PT  - JOURNAL ARTICLE
AU  - OVERLEY, SAMUEL C.
AU  - MCANANY, STEVEN J.
AU  - ANWAR, MUHAMMAD A.
AU  - MERRILL, ROBERT K.
AU  - LOVY, ANDREW
AU  - GUZMAN, JAVIER Z.
AU  - ZHADANOV, SERGEY
AU  - DOSHI, AMISH
AU  - ROTHENBERG, EDWARD
AU  - VAISHNAV, AVANI
AU  - GANG, CATHERINE
AU  - QURESHI, SHEERAZ A.
TI  - Predictive Factors and Rates of Fusion in Minimally Invasive Transforaminal Lumbar Interbody Fusion Utilizing rhBMP-2 or Mesenchymal Stem Cells
AID  - 10.14444/6007
DP  - 2019 Feb 01
TA  - International Journal of Spine Surgery
PG  - 46--52
VI  - 13
IP  - 1
4099  - https://www.ijssurgery.com/content/13/1/46.short
4100  - https://www.ijssurgery.com/content/13/1/46.full
SO  - Int J Spine Surg2019 Feb 01; 13
AB  - Background: Several fusion adjuncts exist to enhance fusion rates during minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). The objective of this study was to compare fusion rates in patients undergoing MI-TLIF with either rhBMP-2 or cellularized bone matrix (CBM).Methods: We conducted a single surgeon retrospective cohort study of patients who underwent MI-TLIF with either rhBMP-2 or CBM placed in an interbody cage. Single and multilevel procedures were included. Fusion was assessed on computed tomography scans at 12-month follow-up by an independent, blinded, board-certified neuroradiologist. Fusion rates and rate of revision surgery were compared with a Fisher exact test between the 2 groups. A multivariate regression analysis was performed to identify patient factors that were predictive of radiographic nonunion after MI-TLIF.Results: A total of 93 fusion levels in 78 patients were reviewed. Thirty-nine patients received CBM, and 39 patients received rhBMP-2. The patients receiving rhBMP-2 were older on average (61.4 vs 55.6, P = .03). The overall fusion rate was 68% in the CBM group (32/47 levels) and 78% in the rhBMP-2 group (36/46) (P = .35). Only preoperative hypertension was predictive of radiographic nonunion (odds ratio = 3.5, P = .05). There were 3 smokers in the CBM group and 4 smokers in the BMP group, and 1 in each group experienced radiographic pseudarthrosis. A total of 4 patients, 3 in the CBM group and 1 in the BMP group (P = .61), required revision for symptomatic pseudarthrosis. All of these patients had a single-level index procedure.Conclusions: There were no differences in radiographic fusion and rate of revision surgery in patients who underwent MI-TLIF with either rhBMP-2 or CBM as fusion adjuncts.Level of Evidence: 3Clinical Relevance: Both rhBMP-2 and CBMs can be used as effective fusion adjuncts without any clear advantage of one over the other.