In the era of recombinant BMP does additional anterior stabilization add value to a posterolateral fusion?

摘要

>Study design: Retrospective cohort study.>Clinical question or objective: Is there a benefit to additional transforaminal lumbar interbody fusion (TLIF) if a solid posterolateral (PL) fusion can be achieved with routine bone morphogenetic protein (BMP) use in low-grade spondylolisthesis?>Methods: We performed a retrospective review of patients who had undergone surgery for grade I or II lumbar spondylolisthesis stratified into two groups. Group 1 had 46 patients who underwent TLIF along with PL instrumented fusion. Group 2 had 40 patients who underwent PL instrumented fusion alone. In both groups, adequate posterior decompression with pedicle screw instrumentation was performed and rhBMP-7 was used. All patients were evaluated clinically using the Oswestry Disability Index (ODI) and by independent radiological examination at 3 and 12 months.>Results: At a minimum follow-up of 12 months, there was no statistically significant difference in the rate of fusion. In addition, there were no differences in the proportion of patients who had a minimal clinically significant difference in their ODI. There was a similar rate of complications between each cohort.>Conclusions: The use of BMP was associated with a high rate of PL lumbar fusion. In the presence of a PL fusion, there appears to be little clinical benefit to additional anterior TLIF in degenerative spondylolisthesis. rules="all" class="rendered small default_table">>Final class of evidence-treatment> valign="top" align="left" rowspan="1" colspan="1">Study design valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1"> RCT valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1"> Cohort valign="top" align="center" rowspan="1" colspan="1">•> valign="top" align="left" rowspan="1" colspan="1"> Case control valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1"> Case series valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1">Methods valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1"> Concealed allocation (RCT) valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1"> Intention to treat (RCT) valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1"> Blinded/independent evaluation of primary outcome valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1"> F/U ≥ 85% valign="top" align="center" rowspan="1" colspan="1">•> valign="top" align="left" rowspan="1" colspan="1"> Adequate sample size valign="top" align="center" rowspan="1" colspan="1">•> valign="top" align="left" rowspan="1" colspan="1"> Control for confounding valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1">>Overall class of evidence valign="top" align="center" rowspan="1" colspan="1">>III> valign="top" align="left" colspan="2" rowspan="1">The definiton of the different classes of evidence is available on page 67. class="head no_bottom_margin" id="__sec2title">Study Rationale and ContextPrior to the widespread use of bone morphogenetic proteins (BMPs), lumbar interbody fusion augmented by posterior fixation was reported to improve patient outcome through indirect decompression of the intervertebral foramen and through increased likelihood of fusion success. These days, BMPs provide greater certainty in PL fusion, raising the question: Is there clinical value in anterior column support in low-grade spondylolisthesis?