2nd day after surgery,bid. Postoperative analgesic efficacy (VAS score) at resting state and active state,postoperative gastrointestinal motility recovery (the time to flatus) and the occurrence of ADR were observed in 2 groups after surgery. RESULTS:Whether at the resting state or the active state 24,48,72,120 h after surgery,VAS score of observation group was significantly lower than that of control group,with statistical significance(P0.05). CONCLUSIONS:Oral administration of oxycodone acetaminophen possesses good effect to relieve spinal postoperative pain,showing fast and safe analgesic efficacy.
ABSTRACT
OBJECTIVE: Postoperative pain is one of the major complaints of patients after lumbar fusion surgery. The authors evaluated the effects of intravenous patient controlled analgesia (IV-PCA) using fentanyl or sufentanil on postoperative pain management and pain-related complications. METHODS: Forty-two patients that had undergone surgery with lumbar instrumentation and fusion at single or double levels constituted the study cohort. Patients were equally and randomly allocated to a sufentanil group (group S) or a fentanyl group (group F) for patient controlled analgesia (PCA). Group S received sufentanil at a dose of 4 μg/kg IV-PCA and group F received fentanyl 24 μg/kg IV-PCA. A numeric rating scale (NRS) of postoperative pain was applied before surgery, and immediately and at 1, 6, and 24 hours (hrs) after surgery. Oswestry disability index (ODI) scores were obtained before surgery and one month after surgery. Opioid-related side effects were also evaluated. RESULTS: No significant intergroup difference was observed in NRS or ODI scores at any of the above-mentioned time points. Side effects were more frequent in group F. More specifically, nausea, vomiting rates were significantly higher (p=0.04), but pruritus, hypotension, and headache rates were non-significantly different in the two groups. CONCLUSION: Sufentanil displayed no analgesic advantage over fentanyl postoperatively. However, sufentanil should be considerable for patients at high risk of GI issues, because it had lower postoperative nausea and vomiting rates than fentanyl.
Subject(s)
Humans , Analgesia, Patient-Controlled , Cohort Studies , Fentanyl , Headache , Hypotension , Nausea , Pain, Postoperative , Postoperative Nausea and Vomiting , Pruritus , Sufentanil , VomitingABSTRACT
Objective To compare the short-term clinical effect of K-Rod pedicle dynamic fixation system and lumbar fusion for multi-ple segmental lumbar degeneration.Methods Between January 2010 and October 2012,56 patients with segmental lumbar degeneration who were accepted K-Rod pedicle dynamic fixation system and posterior lumbar interbody fusion were retrospectively reviewed.The 56 patients were divided into K-Rod and fusion group,28 patients with K-Rod pedicle dynamic fixation system and 28 cases with traditional lumbar fusion and internal fixation.Clinical assessments were based on comparion of Oswestry disability index score ,visual analogous scale (VAS),im-provement rate of low back pain,postoperative lumbar spine X-ray,average operation time and intraoperative blood loss of two groups.Results All of 56 cases were followed up for 12 to 24 months,the difference of Oswestry disability index score and VAS between two groups were not statistically significant(P >0.05),but the difference of average operation time,blood loss and the average length of stay(ALOS)were statis-tically significant(P <0.05),the K-Rod group was superior to the fusion group.Conclusion In the treatment of multiple segmental lumbar degeneration both K-Rod pedicle dynamic fixation system and traditional lumbar fusion can obtain satisfactory short-term clinical effect,but the K-Rod pedicle dynamic fixation system has advantages of less intraoperative blood loss,shorter operation time,postoperative small effects on lumbar spine mobility.
ABSTRACT
STUDY DESIGN: Retrospective study. PURPOSE: To compare the union rate of posterolateral lumbar fusion (PLF) using demineralized bone matrix (DBM) versus hydroxyapatite (HA) as bone graft extender. OVERVIEW OF LITERATURE: To our knowledge, there has been no clinical trial to compare the outcomes of DBM versus HA as a graft material for PLF. METHODS: We analyzed prospectively collected data from consecutive 79 patients who underwent instrumented PLF. Patients who received DBM were assigned to group B (n=38), and patients who received HA were assigned into group C (n=41). The primary study outcome was fusion rate assessed with radiographs. The secondary outcomes included pain intensity using a visual analogue scale, functional outcome using Oswestry disability index score, laboratory tests of inflammatory profiles and infection rate. RESULTS: One year postoperatively, bone fusion was achieved in 73% in group B and 58% in group C without significant difference between the groups (p=0.15). There were no differences between the groups with respect to secondary outcomes. CONCLUSIONS: DBM would provide noninferior outcomes compared to the HA as a fusion material for PLF, and could be a notable alternative.
Subject(s)
Humans , Bone Matrix , Durapatite , Hydroxyapatites , Prospective Studies , Retrospective Studies , TransplantsABSTRACT
Lumbar degenerative disc disease is extremely common. Current evidence supports surgery in carefully selected patients who have failed non-operative treatment and do not exhibit any substantial psychosocial overlay. Fusion surgery employing the correct grafting and stabilization techniques has long-term results demonstrating successful clinical outcomes. However, the best approach for fusion remains debatable. There is some evidence supporting the more complex, technically demanding and higher risk interbody fusion techniques for the younger, active patients or patients with a higher risk of non-union. Lumbar disc arthroplasty and hybrid techniques are still relatively novel procedures despite promising short-term and mid-term outcomes. Long-term studies demonstrating superiority over fusion are required before these techniques may be recommended to replace fusion as the gold standard. Novel stem cell approaches combined with tissue engineering therapies continue to be developed in expectation of improving clinical outcomes. Results with appropriate follow-up are not yet available to indicate if such techniques are safe, cost-effective and reliable in the long-term.
Subject(s)
Humans , Arthroplasty , Follow-Up Studies , Intervertebral Disc Degeneration , Low Back Pain , Stem Cells , Tissue Engineering , TransplantsABSTRACT
STUDY DESIGN: Single center retrospective cohort analysis. PURPOSE: The goal was to evaluate the influence of varying amount of recombinant human bone morphogenetic protein 2 (rhBMP-2) per level on fusion rates and complications in posterolateral spinal fusions. OVERVIEW OF LITERATURE: rhBMP-2 has been utilized for lumbar posterolateral fusions for many years. Initial rhBMP-2 recommendations were 20 mg/level of fusion. Dose and concentration per level in current studies vary from 4.2 to 40 mg and 1.5 to 2.0 mg/mL, respectively. Variable fusion and complication rates have been reported. METHODS: Patients (n=1,610) undergoing instrumented lumbar spinal fusion (2003-2009) with utilization of rhBMP-2 were retrospectively evaluated. Patient demographics, body mass index (BMI), comorbidities, number of levels, associated interbody fusion, and types of bone void filler were analyzed. Fusions rates and nonunions were subdivided into number of levels and amount of rhBMP-2 used per level. RESULTS: Patients (n=559) were evaluated with 58.5% females having an average age of 63 years, BMI of 31 kg/m2. Number of levels fused ranged from 1 to 8. rhBMP-2 averaged 7.3 mg/level (range, 1.5-24 mg/level) based upon length of collagen sponge in relation to length of fusion levels. Patients with non-union formation had lower rhBMP-2 dose per level (p=0.016). A significant difference in non-union rate was found between patients undergoing fusion with 6 mg/level (9.1% vs. 2.4%, χ2=0.012). No significant differences were noted between 6-11.9 mg/level and ≥12 mg/level. No threshold was found for seroma formation or bone overgrowth. CONCLUSIONS: Previous recommendation of 20 mg/level of rhBMP-2 is more than what is required for predictable fusion rates of 98%. No dose related increase of infection, seroma formation, and bone overgrowth has been found. In order to provide variable dosing and cost reduction, industry generated rhBMP-2 kit size should be optimized.
Subject(s)
Female , Humans , Body Mass Index , Bone Morphogenetic Protein 2 , Cohort Studies , Collagen , Comorbidity , Demography , Porifera , Retrospective Studies , Seroma , Spinal FusionABSTRACT
STUDY DESIGN: Single center retrospective cohort analysis. PURPOSE: The goal was to evaluate the influence of varying amount of recombinant human bone morphogenetic protein 2 (rhBMP-2) per level on fusion rates and complications in posterolateral spinal fusions. OVERVIEW OF LITERATURE: rhBMP-2 has been utilized for lumbar posterolateral fusions for many years. Initial rhBMP-2 recommendations were 20 mg/level of fusion. Dose and concentration per level in current studies vary from 4.2 to 40 mg and 1.5 to 2.0 mg/mL, respectively. Variable fusion and complication rates have been reported. METHODS: Patients (n=1,610) undergoing instrumented lumbar spinal fusion (2003-2009) with utilization of rhBMP-2 were retrospectively evaluated. Patient demographics, body mass index (BMI), comorbidities, number of levels, associated interbody fusion, and types of bone void filler were analyzed. Fusions rates and nonunions were subdivided into number of levels and amount of rhBMP-2 used per level. RESULTS: Patients (n=559) were evaluated with 58.5% females having an average age of 63 years, BMI of 31 kg/m2. Number of levels fused ranged from 1 to 8. rhBMP-2 averaged 7.3 mg/level (range, 1.5-24 mg/level) based upon length of collagen sponge in relation to length of fusion levels. Patients with non-union formation had lower rhBMP-2 dose per level (p=0.016). A significant difference in non-union rate was found between patients undergoing fusion with 6 mg/level (9.1% vs. 2.4%, χ2=0.012). No significant differences were noted between 6-11.9 mg/level and ≥12 mg/level. No threshold was found for seroma formation or bone overgrowth. CONCLUSIONS: Previous recommendation of 20 mg/level of rhBMP-2 is more than what is required for predictable fusion rates of 98%. No dose related increase of infection, seroma formation, and bone overgrowth has been found. In order to provide variable dosing and cost reduction, industry generated rhBMP-2 kit size should be optimized.