Use of rhBMP for minimally invasive TLIF offers highest fusion rates

SAN DIEGO — The rates of fusion following a minimally invasive transforaminal lumbar interbody fusion are directly affected by the choice of graft material, a speaker said here.

Marjan Alimi, MD, said the addition of rhBMP resulted in higher rates of fusion compared with non-rhBMP grafts, iliac bone graft material and isolated use of autologous local bone.

“Utilization of rhBMP results in high fusion rates, and isolated use of local bone has the lowest fusion rate in the entire group,” Alimi said at the International Society for the Advancement of Spine Surgery Annual Meeting.

Marjan Alimi

Using a Medline search, Alimi and colleagues identified a total of 40 series with 1,320 patients, in which rates of fusion from minimally invasive transforaminal lumbar interbody fusion (TLIF) procedures using different graft materials were reported. The researchers used patient demographics, preoperative data, type of graft material, clinical outcome, fusion rate and duration of follow-up to create a database and defined certain study groups based on the types of grafts utilized. The most commonly operated level in the study was L4-L5, according to Alimi.

Although materials with rhBMP offered the highest fusion rates, all of the materials studied resulted in high rates of fusion, ranging from 92% to 99%. Autologous local bone had the lowest fusion rate at 91.7%, but with the addition of rhBMP, the rate jumped to 93%, Alimi said.

Overall, Alimi said materials with rhBMP resulted in a 96.6% fusion rate, whereas materials without rhBMP resulted in a 92.5% fusion rate.

Alimi concluded that the harvesting of rhBMP and iliac bone is difficult, so the use of other non-bone graft materials is reasonable. – by Robert Linnehan

Reference:

Parajon A, et al. Paper #561. Presented at: International Society for the Advancement of Spine Surgery Annual Meeting. April 15-17, 2015; San Diego.

Disclosure: Alimi reports no relevant financial disclosures.