Symptomatic calcified perineural cyst after use of bone morphogenetic protein in transforaminal lumbar interbody fusion: a case report.

Human recombinant bone morphogenetic protein-2 (BMP-2) is commonly used in spinal surgery to augment arthrodesis, and a number of potential complications have been documented.
To present the case of a delayed radiculopathy that occurred because of a calcified perineural cyst that formed after an L4-L5 transforaminal lumbar interbody fusion (TLIF) in which BMP-2 was used.
Case report of a 70-year-old man presented with back and right lower extremity pain.
A 70-year-old man who had previously undergone a right L4-L5 TLIF presented 20 months after surgery with progressively radiating right leg pain. Imaging revealed a right-sided L4-L5 cystic lesion posterior to the interbody cage. The patient underwent reexploration, and a calcified mass was discovered.
Histopathology revealed fragments of organized collagenous connective tissue, new collagen, and partially calcified fragments of fibrocartilage, bone, and ligament.
This is the first reported case of a symptomatic calcified perineural cyst developing after a fusion procedure in which BMP-2 was used. The presence of connective tissue with metaplastic bone formation and maturation within the lesion suggests that formation of the cyst was secondary to application of BMP-2, as it possesses both osteogenic and chondrogenic capabilities.
AuthorsKhoi D Than, Shayan U Rahman, Paul E McKeever, Anthony C Wang, Frank La Marca, Paul Park
JournalThe spine journal : official journal of the North American Spine Society (Spine J) Vol. 13 Issue 8 Pg. e31-5 (Aug 2013) ISSN: 1878-1632 [Electronic] United States
PMID23792101 (Publication Type: Case Reports, Journal Article)
CopyrightCopyright © 2013 Elsevier Inc. All rights reserved.
Chemical References
  • Bone Morphogenetic Proteins
  • Aged
  • Bone Morphogenetic Proteins (adverse effects, therapeutic use)
  • Humans
  • Lumbar Vertebrae (pathology, surgery)
  • Male
  • Radiculopathy (etiology, pathology, surgery)
  • Spinal Fusion (adverse effects, instrumentation)
  • Tarlov Cysts (etiology, pathology, surgery)

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