The Use of Recombinant Human Bone Morphogenic Protein in Posterior Interbody Fusions of the Lumbar Spine

Abstract

A 48 patient clinical series investigated posterior lumbar interbody fusions (PLIFs) incorporating bone morphogenic protein as an alternative to iliac crest bone graft. Patients were radiographically evaluated at an average of 16.9 months postsurgery. To determine safety and efficacy of PLIF procedures using recombinant human bone morphogenic protein type 2 (rhBMP-2) and an absorbable collagen sponge carrier as an alternative for iliac crest bone graft. Studies have shown that rhBMP-2 is safe and effective in anterior interbody and posterolateral lumbar spinal fusions to promote osteoinduction. Consecutive series of 48 patients who underwent PLIF procedures at a total of 59 operative levels, without autologous bone grafting, were evaluated preoperatively and at a minimum of 11.2 months postoperatively (maximum 23.8 mo). Radiographic assessment was conducted with thin-slice computed tomography reconstructions to assess for fusion. Clinical measures including Oswestry Disability Questionnaire were also used. All patients demonstrated successful interbody and posterolateral fusions at all levels as determined by computed tomography scans. No patients demonstrated canal compromise, heterotopic bone formation, or adjacent level fusion. PLIF using rhBMP-2 is a promising method for facilitating lumbar arthrodesis while eliminating the need for iliac crest bone graft harvesting.