Radiographic and CT Evaluation of Recombinant Human Bone Morphogenetic Protein-2–Assisted Spinal Interbody Fusion

Abstract

Bone morphogenetic proteins BMPs, when used in spinal fusion, hasten healing and initiate distinct imaging features. We undertook a study to record and analyze the radiographic and CT changes after the use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in spinal fusion surgery. This study included 95 patients who underwent spinal interbody fusion using rhBMP-2. The lumbar spine fusion cohort consisted of 23 patients who underwent anterior lumbar interbody fusion, 36 patients who underwent transforaminal lumbar interbody fusion, and two patients who underwent posterior lumbar interbody fusion. The remaining 34 patients underwent anterior cervical decompression and fusion. A polyetheretherketone cage was used as an interbody spacer in 59 patients (82 levels) and an allograft bone was the spacer in 36 patients (55 levels). Patients were evaluated 2 and 6 weeks after the procedure and then 3, 6, 12, and 24 months after the procedure. All patients underwent radiography at every follow-up visit, and CT evaluation was performed in 32 patients. Features observed on imaging that we attributed to the use of rhBMP-2 included an enhanced fusion rate and an increased incidence of prevertebral soft-tissue swelling in patients who underwent cervical fusion. Endplate resorption was observed in 100% of patients who underwent cervical fusion and in 82% of the lumbar levels. Subsidence of the cage resulting in narrowing of the disk space was seen in more than 50% of cases. Cage migration and heterotopic bone formation in the spinal canal and neural foramen occurred maximally in the lumbar spine of patients in whom a polyetheretherketone cage was placed using a transforaminal approach.