使用骨形态发生蛋白能否降低单层经椎间孔腰椎椎体融合手术中的假关节发生率？

IF 1.7 Q2 SURGERY

International Journal of Spine Surgery Pub Date : 2024-04-03 DOI:10.14444/8590

Jack Zhong, Jarid Tareen, Kimberly Ashayeri, C. Leon, E. Balouch, Nicholas A. O'Malley, C. Stickley, C. Maglaras, Brooke K. O'Connell, Ethan W. Ayres, C. Fischer, Yong Kim, T. Protopsaltis, A. Buckland

{"title":"使用骨形态发生蛋白能否降低单层经椎间孔腰椎椎体融合手术中的假关节发生率？","authors":"Jack Zhong, Jarid Tareen, Kimberly Ashayeri, C. Leon, E. Balouch, Nicholas A. O'Malley, C. Stickley, C. Maglaras, Brooke K. O'Connell, Ethan W. Ayres, C. Fischer, Yong Kim, T. Protopsaltis, A. Buckland","doi":"10.14444/8590","DOIUrl":null,"url":null,"abstract":"BACKGROUND\nRecombinant human bone morphogenetic protein 2 (rhBMP-2, or BMP for short) is a popular biological product used in spine surgeries to promote fusion and avoid the morbidity associated with iliac crest autograft. BMP's effect on pseudarthrosis in transforaminal lumbar interbody fusion (TLIF) remains unknown.\n\n\nOBJECTIVE\nTo assess the rates of pseudarthrosis in single-level TLIF with and without concurrent use of BMP.\n\n\nMETHODS\nThis was a retrospective cohort study conducted at a single academic institution. Adults undergoing primary single-level TLIF with a minimum of 1 year of clinical and radiographic follow-up were included. BMP use was determined by operative notes at index surgery. Non-BMP cases with iliac crest bone graft were excluded. Pseudarthrosis was determined using radiographic and clinical evaluation. Bivariate differences between groups were assessed by independent t test and χ 2 analyses, and perioperative characteristics were analyzed by multiple logistic regression.\n\n\nRESULTS\nOne hundred forty-eight single-level TLIF patients were included. The mean age was 59.3 years, and 52.0% were women. There were no demographic differences between patients who received BMP and those who did not. Pseudarthrosis rates in patients treated with BMP were 6.2% vs 7.5% in the no BMP group (P = 0.756). There was no difference in reoperation for pseudarthrosis between patients who received BMP (3.7%) vs those who did not receive BMP (7.5%, P = 0.314). Patients who underwent revision surgery for pseudarthrosis more commonly had diabetes with end-organ damage (revised 37.5% vs not revised 1.4%, P < 0.001). Multiple logistic regression analysis demonstrated no reduction in reoperation for pseudarthrosis related to BMP use (OR 0.2, 95% CI 0.1-3.7, P = 0.269). Diabetes with end-organ damage (OR 112.6,95% CI 5.7-2225.8, P = 0.002) increased the risk of reoperation for pseudarthrosis.\n\n\nCONCLUSIONS\nBMP use did not reduce the rate of pseudarthrosis or the number of reoperations for pseudarthrosis in single-level TLIFs. Diabetes with end-organ damage was a significant risk factor for pseudarthrosis.\n\n\nCLINICAL RELEVANCE\nBMP is frequently used \"off-label\" in transforaminal lumbar interbody fusion; however, little data exists to demonstrate its safety and efficacy in this procedure.\n\n\nLEVEL OF EVIDENCE: 3","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.7000,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Does Bone Morphogenetic Protein Use Reduce Pseudarthrosis Rates in Single-Level Transforaminal Lumbar Interbody Fusion Surgeries?\",\"authors\":\"Jack Zhong, Jarid Tareen, Kimberly Ashayeri, C. Leon, E. Balouch, Nicholas A. O'Malley, C. Stickley, C. Maglaras, Brooke K. O'Connell, Ethan W. Ayres, C. Fischer, Yong Kim, T. Protopsaltis, A. Buckland\",\"doi\":\"10.14444/8590\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"BACKGROUND\\nRecombinant human bone morphogenetic protein 2 (rhBMP-2, or BMP for short) is a popular biological product used in spine surgeries to promote fusion and avoid the morbidity associated with iliac crest autograft. BMP's effect on pseudarthrosis in transforaminal lumbar interbody fusion (TLIF) remains unknown.\\n\\n\\nOBJECTIVE\\nTo assess the rates of pseudarthrosis in single-level TLIF with and without concurrent use of BMP.\\n\\n\\nMETHODS\\nThis was a retrospective cohort study conducted at a single academic institution. Adults undergoing primary single-level TLIF with a minimum of 1 year of clinical and radiographic follow-up were included. BMP use was determined by operative notes at index surgery. Non-BMP cases with iliac crest bone graft were excluded. Pseudarthrosis was determined using radiographic and clinical evaluation. Bivariate differences between groups were assessed by independent t test and χ 2 analyses, and perioperative characteristics were analyzed by multiple logistic regression.\\n\\n\\nRESULTS\\nOne hundred forty-eight single-level TLIF patients were included. The mean age was 59.3 years, and 52.0% were women. There were no demographic differences between patients who received BMP and those who did not. Pseudarthrosis rates in patients treated with BMP were 6.2% vs 7.5% in the no BMP group (P = 0.756). There was no difference in reoperation for pseudarthrosis between patients who received BMP (3.7%) vs those who did not receive BMP (7.5%, P = 0.314). Patients who underwent revision surgery for pseudarthrosis more commonly had diabetes with end-organ damage (revised 37.5% vs not revised 1.4%, P < 0.001). Multiple logistic regression analysis demonstrated no reduction in reoperation for pseudarthrosis related to BMP use (OR 0.2, 95% CI 0.1-3.7, P = 0.269). Diabetes with end-organ damage (OR 112.6,95% CI 5.7-2225.8, P = 0.002) increased the risk of reoperation for pseudarthrosis.\\n\\n\\nCONCLUSIONS\\nBMP use did not reduce the rate of pseudarthrosis or the number of reoperations for pseudarthrosis in single-level TLIFs. Diabetes with end-organ damage was a significant risk factor for pseudarthrosis.\\n\\n\\nCLINICAL RELEVANCE\\nBMP is frequently used \\\"off-label\\\" in transforaminal lumbar interbody fusion; however, little data exists to demonstrate its safety and efficacy in this procedure.\\n\\n\\nLEVEL OF EVIDENCE: 3\",\"PeriodicalId\":38486,\"journal\":{\"name\":\"International Journal of Spine Surgery\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.7000,\"publicationDate\":\"2024-04-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal of Spine Surgery\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.14444/8590\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Spine Surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.14444/8590","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}

引用次数: 0

摘要

背景重组人骨形态发生蛋白 2（rhBMP-2，简称 BMP）是脊柱手术中常用的生物制品，可促进融合并避免髂嵴自体移植物带来的发病率。BMP 对经椎间孔腰椎椎体融合术（TLIF）假关节的影响尚不清楚。目的评估同时使用和未同时使用 BMP 的单层 TLIF 假关节发生率。研究对象包括接受过单层 TLIF 初级手术且至少接受过 1 年临床和影像学随访的成年人。根据索引手术的手术记录确定是否使用了 BMP。不包括髂嵴植骨的非 BMP 病例。假关节通过放射学和临床评估确定。组间二变量差异通过独立 t 检验和 χ 2 分析进行评估，围手术期特征通过多元 Logistic 回归进行分析。平均年龄为 59.3 岁，52.0% 为女性。接受 BMP 治疗的患者与未接受 BMP 治疗的患者在人口统计学上没有差异。接受 BMP 治疗的患者假关节发生率为 6.2%，而未接受 BMP 治疗的患者假关节发生率为 7.5%（P = 0.756）。接受BMP治疗的患者（3.7%）与未接受BMP治疗的患者（7.5%，P = 0.314）在假关节再手术方面没有差异。因假关节而接受翻修手术的患者中，糖尿病合并内脏损害的患者更常见（接受翻修手术的患者占 37.5%，未接受翻修手术的患者占 1.4%，P < 0.001）。多元逻辑回归分析表明，假关节再手术的减少与 BMP 的使用无关（OR 0.2，95% CI 0.1-3.7，P = 0.269）。糖尿病合并内脏损害（OR 112.6，95% CI 5.7-2225.8，P = 0.002）增加了假关节再手术的风险。临床意义BMP经常在 "标签外 "用于经椎间孔腰椎椎体融合术，但很少有数据能证明其在该手术中的安全性和有效性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Does Bone Morphogenetic Protein Use Reduce Pseudarthrosis Rates in Single-Level Transforaminal Lumbar Interbody Fusion Surgeries?

BACKGROUND Recombinant human bone morphogenetic protein 2 (rhBMP-2, or BMP for short) is a popular biological product used in spine surgeries to promote fusion and avoid the morbidity associated with iliac crest autograft. BMP's effect on pseudarthrosis in transforaminal lumbar interbody fusion (TLIF) remains unknown. OBJECTIVE To assess the rates of pseudarthrosis in single-level TLIF with and without concurrent use of BMP. METHODS This was a retrospective cohort study conducted at a single academic institution. Adults undergoing primary single-level TLIF with a minimum of 1 year of clinical and radiographic follow-up were included. BMP use was determined by operative notes at index surgery. Non-BMP cases with iliac crest bone graft were excluded. Pseudarthrosis was determined using radiographic and clinical evaluation. Bivariate differences between groups were assessed by independent t test and χ 2 analyses, and perioperative characteristics were analyzed by multiple logistic regression. RESULTS One hundred forty-eight single-level TLIF patients were included. The mean age was 59.3 years, and 52.0% were women. There were no demographic differences between patients who received BMP and those who did not. Pseudarthrosis rates in patients treated with BMP were 6.2% vs 7.5% in the no BMP group (P = 0.756). There was no difference in reoperation for pseudarthrosis between patients who received BMP (3.7%) vs those who did not receive BMP (7.5%, P = 0.314). Patients who underwent revision surgery for pseudarthrosis more commonly had diabetes with end-organ damage (revised 37.5% vs not revised 1.4%, P < 0.001). Multiple logistic regression analysis demonstrated no reduction in reoperation for pseudarthrosis related to BMP use (OR 0.2, 95% CI 0.1-3.7, P = 0.269). Diabetes with end-organ damage (OR 112.6,95% CI 5.7-2225.8, P = 0.002) increased the risk of reoperation for pseudarthrosis. CONCLUSIONS BMP use did not reduce the rate of pseudarthrosis or the number of reoperations for pseudarthrosis in single-level TLIFs. Diabetes with end-organ damage was a significant risk factor for pseudarthrosis. CLINICAL RELEVANCE BMP is frequently used "off-label" in transforaminal lumbar interbody fusion; however, little data exists to demonstrate its safety and efficacy in this procedure. LEVEL OF EVIDENCE: 3

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

International Journal of Spine Surgery Medicine-Surgery

CiteScore

3.10

自引率

0.00%

发文量

162

期刊介绍： The International Journal of Spine Surgery is the official scientific journal of ISASS, the International Intradiscal Therapy Society, the Pittsburgh Spine Summit, and the Büttner-Janz Spinefoundation, and is an official partner of the Southern Neurosurgical Society. The goal of the International Journal of Spine Surgery is to promote and disseminate online the most up-to-date scientific and clinical research into innovations in motion preservation and new spinal surgery technology, including basic science, biologics, and tissue engineering. The Journal is dedicated to educating spine surgeons worldwide by reporting on the scientific basis, indications, surgical techniques, complications, outcomes, and follow-up data for promising spinal procedures.