Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Effect of Mixture of Recombinant Human Bone Morphogenic Protein-2 and Demineralized Bone Matrix in Lateral Lumbar Interbody Fusion

  • Jun Ik Son (Department of Neurosurgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University) ;
  • Young-Seok Lee (Department of Neurosurgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University) ;
  • Myeong Jin Ko (Department of Neurosurgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University) ;
  • Seong-Hyun Wui (Department of Neurosurgery, Chung-Ang University Gwangmyeong Hospital, College of Medicine, Chung-Ang University) ;
  • Seung Won Park (Department of Neurosurgery, Chung-Ang University Gwangmyeong Hospital, College of Medicine, Chung-Ang University)
  • Received : 2023.06.27
  • Accepted : 2023.10.11
  • Published : 2024.05.01
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Abstract

Objective : This study aims to determine the optimal dose of recombinant-human bone morphogenic protein-2 (rhBMP-2) for successful bone fusion in minimally invasive lateral lumbar interbody fusion (MIS LLIF). Previous studies show that rhBMP is an effective alternative to autologous iliac crest bone graft, but the optimal dose remains uncertain. The study analyzes the fusion rates associated with different rhBMP doses to provide a recommendation for the optimal dose in MIS LLIF. Methods : Ninety-three patients underwent MIS LLIF using demineralized bone matrix (DBM) or a mixture of rhBMP-2 and DBM as fusion material. The group was divided into the following three groups according to the rhBMP-2 usage : group A, only DBM was used (n=27); group B, 1 mg of rhBMP-2 per 5 mL of DBM paste (n=41); and group C, 2 mg of rhBMP-2 per 5 mL of DBM paste (n=25). Demographic data, clinical outcomes, postoperative complication and fusion were assessed. Results : At 12 months post-surgery, the overall fusion rate was 92.3% according to Bridwell fusion grading system. Groups B and C, who received rhBMP-2, had significantly higher fusion rates than group A, who received only DBM. However, there was no significant increase in fusion rate when the rhBMP-2 dosage was increased from group B to group C. The groups B and C showed significant improvement in back pain and Oswestry disability index compared to the group A. The incidence of screw loosening was decreased in groups B and C, but there was no significant difference in the occurrence of other complications. Conclusion : Usage of rhBMP-2 in LLIF surgery leads to early and increased final fusion rates, which can result in faster pain relief and return to daily activities for patients. The benefits of using rhBMP-2 were not significantly different between the groups that received 1 mg/5 mL and 2 mg/5 mL of rhBMP-2. Therefore, it is recommended to use 1 mg of rhBMP-2 with 5 mL of DBM, taking both economic and clinical aspects into consideration.

Keywords

References

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