Pseudo-Pedicle Heterotopic Ossification From Use of Recombinant Human Bone Morphogenetic Protein 2 (rhBMP-2) in Transforaminal Lumbar Interbody Fusion Cages.

Abstract

We conducted a study to determine the common characteristics of patients who developed radiculopathy symptoms and corresponding heterotopic ossification (HO) from transforaminal lumbar interbody fusions (TLIF) using recombinant human bone morphogenetic protein 2 (rhBMP-2). HO can arise from a disk space with rhBMP-2 use in TLIF. Formation of bone around nerve roots or the thecal sac can cause a radiculopathy with a consistent pattern of symptoms. We identified 38 patients (26 males, 12 females) with a mean (SD) age of 50.8 (7.5) years who developed radiculopathy symptoms and corresponding HO from TLIF with rhBMP-2 in the disk space between 2002 and 2015. To document this complication and improve its recognition, we recorded common patterns of symptom development and radiologic findings: specifically, time from implantation of rhBMP-2 to symptom development, consistency with side of TLIF placement, and radiologic findings. Radicular pain generally developed a mean (SD) of 3.8 (1.0) months after TLIF with rhBMP-2. Development of radiculopathy symptoms corresponded to consistent "pseudo-pedicle"-like HO. In all 38 patients, HO arising from the annulotomy site showed a distinct pseudo-pedicle pattern encompassing nerve roots and the thecal sac. In addition, development of radiculopathy symptoms and corresponding HO appear to be independent of amount of rhBMP-2. HO resulting from TLIF with rhBMP-2 in the disk space is a pain generator and a recognizable complication that can be diagnosed by assessment of symptoms and computed tomography characteristics.

• Authors: Charles D Rosen, P Douglas Kiester, Thay Q Lee
• Journal: American journal of orthopedics (Belle Mead, N.J.) (Am J Orthop (Belle Mead NJ)) Vol. 47 Issue 1 (Jan 2018) ISSN: 1934-3418 [Electronic] United States
• PMID: 29447305 (Publication Type: Journal Article)

Chemical References

• Bone Morphogenetic Protein 2
• Recombinant Proteins
• Transforming Growth Factor beta
• recombinant human bone morphogenetic protein-2

Topics

• Bone Morphogenetic Protein 2 (adverse effects, therapeutic use)
• Humans
• Lumbar Vertebrae (surgery)
• Ossification, Heterotopic (etiology)
• Postoperative Complications (etiology)
• Radiculopathy (surgery)
• Recombinant Proteins (adverse effects, therapeutic use)
• Retrospective Studies
• Spinal Fusion (adverse effects, methods)
• Transforming Growth Factor beta (adverse effects, therapeutic use)