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Complication Rates in Posterior Lumbar Interbody Fusion (PLIF) Surgery With Human Bone Morphogenetic Protein 2:
Raed Alobaidaan1, Jeremiah R Cohen2, Elizabeth L Lord2
1Ministry of Health, Riyadh, Saudi Arabia.
Study Design:
Retrospective cohort study among Medicare beneficiaries who underwent posterior lumbar interbody fusion (PLIF) surgery.
Objective:
To identify the complication rates associated with the use of bone morphogenetic protein 2 (BMP2) in PLIF. Human BMP2 is commonly used in the "off-label" manner for various types of spine fusion procedures, including PLIF. However, recent studies have reported potential complications associated with the recombinant human BMP2 (rhBMP2) use in the posterior approach.
Methods:
Medicare records within the PearlDiver database were queried for patients undergoing PLIF procedure with and without rhBMP2 between 2005 and 2010. We evaluated complications within 1 year postoperatively. Chi-square was used to compare the complication rates between the 2 groups.
Results:
A total of 8609 patients underwent PLIF procedure with or without rhBMP2. Individual complication rates in the rhBMP2 group ranged from 0.45% to 7.68% compared with 0.65% to 10.99 in the non-rhBMP2 group. Complication rates for cardiac, pulmonary, lumbosacral neuritis, infection, wound, and urinary tract (include acute kidney failure and post-operative complications) were significantly lower in the rhBMP2 group (P < .05). There was no difference in the rates of central nervous system complications or radiculitis between the 2 groups.
Conclusion:
Our data showed that the patients who received rhBMP2 had lower complication rates compared to the non-rhBMP2 group. However, use of rhBMP2 was associated with a higher rate of pseudarthrosis. We did not observe any difference in radiculitis and central nervous system complications between the groups.
Insights
Recombinant human bone morphogenetic protein 2 (rhBMP2) use in posterior lumbar interbody fusion (PLIF) surgery was associated with fewer complications but a higher pseudarthrosis rate. Further research is needed to fully understand rhBMP2 risks and benefits in PLIF.
Area of Science:
- Spine surgery outcomes
- Orthopedic biomaterials
- Surgical complication analysis
Background:
- Bone morphogenetic protein 2 (BMP2) is frequently used off-label in spine fusion procedures like PLIF.
- Concerns exist regarding potential complications associated with recombinant human BMP2 (rhBMP2) in posterior spinal approaches.
Purpose of the Study:
- To evaluate complication rates linked to rhBMP2 in PLIF surgery.
- To compare outcomes between PLIF patients who received rhBMP2 and those who did not.
Main Methods:
- Retrospective cohort study of Medicare beneficiaries undergoing PLIF between 2005-2010.
- Analysis of Medicare records from the PearlDiver database.
- Comparison of 1-year postoperative complication rates using chi-square testing.
Main Results:
- 8609 patients were included; rhBMP2 group complication rates ranged from 0.45% to 7.68%.
- Significantly lower rates of cardiac, pulmonary, infection, wound, and urinary tract complications were observed in the rhBMP2 group (P < .05).
- No significant differences in central nervous system complications or radiculitis were found between groups.
Conclusions:
- rhBMP2 use in PLIF was associated with lower overall complication rates compared to non-rhBMP2 cases.
- A higher incidence of pseudarthrosis was noted in the rhBMP2 group.
- Radiculitis and central nervous system complication rates did not differ between the groups.
