1
|
Zhao E, Hirase T, Kim AG, Du JY, Amen TB, Araghi K, Subramanian T, Kamil R, Shahi P, Fourman MS, Asada T, Simon CZ, Singh N, Korsun M, Tuma OC, Zhang J, Lu AZ, Mai E, Kim AYE, Allen MRJ, Kwas C, Dowdell JE, Sheha ED, Qureshi SA, Iyer S. The Impact of Posterior Intervertebral Osteophytes on Patient-Reported Outcome Measures After L5-S1 Anterior Lumbar Interbody Fusion and Transforaminal Lumbar Interbody Fusion. Spine (Phila Pa 1976) 2024; 49:652-660. [PMID: 38193931 DOI: 10.1097/brs.0000000000004904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/11/2023] [Indexed: 01/10/2024]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE (1) To develop a reliable grading system to assess the severity of posterior intervertebral osteophytes and (2) to investigate the impact of posterior intervertebral osteophytes on clinical outcomes after L5-S1 decompression and fusion through anterior lumbar interbody fusion (ALIF) and minimally-invasive transforaminal lumbar interbody fusion (MIS-TLIF). BACKGROUND There is limited evidence regarding the clinical implications of posterior lumbar vertebral body osteophytes for ALIF and MIS-TLIF surgeries and there are no established grading systems that define the severity of these posterior lumbar intervertebral osteophytes. PATIENTS AND METHODS A retrospective analysis of patients undergoing L5-S1 ALIF or MIS-TLIF was performed. Preoperative and postoperative patient-reported outcome measures of the Oswestry Disability Index (ODI) and leg Visual Analog Scale (VAS) at 2-week, 6-week, 12-week, and 6-month follow-up time points were assessed. Minimal clinically important difference (MCID) for ODI of 14.9 and VAS leg of 2.8 were utilized. Osteophyte grade was based on the ratio of osteophyte length to foraminal width. "High-grade" osteophytes were defined as a maximal osteophyte length >50% of the total foraminal width. RESULTS A total of 70 consecutive patients (32 ALIF and 38 MIS-TLIF) were included in the study. There were no significant differences between the two cohorts in patient-reported outcome measures or achievement of MCID for Leg VAS or ODI preoperatively or at any follow-ups. On multivariate analysis, neither the surgical approach nor the presence of high-grade foraminal osteophytes was associated with leg VAS or ODI scores at any follow-up time point. In addition, neither the surgical approach nor the presence of high-grade foraminal osteophytes was associated with the achievement of MCID for leg VAS or ODI at 6 months. CONCLUSION ALIF and MIS-TLIF are both valid options for treating degenerative spine conditions and lumbar radiculopathy, even in the presence of high-grade osteophytes that significantly occupy the intervertebral foramen. LEVEL OF EVIDENCE 3.
Collapse
Affiliation(s)
- Eric Zhao
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
- Department of Spine Surgery, Weill Cornell Medicine, New York, NY
| | - Takashi Hirase
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Andrew G Kim
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Jerry Y Du
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Troy B Amen
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Kasra Araghi
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Tejas Subramanian
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
- Department of Spine Surgery, Weill Cornell Medicine, New York, NY
| | - Robert Kamil
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Pratyush Shahi
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | | | - Tomoyuki Asada
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Chad Z Simon
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Nishtha Singh
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Maximilian Korsun
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Olivia C Tuma
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Joshua Zhang
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Amy Z Lu
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
- Department of Spine Surgery, Weill Cornell Medicine, New York, NY
| | - Eric Mai
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
- Department of Spine Surgery, Weill Cornell Medicine, New York, NY
| | - Ashley Yeo Eun Kim
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
- Department of Spine Surgery, Weill Cornell Medicine, New York, NY
| | - Myles R J Allen
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Cole Kwas
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - James E Dowdell
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Evan D Sheha
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Sheeraz A Qureshi
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Sravisht Iyer
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| |
Collapse
|
2
|
Concentration-Dependent Efficacy of Recombinant Human Bone Morphogenetic Protein-2 Using a HA/β-TCP Hydrogel Carrier in a Mini-Pig Vertebral Oblique Lateral Interbody Fusion Model. Int J Mol Sci 2023; 24:ijms24010892. [PMID: 36614335 PMCID: PMC9821164 DOI: 10.3390/ijms24010892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023] Open
Abstract
Bone morphogenetic protein-2 (BMP-2) is used in the treatment of degenerative spinal disease and vertebral fractures, spine fusion, dental surgery, and facial surgery. However, high doses are associated with side effects such as inflammation and osteophytes. In this study, we performed spinal fusion surgery on mini-pigs using BMP-2 and a HA/β-TCP hydrogel carrier, and evaluated the degree of fusion and osteophyte growth according to time and dosage. Increasing the dose of BMP-2 led to a significantly higher fusion rate than was observed in the control group, and there was no significant difference between the 8-week and 16-week samples. We also found that the HA + β-TCP hydrogel combination helped maintain the rate of BMP-2 release. In conclusion, the BMP-2-loaded HA/β-TCP hydrogel carrier used in this study overcame the drawback of potentially causing side effects when used at high concentrations by enabling the sustained release of BMP-2. This method is also highly efficient, since it provides mineral matter to accelerate the fusion rate of the spine and improve bone quality.
Collapse
|