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The Combined Effects of RhBMP-2 and Systemic RANKL Inhibitor in Patients With Bone Density Loss Undergoing Posterior Lumbar Interbody Fusion: A Retrospective Observational Analysis With Propensity Score Matching – Lumbar Fusion

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This article published in Neurospine discusses the combined effect of recombinant human bone morphogenic protein 2 (rhBMP-2) and denosumab, a human monoclonal antibody targeting the receptor activator of nuclear factor kappa B ligand (RANKL), on postoperative spinal fusion in patients with bone density loss. The study included 251 patients who underwent posterior lumbar interbody fusion (PLIF) and found that the combination of rhBMP-2 and denosumab improved bone formation and reduced complications compared to rhBMP-2 alone. The results suggest that this combination treatment may be beneficial for patients undergoing spinal fusion surgery

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

: The combined use of rhBMP-2 and RANKL inhibition in patients with bone density loss can enhance bone formation after PLIF with fewer complications than rhBMP-2 alone.

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Neurospine. 2023 Dec;20(4):1186-1192. doi: 10.14245/ns.2346702.351. Epub 2023 Dec 31.ABSTRACTOBJECTIVE: The risks of nonunion and subsidence are high in patients with bone density loss undergoing spinal fusion surgery. The internal application of recombinant human bone morphogenic protein 2 (rhBMP-2) in an interbody cage improves spinal fusion; however, related complications have been reported. Denosumab, a human monoclonal,

Neurospine. 2023 Dec;20(4):1186-1192. doi: 10.14245/ns.2346702.351. Epub 2023 Dec 31.

ABSTRACT

OBJECTIVE: The risks of nonunion and subsidence are high in patients with bone density loss undergoing spinal fusion surgery. The internal application of recombinant human bone morphogenic protein 2 (rhBMP-2) in an interbody cage improves spinal fusion; however, related complications have been reported. Denosumab, a human monoclonal antibody targeting the receptor activator of nuclear factor kappa B ligand (RANKL), hinders osteoblast differentiation and function. Therefore, this study aimed to observe the combined effect of the local application of rhBMP-2 in a lumbar cage and systemic RANKL inhibition on postoperative spinal fusion in patients with bone density loss undergoing posterior lumbar interbody fusion (PLIF).

METHODS: This retrospective observational study included 251 consecutive patients with spinal stenosis who underwent PLIF at a single center between 2017 and 2021. Clinical outcomes were assessed, and radiographic evaluations included lumbar flexion, extension, range of motion, and subsidence. Statistical analyses were conducted to identify the combined effect of the treatment and the subsidence and spinal fusion status.

RESULTS: One hundred patients were included in the final analysis. Denosumab treatment significantly reduced the rate of osteolysis (p = 0.013). When denosumab was administered in combination with rhBMP-2, the fusion status remained similar; however, the incidences of postoperative osteolysis and postoperative oozing day decreased.

: The combined use of rhBMP-2 and RANKL inhibition in patients with bone density loss can enhance bone formation after PLIF with fewer complications than rhBMP-2 alone.

PMID:38171287 | DOI:10.14245/ns.2346702.351

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Read the original publication:

The Combined Effects of RhBMP-2 and Systemic RANKL Inhibitor in Patients With Bone Density Loss Undergoing Posterior Lumbar Interbody Fusion: A Retrospective Observational Analysis With Propensity Score Matching

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Neurospine. 2023 Dec;20(4):1186-1192. doi: 10.14245/ns.2346702.351. Epub 2023 Dec 31.ABSTRACTOBJECTIVE: The risks of nonunion and subsidence are high in patients with bone density loss undergoing spinal fusion surgery. The internal application of recombinant human bone morphogenic protein 2 (rhBMP-2) in an interbody cage improves spinal fusion; however, related complications have been reported. Denosumab, a human monoclonal

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