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High Rate of Osteolysis in Fusions Using Morphogenetic Protein

Most cases of osteolysis in transforaminal lumbar interbody fusions using BMP persist

FRIDAY, July 15 (HealthDay News) -- Use of bone morphogenetic protein (BMP) in transforaminal lumbar interbody fusion (TLIF) is associated with a high rate of adjacent vertebral body osteolysis in the first three to six months post-surgery, with osteolysis persisting at one-year fusion in most cases, according to a study published in the June issue of The Spine Journal.

Melvin D. Helgeson, M.D., from the Walter Reed Army Medical Center in Washington, D.C., and colleagues investigated the incidence and resolution of osteolysis associated with the use of BMP in 23 patients who underwent TLIF. Computed tomography (CT) scans were taken within 48 hours of surgery, three to six months postoperatively, and one to two years postoperatively; and the volume of osteolysis was compared at three to six months and after one year. Areas of osteolysis were measured in all three planes. A total of 78 vertebral bodies/end plates were assessed for osteolysis at 39 levels.

The investigators found that the incidence of postoperative osteolysis in the adjacent vertebral bodies was 54 percent at three to six months compared with 41 percent at one to two years. The mean volume of osteolysis decreased from 0.306 cm³ at three to six months to 0.216 cm³ at one to two years (P = 0.082). The rate of fusion or final outcome did not appear to be significantly affected by the area or rate of osteolysis, with an overall union rate of 83 percent.

"The use of BMP in TLIFs is associated with a high rate of osteolysis in the first three to six months. Although the incidence of osteolysis decreased at one year, most cases of osteolysis did not resolve and were present at ultimate fusion," the authors write.

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