Osteolysis in Lumbar Interbody Fusions: The Role of Recombinant Human Bone Morphogenetic Protein-2 (rhBMP-2)

Abstract

ABSTRACT Osteolysis may occur following lumbar interbody fusion procedures in which recombinant human bone morphogenetic protein-2, more commonly known as rhBMP-2, is used. The actual incidence of this process is unknown. Osteolysis results from an osteoclastic, rather than an osteoblastic response to rhBMP-2 and its carrier on trabecular vertebral bone, early in the sequence of bone graft healing. This osteoclastic response may represent an idiosyncratic reaction in those affected. The patient usually does well in the immediate postoperative period with resolution of their preoperative complaints of axial and radicular pain. However, at 4 to 12 weeks following the index surgery, the patient experiences a recurrence of severe back and radicular pain corresponding to the dermatomal level(s) operated upon. Laboratory studies including erythrocyte sedimentation rate, C reactive protein, and cultures are negative for infection. Imaging studies show areas of bone destruction and cyst formation containing fluid. In the majority of post-operative patients with osteolysis, there is an osteoblastic healing response with symptom resolution. Supportive, nonoperative care is usually effective in managing the patient. Nasca RJ. Osteolysis in Lumbar Interbody Fusions: The Role of Recombinant Human Bone Morphogenetic Protein-2 (rhBMP-2). The Duke Orthop J 2012;2(1):50-54.