Autologous iliac crest bone, which involves harvesting a part of the patient’s own iliac crest bone, was previously considered the “gold standard” in spine fusion surgery. This method potentially results in a significant additional morbidity. The autograft harvesting procedure can be associated with increased blood loss, increased operative time, additional complications, prolonged hospital stays and recovery time, along with long-term hip pain and even chronic fractures.
BNA surgeons recently published a landmark paper describing a new type of spinal fusion material called rhBMP-2 (recombinant human bone morphogenetic protein) for interbody fusions from a posterior (less invasive) approach. This technique virtually eliminates the need for painful bone graft harvesting in 99% of patients and significantly shortens patients’ recovery time. RhBMP-2 (Medtronic Sofamor Danek, Inc.) is a genetically engineered version of a naturally occurring protein that helps to stimulate bone growth. Boulder Neurosurgical & Spine Associates has performed a clinical trial that demonstrated the osteoinductive (ability to cause new bone formation) potential and safety of rhBMP-2 for TLIF in the clinical settings.
TLIF refers to Transforaminal Lumbar Interbody Fusion, which is a revolutionary technique that allows for anterior interbody fusion without the anterior abdominal incision. In other words, this surgery has all the advantages of the anterior-posterior surgical approach (higher rate of fusion, reconstitution of sagittal alignment, etc.) without the added incision and significant morbidity associated with anterior abdominal approaches. Additional fairly devastating complications could be encountered (vascular injury or sympathetic plexus injury, and retrograde ejaculation in men) that are not associated with the posterior approach. To determine rhBMP-2 safety, patients that participated in this clinical study were evaluated for possible complications. There were no complications as a result of rhBMP-2 use during the surgery or the two-year postoperative follow-up period.
The study also suggested that the use of the bone morphogenetic protein results in a reliable fusion sooner and almost completely eliminates the need for an iliac crest bone harvesting. A solid fusion was achieved in 100% of the patients that participated in this study. X-rays below demonstrate solid fusion.
The study was published in one of the top journals in the field, the Journal of Neurosurgery. Click this link (PDF) to read the paper.