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Fusion and subsidence rate of stand alone anterior lumbar interbody fusion using PEEK cage with recombinant human bone morphogenetic protein-2

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Abstract

Introduction

Anterior lumbar interbody fusion (ALIF) is an established treatment for structural instability associated with symptomatic disk degeneration (SDD). Stand-alone ALIF offers many advantages, however, it may increase the risk of non-union. Recombinant human bone morphogenetic protein-2 (BMP-2) may enhance fusion rate but is associated with postoperative complication. The optimal dose of BMP-2 remains unclear. This study assessed the fusion and subsidence rates of stand-alone ALIF using the SynFix-LR interbody cage with 6 ml/level of BMP-2.

Methods

Thirty-two ALIF procedures were performed by a single surgeon in 25 patients. Twenty-five procedures were performed for SDD without spondylolisthesis (SDD group) and seven procedures were performed for SDD with grade-I olisthesis (SDD-olisthesis group). Patients were followed-up for a mean of 17 ± 6 months.

Results

Solid fusion was achieved in 29 cases (90.6 %) within 6 months postoperatively. Five cases of implant subsidence were observed (16 %). Four of these occurred in the SDD-olisthesis group and one occurred in the SDD group (57 % vs. 4 % respectively; p = 0.004). Three cases of subsidence failed to fuse and required revision. The body mass index of patients with olisthesis who developed subsidence was higher than those who did not develop subsidence (29 ± 2.6 vs. 22 ± 6.5 respectively; p = 0.04). No BMP-2 related complications occurred.

Conclusion

The overall fusion rate of stand-alone ALIF using the SynFix-LR system with BMP-2 was 90.6 %, comparable with other published series. No BMP-2 related complication occurred at a dose of 6 mg/level. Degenerative spondylolisthesis and obesity seemed to increase the rate of implant subsidence, and thus we believe that adding posterior fusion for these cases should be considered.

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Acknowledgments

I hereby declare that no funding or grants were given to conduct this study.

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Authors and Affiliations

  1. The Spine Unit, Queen’s Medical Centre, Nottingham, UK

    Eyal Behrbalk, Ruth M. Parks, Reuben Chee Cheong Soh & Bronek Maximilian Boszczyk

  2. Royal National Orthopaedic Hospital NHS Trust Brockley Hill, Stanmore, Middlesex, UK

    Ofir Uri

  3. The Radiology Department, Queen’s Medical Centre, Nottingham, UK

    Rachel Musson

Authors
  1. Eyal Behrbalk
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  2. Ofir Uri
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  3. Ruth M. Parks
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  4. Rachel Musson
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  5. Reuben Chee Cheong Soh
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  6. Bronek Maximilian Boszczyk
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Correspondence to Eyal Behrbalk.

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Behrbalk, E., Uri, O., Parks, R.M. et al. Fusion and subsidence rate of stand alone anterior lumbar interbody fusion using PEEK cage with recombinant human bone morphogenetic protein-2. Eur Spine J 22, 2869–2875 (2013). https://doi.org/10.1007/s00586-013-2948-5

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  • DOI: https://doi.org/10.1007/s00586-013-2948-5

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