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Feasibility of percutaneous posterolateral spinal fusion with recombinant bone morphogenetic protein-2 (rhBMP-2): a comparison with standard methods using an animal model study

Background Context: The clinical application of recombinant bone morphogenetic protein in spinal surgery has been shown to be safe and effective. However, its use in minimally invasive spine surgery has been limited to anterior interbody fusion procedures. To date, no study has evaluated the feasibi...

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Main Authors: Chan, Chris Yin Wei, Kwan, Mun Keong, Saw, Lim Beng, Hussin, Paisal
Format: Article
Language:English
Published: Lippincott, Williams & Wilkins 2017
Online Access:http://psasir.upm.edu.my/id/eprint/61875/1/Feasibility%20of%20percutaneous%20posterolateral%20spinal%20fusion%20with%20recombinant%20bone%20morphogenetic%20protein-2%20.pdf
http://psasir.upm.edu.my/id/eprint/61875/
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spelling my.upm.eprints.618752019-02-25T07:57:50Z http://psasir.upm.edu.my/id/eprint/61875/ Feasibility of percutaneous posterolateral spinal fusion with recombinant bone morphogenetic protein-2 (rhBMP-2): a comparison with standard methods using an animal model study Chan, Chris Yin Wei Kwan, Mun Keong Saw, Lim Beng Hussin, Paisal Background Context: The clinical application of recombinant bone morphogenetic protein in spinal surgery has been shown to be safe and effective. However, its use in minimally invasive spine surgery has been limited to anterior interbody fusion procedures. To date, no study has evaluated the feasibility of percutaneous posterolateral fusion in the spine utilizing recombinant bone morphogenetic protein-2 (rhBMP-2). Purpose: To evaluate the feasibility of percutaneous posterolateral fusion in the spine utilizing rhBMP-2. Study Design: Animal study. Methods: This is an animal research model involving 32 New Zealand white rabbits stratified into 4 study groups: control, autogenous iliac crest bone graft (ICBG), demineralized bone matrix (DBM), and rhBMP-2 groups, with 8 study subjects per group. The rhBMP-2 group was subdivided into the open technique (right side) and the percutaneous technique groups (left side). Fusion was graded at 6 weeks and 3 months after plain radiography, computed tomography, and clinical assessment with the following grading system: grade A, no bone formation; grade B, non-bridging bone formation; grade C, fusion; and grade D, fusion with ectopic bone formation. Results: No fusion was noted in the placebo and the DBM groups. However, in the DBM group, bone formation occurred in 37.5% of the subjects. The rhBMP-2 group had a higher fusion rate compared with the ICBG group at 6 weeks and 3 months. The fusion rate for the ICBG, the rhBMP-2 (open), and the rhBMP-2 (percutaneous) groups were 37.5%, 87.5%, and 50.0% at 6 weeks and 50.0%, 100.0%, and 62.5% at 3 months, respectively. Ectopic bone formation occurred in 12.5% of the cases in the rhBMP-2 (percutaneous) group and in 25.0% of the cases in the rhBMP-2 (open) group. Conclusions: Usage of rhBMP-2 is feasible for percutaneous posterolateral fusion of the lumbar spine in this animal model. However, a more precise delivery system might improve the fusion rate when the percutaneous technique is used. A significant rate of ectopic bone formation occurred when rhBMP-2 was used. Lippincott, Williams & Wilkins 2017-03 Article PeerReviewed text en http://psasir.upm.edu.my/id/eprint/61875/1/Feasibility%20of%20percutaneous%20posterolateral%20spinal%20fusion%20with%20recombinant%20bone%20morphogenetic%20protein-2%20.pdf Chan, Chris Yin Wei and Kwan, Mun Keong and Saw, Lim Beng and Hussin, Paisal (2017) Feasibility of percutaneous posterolateral spinal fusion with recombinant bone morphogenetic protein-2 (rhBMP-2): a comparison with standard methods using an animal model study. Clinical Spine Surgery, 30 (2). 138 - 147. ISSN 2380-0186; ESSN: 2380-0194 10.1097/BSD.0b013e3182aa6860
institution Universiti Putra Malaysia
building UPM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Putra Malaysia
content_source UPM Institutional Repository
url_provider http://psasir.upm.edu.my/
language English
description Background Context: The clinical application of recombinant bone morphogenetic protein in spinal surgery has been shown to be safe and effective. However, its use in minimally invasive spine surgery has been limited to anterior interbody fusion procedures. To date, no study has evaluated the feasibility of percutaneous posterolateral fusion in the spine utilizing recombinant bone morphogenetic protein-2 (rhBMP-2). Purpose: To evaluate the feasibility of percutaneous posterolateral fusion in the spine utilizing rhBMP-2. Study Design: Animal study. Methods: This is an animal research model involving 32 New Zealand white rabbits stratified into 4 study groups: control, autogenous iliac crest bone graft (ICBG), demineralized bone matrix (DBM), and rhBMP-2 groups, with 8 study subjects per group. The rhBMP-2 group was subdivided into the open technique (right side) and the percutaneous technique groups (left side). Fusion was graded at 6 weeks and 3 months after plain radiography, computed tomography, and clinical assessment with the following grading system: grade A, no bone formation; grade B, non-bridging bone formation; grade C, fusion; and grade D, fusion with ectopic bone formation. Results: No fusion was noted in the placebo and the DBM groups. However, in the DBM group, bone formation occurred in 37.5% of the subjects. The rhBMP-2 group had a higher fusion rate compared with the ICBG group at 6 weeks and 3 months. The fusion rate for the ICBG, the rhBMP-2 (open), and the rhBMP-2 (percutaneous) groups were 37.5%, 87.5%, and 50.0% at 6 weeks and 50.0%, 100.0%, and 62.5% at 3 months, respectively. Ectopic bone formation occurred in 12.5% of the cases in the rhBMP-2 (percutaneous) group and in 25.0% of the cases in the rhBMP-2 (open) group. Conclusions: Usage of rhBMP-2 is feasible for percutaneous posterolateral fusion of the lumbar spine in this animal model. However, a more precise delivery system might improve the fusion rate when the percutaneous technique is used. A significant rate of ectopic bone formation occurred when rhBMP-2 was used.
format Article
author Chan, Chris Yin Wei
Kwan, Mun Keong
Saw, Lim Beng
Hussin, Paisal
spellingShingle Chan, Chris Yin Wei
Kwan, Mun Keong
Saw, Lim Beng
Hussin, Paisal
Feasibility of percutaneous posterolateral spinal fusion with recombinant bone morphogenetic protein-2 (rhBMP-2): a comparison with standard methods using an animal model study
author_facet Chan, Chris Yin Wei
Kwan, Mun Keong
Saw, Lim Beng
Hussin, Paisal
author_sort Chan, Chris Yin Wei
title Feasibility of percutaneous posterolateral spinal fusion with recombinant bone morphogenetic protein-2 (rhBMP-2): a comparison with standard methods using an animal model study
title_short Feasibility of percutaneous posterolateral spinal fusion with recombinant bone morphogenetic protein-2 (rhBMP-2): a comparison with standard methods using an animal model study
title_full Feasibility of percutaneous posterolateral spinal fusion with recombinant bone morphogenetic protein-2 (rhBMP-2): a comparison with standard methods using an animal model study
title_fullStr Feasibility of percutaneous posterolateral spinal fusion with recombinant bone morphogenetic protein-2 (rhBMP-2): a comparison with standard methods using an animal model study
title_full_unstemmed Feasibility of percutaneous posterolateral spinal fusion with recombinant bone morphogenetic protein-2 (rhBMP-2): a comparison with standard methods using an animal model study
title_sort feasibility of percutaneous posterolateral spinal fusion with recombinant bone morphogenetic protein-2 (rhbmp-2): a comparison with standard methods using an animal model study
publisher Lippincott, Williams & Wilkins
publishDate 2017
url http://psasir.upm.edu.my/id/eprint/61875/1/Feasibility%20of%20percutaneous%20posterolateral%20spinal%20fusion%20with%20recombinant%20bone%20morphogenetic%20protein-2%20.pdf
http://psasir.upm.edu.my/id/eprint/61875/
_version_ 1643837615268429824
score 13.211869

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