BMP-2-Augmented Transforaminal Lumbar Interbody Fusion for the Treatment of Chronic Low Back Pain Secondary to the Homogeneous Diagnosis of Discogenic Pain Syndrome: Two-Year Outcomes.
Spine (Phila Pa 1976). 2013 Jun 17;
Authors: Corenman DS, Gillard DM, Dornan G, Strauch E
: Study Design: A retrospective observational study.Objective: To assess clinical outcomes; perioperative complications; revision surgery rates; and BMP-2-related osteolysis, heterotopic bone, and unexplained postoperative radiculitis (BMPP) in a group of patients treated with BMP-2-augmented transforaminal lumbar interbody fusion (bTLIF) for the homogeneous diagnosis of discogenic pain syndrome (DPS) and to put forth the algorithm used to make the diagnosis.Summary of Background Data: There is a paucity of literature describing outcomes of TLIF for the homogeneous diagnosis of DPS, an old but controversial member of the lumbar degenerative disease family.Methods: The registry from a single-surgeon was queried for patients who had undergone bTLIF for the homogeneous diagnosis of DPS, which was made via specific diagnostic algorithm. Clinical outcomes were determined by analyzing point-improvement from typical outcome questionnaires (OQs) and the data from Patient Satisfaction and Return to Work (RTW) questionnaires. Independent record review was employed to assess all outcomes.Results: 80% of the cohort (36/45) completed pre-op and post-op OQs at an average follow-up of 41.9 ± 11.9 months, which demonstrated significant clinical improvement: ODI = 16.4 (p<0.0001), SF12-PCS = 10.0 (p<0.0001), and a Numeric Rating Scale for back pain = 2.3 (p<0.0001). The median patient satisfaction score was 9.0 (10 = complete satisfaction), and 84.4% (27/32) of the cohort were able to return to their pre-op job, with or without modification. There were 3 perioperative complications; 4 revision surgeries; and 11 cases of benign BMPP. There were no incidents of the intraoperative dural tears or nerve root injury, and neither litigation involvement (11/36, P>0.17), preoperative depression (15/36, P >0.19), nor prior discectomy/decompression (14/36, P<0.37) were predictors of outcomes.Conclusions: Although limited by retrospective design and small cohort, the results of this investigation suggest that bTLIF is a reasonable treatment option for patients who suffer DPS and affords high patient satisfaction. A larger study is needed to confirm these findings.
PMID: 23778368 [PubMed – as supplied by publisher]