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Complications associated with single-level transforaminal lumbar interbody fusion

BACKGROUND CONTEXT: The transforaminal lumbar interbody fusion (TLIF) procedure has become an increasingly popular means of obtaining a circumferential fusion while avoiding the morbidity of the anterior approach. Concerns remain, however, regarding the clinical efficacy and safety of its use. PURPOSE: The purpose of this study was to evaluate the complications of the single-level TLIF procedure. The difference in complications observed with the use of iliac crest autograft compared with rhBMP-2 will be assessed. STUDY DESIGN: Retrospective cohort study; a review of complications. METHODS: Patients who underwent a single-level TLIF between January 2004 to May 2007 with either autograft iliac crest or rhBMP-2 were identified. A retrospective review of these patients included operative reports, pre- and postoperative medical records, most recent postoperative dynamic and static lumbar radiographs, and computed tomography scans (when available). RESULTS: A total of 130 patients met the study criteria; 119 patients were available for follow-up, with an average radiographic follow-up of 19.1 months and an average clinical follow-up of 27.6 months. Thirty-three patients received iliac crest autograft and 86 patients received rhBMP-2. Complications occurred in 40 of the 119 study patients (33.6%). The autograft group had a higher complication rate (45.5% vs. 29.1%), but the difference was not statistically significant (p=.09). Complications in the autograft group included persistent donor-site pain (30.3%), donor-site infection (3.1%), lumbar wound infection (6.1%), and postoperative radiculitis (3.0%). Complications in the rhBMP-2 group included postoperative radiculitis (14.0%), vertebral osteolysis (5.8%), ectopic bone formation (2.3%), and lumbar wound infection (3.5%). A hydrogel sealant (Duraseal; Confluent Surgical Inc., Waltham, MA, USA) was used in 37 out of 86 patients in the rhBMP-2 group. The use of this sealant decreased the rate of postoperative radiculitis in the rhBMP-2 group from 20.4% to 5.4% (p=.047). The radiographic nonunion rate at most recent follow-up was 3.0% in the autograft group and 3.5% (p=.90) in the rhBMP-2 group. CONCLUSIONS: The most common complications in the autograft group were related to the donor site. The most common complication in the rhBMP-2 group was postoperative radiculitis, the incidence of which is reduced by the use of a hydrogel sealant

Keywords : adverse effects,Bone Morphogenetic Protein 2,Bone Morphogenetic Proteins,Cohort Studies,complications,epidemiology,Female,Growth,Humans,Incidence,Lumbar Vertebrae,Male,Medical Records,methods,Middle Aged,Morbidity,Osteolysis,Pain,Postoperative Complications,Recombinant Proteins,Retrospective Studies,Safety,Spinal Fusion,surgery,therapeutic use,Transforming Growth Factor beta,Transplantation,Autologous,, Associated,With,Singlelevel,Transforaminal,Lumbar, how much do cortisone injections cost uk

Date of Publication : 2009 Aug

Authors : Rihn JA;Patel R;Makda J;Hong J;Anderson DG;Vaccaro AR;Hilibrand AS;Albert TJ;

Organisation : Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University Hospital, 925 Chestnut Street, Philadelphia, PA 19107, USA. jrihno16@yahoo.com

Journal of Publication : Spine J

Pubmed Link : https://www.ncbi.nlm.nih.gov/pubmed/19482519

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