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Off-Label Bone Morphogenetic Protein 2 Use Results in Successful Posterolateral Lumbar Fusion in a Veteran Population
Maria A Munsch1, Jonathan Dalton, Stephen R Chen
1From the Department of Orthopaedic Surgery, Division of Spine Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (Dr. Munsch, Dr. Dalton, Dr. Chen, Dr. Tang, Dr. Como, Dr. Whaley, Dr. Sadhwani, Dr. Fourman, Dr. Shaw, and Dr. Lee); Department of Surgery, Orthopaedic Surgery Service, VA Pittsburgh Medical Center, Pittsburgh, PA (Dr. Munsch, Dr. Dalton, Dr. Chen, Dr. Fourman, Dr. Shaw, and Dr. Lee); the Pittsburgh Orthopaedic Spine Research Group (POSR), Pittsburgh, PA (Dr. Munsch, Dr. Dalton, Dr. Chen, Dr. Tang, Dr. Como, Dr. Whaley, Dr. Shaw, and Dr. Lee); and the Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA (Dr. Chen, Dr. Tang, Dr. Como, Dr. Shaw, and Dr. Lee).
Introduction:
Patients within the US Veterans Health Administration (VA) system have higher rates of comorbidities and chronic pain, increasing risks of complications/poor outcomes following spine surgery. Although the use of bone morphogenetic protein 2 (BMP-2) is established for anterior lumbar interbody fusion, its indications for off-label use in posterolateral fusion are unclear. The objective of this study was to evaluate safety and utility of BMP-2 in posterolateral fusion through a 15-year experience at the VA.
Methods:
Patients underwent posterolateral lumbosacral fusions with BMP-2 by a single VA surgeon from January 1, 2005, to January 1, 2020. The primary outcome was fusion assessed through postoperative radiographs. Secondary outcomes included adjacent segment disease (ASD) and postoperative pain clinic utilization.
Results:
Sixty-eight patients underwent lumbosacral posterolateral fusion with BMP-2; 77.9% were discharged home and had no postoperative complications. All patients achieved bony fusion at a mean of 113.3 ± 59.9 days postoperatively. Five patients were diagnosed with cancer postoperatively, and eight patients required revision for ASD. No notable predictors of ASD exist. Preoperative opioid use predicted postoperative pain clinic utilization.
Discussion:
Posterolateral lumbar fusion with BMP-2 in veterans yields high fusion rates and favorable complication profiles and should be considered in multimorbid hosts.
Study Design:
Retrospective review of prospectively collected data.
