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Study finds better lumbar fusion rates using rhBMP-2 with allograft ring vs. allograft alone

The rhBMP-2 group had significantly better clinical scores at 6-months postop, although outcomes were similar between groups at 2 years.

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Adding recombinant human bone morphogenetic protein-2 to interbody femoral ring allograft can significantly improve rates of lumbar fusion compared to using allograft alone, a prospective study shows.

Paul J. Slosar, MD, and colleagues at the San Francisco Spine Institute in Daly City, Calif., and at Orthopaedic Specialists of Austin, Texas, investigated the effect from incorporating recombinant human bone morphogenetic protein-2 (rhBMP-2) into a variation of anterior lumbar interbody fusion (ALIF). The study included 75 consecutive patients undergoing arthrodesis at 1 to 3 lumbar spine levels.

The control group included 30 patients incorporating 62 fusion levels. These patients received a femoral ring allograft [Precision Regeneration Technologies Inc.], which was filled with allograft chips only.

The study group included 45 patients incorporating 103 fusion levels. Surgeons used the same allograft ring, but the ring was filled with two sponges containing rhBMP-2 [InFuse Bone Graft; Medtronic Sofamor Danek], according to the study, published in The Spine Journal.

Surgeons used pedicle screw fixation in all patients, the authors noted.

Investigators found that patients who received rhBMP-2 had significantly better fusion rates at all follow-up points out to 24 months postop (P<.001).

Also, five control patients experienced seven pseudarthroses. Four of these patients underwent a salvage posterolateral fusion and the fifth patient is pending reoperation, according to the study.

No patients in the rhBMP-2 group have required revision or salvage fusions, the authors noted.

Patients in the rhBMP-2 group also had significantly better improvements in Oswestry Disability Index (ODI) scores and the Numerical Rating Scale (NRS) at 6-months follow-up.

Preoperatively, ODI scores averaged 61.1 points for the rhBMP-2 group and 58.6 for the control group. At 6 months, mean ODI scores improved to 34.1 points for the rhBMP-2 group and to 41.5 points for controls (P<.001).

Preoperative NRS scores averaged 8.1 points for rhBMP patients and 8.2 points for controls. At 6 months, mean NRS scores improved to 3.9 points for the rhBMP-2 group and to 5.4 points for controls, according to the study.

Both groups had similar clinical outcomes at 2 years.

For more information:

• Slosar PJ, Josey R, Reynolds J. Accelerating lumbar fusions by combining rhBMP-2 with allograft bone: a prospective analysis of interbody fusion rates and clinical outcomes. Spine J. 2007;7:301-307.