The Fate of L5–S1 With Low-Dose BMP-2 and Pelvic Fixation, With or Without Interbody Fusion, in Adult Deformity Surgery. Issue 11 (1st June 2015)

• Record Type: Journal Article
• Authors: Annis, Prokopis; Brodke, Darrel S.; Spiker, William R.; Daubs, Michael D.; Lawrence, Brandon D.
• Is Part Of: Spine. Volume 40:Issue 11(2015)
• Publication Date: 2015-06-01
• Subjects: Spine -- Abnormalities -- Periodicals; Spine -- Diseases -- Periodicals; Spine -- Surgery -- Periodicals; 616.73005
• DOI: 10.1097/BRS.0000000000000867
• Languages: English
• ISSNs: 0362-2436

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Study Design.</title> <p>Retrospective comparative case series.</p> </sec> <sec> <title>Objective.</title> <p>Evaluate L5–S1 fusion rates when lower dose of bone morphogenic protein-2 (BMP-2) (average 3.2 mg) and pelvic fixation were used, with or without interbody fusion.</p> </sec> <sec> <title>Summary of Background Data.</title> <p>Pseudarthrosis at L5–S1 is one of the most common complications of long fusions to the sacrum in adult deformity surgery. Strategies for decreasing pseudarthrosis include interbody fusion, use of BMP-2 at the lumbosacral junction, and the use of sacropelvic fixation, individually or in combination. High-dose BMP-2 (20–40 mg) placed posterolaterally has shown comparable fusion rates with interbody fusion.</p> </sec> <sec> <title>Methods.</title> <p>Retrospective review of 61 consecutive patients with minimum 2-year follow-up at a single institution. All patients had an isolated posterior approach, 5 or more levels fused including L5–S1, use of pelvic fixation, and no prior L5–S1 procedures. The patients were divided in 2 groups for comparison on the basis of the use of an interbody cage/fusion at the L5–S1 level. Revision rates and implant-related complications were also reported.</p> </sec> <sec> <title>Results.</title> <p>The fusion rate at L5–S1 was 97% (59/61), with no difference between the interbody and no interbody fusion groups (97% <italic>vs</italic>. 96%, <italic>P</italic> = 1.0). There were no significant differences in the radiographical parameters or deformity correction between the groups. The mean amount of BMP-2 used in the interbody group was 4.1 mg (2–10), 2.5 mg (0–8) in the disc space, and 1.6 mg (0-4) in the interbody cage, whereas there was no difference in the amount of recombinant human bone morphogenic protein-2 placed posterolaterally between the 2 groups (interbody fusion = 1.6 <italic>vs</italic>. non–interbody fusion = 2.0 mg, <italic>P</italic> = 0.08) along with autograft and allograft. The overall revision rate for L5–S1 nonunion was 1.6%.</p> </sec> <sec> <title>Conclusion.</title> <p>The use of low dose of BMP-2 at the L5–S1 level in combination with sacropelvic fixation achieved satisfactory fusion rates in adult deformity surgery. No additional benefit was encountered by adding an interbody cage.</p> <p> <bold>Level of Evidence:</bold> 4</p> </sec> </abstract>