Document Detail

Complications associated with single-level transforaminal lumbar interbody fusion.
MedLine Citation:
PMID:  19482519     Owner:  NLM     Status:  MEDLINE    
BACKGROUND CONTEXT: The transforaminal lumbar interbody fusion (TLIF) procedure has become an increasingly popular means of obtaining a circumferential fusion while avoiding the morbidity of the anterior approach. Concerns remain, however, regarding the clinical efficacy and safety of its use. PURPOSE: The purpose of this study was to evaluate the complications of the single-level TLIF procedure. The difference in complications observed with the use of iliac crest autograft compared with rhBMP-2 will be assessed. STUDY DESIGN: Retrospective cohort study; a review of complications. METHODS: Patients who underwent a single-level TLIF between January 2004 to May 2007 with either autograft iliac crest or rhBMP-2 were identified. A retrospective review of these patients included operative reports, pre- and postoperative medical records, most recent postoperative dynamic and static lumbar radiographs, and computed tomography scans (when available). RESULTS: A total of 130 patients met the study criteria; 119 patients were available for follow-up, with an average radiographic follow-up of 19.1 months and an average clinical follow-up of 27.6 months. Thirty-three patients received iliac crest autograft and 86 patients received rhBMP-2. Complications occurred in 40 of the 119 study patients (33.6%). The autograft group had a higher complication rate (45.5% vs. 29.1%), but the difference was not statistically significant (p=.09). Complications in the autograft group included persistent donor-site pain (30.3%), donor-site infection (3.1%), lumbar wound infection (6.1%), and postoperative radiculitis (3.0%). Complications in the rhBMP-2 group included postoperative radiculitis (14.0%), vertebral osteolysis (5.8%), ectopic bone formation (2.3%), and lumbar wound infection (3.5%). A hydrogel sealant (Duraseal; Confluent Surgical Inc., Waltham, MA, USA) was used in 37 out of 86 patients in the rhBMP-2 group. The use of this sealant decreased the rate of postoperative radiculitis in the rhBMP-2 group from 20.4% to 5.4% (p=.047). The radiographic nonunion rate at most recent follow-up was 3.0% in the autograft group and 3.5% (p=.90) in the rhBMP-2 group. CONCLUSIONS: The most common complications in the autograft group were related to the donor site. The most common complication in the rhBMP-2 group was postoperative radiculitis, the incidence of which is reduced by the use of a hydrogel sealant.
Jeffrey A Rihn; Ravi Patel; Junaid Makda; Joseph Hong; David G Anderson; Alexander R Vaccaro; Alan S Hilibrand; Todd J Albert
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Publication Detail:
Type:  Journal Article     Date:  2009-05-30
Journal Detail:
Title:  The spine journal : official journal of the North American Spine Society     Volume:  9     ISSN:  1878-1632     ISO Abbreviation:  Spine J     Publication Date:  2009 Aug 
Date Detail:
Created Date:  2009-07-22     Completed Date:  2009-10-01     Revised Date:  2010-03-16    
Medline Journal Info:
Nlm Unique ID:  101130732     Medline TA:  Spine J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  623-9     Citation Subset:  IM    
Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University Hospital, 925 Chestnut Street, Philadelphia, PA 19107, USA.
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MeSH Terms
Bone Morphogenetic Proteins / therapeutic use
Cohort Studies
Lumbar Vertebrae
Middle Aged
Postoperative Complications / epidemiology*
Recombinant Proteins / therapeutic use
Retrospective Studies
Spinal Fusion / adverse effects*,  methods*
Transforming Growth Factor beta / therapeutic use
Transplantation, Autologous
Reg. No./Substance:
0/Bone Morphogenetic Proteins; 0/Recombinant Proteins; 0/Transforming Growth Factor beta; 0/recombinant human bone morphogenetic protein-2
Comment In:
Spine J. 2010 Mar;10(3):279; author reply 279-80   [PMID:  20207336 ]
Spine J. 2009 Aug;9(8):667-9   [PMID:  19622413 ]

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