Complications Associated With the Use of the Recombinant Human Bone Morphogenetic Proteins for Posterior Interbody Fusions of the Lumbar Spine

In Brief Study Design. Systematic review. Objective. The objectives of this review are to examine the spectrum of complications that have been reported in the literature after posterior interbody fusions of the lumbar spine augmented with bone morphogenetic proteins (BMPs) and discuss potential methods for their prevention. Summary of Background Data. The use of BMPs for spinal arthrodesis procedures has increased dramatically during the past decade. These products are commonly used in “off-label” fashion in posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) constructs. Recently, a number of adverse events have been attributed to the use of BMP for PLIF and TLIF surgical procedure, including heterotopic ossification within the epidural space or neuroforamina, postoperative radiculitis, and endplate osteolysis with interbody device subsidence. Methods. A computer aided literature search was performed on the electronic databases PubMed, MEDLINE, EMBASE, CINAHL, and Cochrane Database of Systematic Reviews. Key words of interest included BMPs, PLIF, TLIF, complications, heterotopic ossification, radiculitis, and osteolysis. All articles, in the English language, between 1990 and 2011 were considered relating to the use of BMPs in PLIF and TLIF constructs. Results. Seventeen articles discussing the use and potential complications of BMPs in PLIF and TLIF constructs were identified and reviewed. The studies were in the range of a level I prospective randomized trial to case reports of complications. There is a wide variation of published complications associated with BMP-augmented PLIF and TLIF constructs. Conclusion. Despite high fusion rates there is a growing body of evidence that the use of BMP in PLIF and TLIF constructs does not come without potential complication. There are appreciable rates of BMP-specific complications, which include heterotopic ossification within the epidural space or neuroforamina, postoperative radiculitis, and endplate osteolysis with interbody device subsidence. Level of Evidence: 2 Bone morphogenetic proteins are used “off-label” in a high percentage of posterior lumbar and transforaminal lumbar interbody fusions. There have been several documented complications associated with bone morphogenetic protein including heterotopic ossification, postoperative radiculitis, and endplate osteolysis with interbody device subsidence. This literature review identifies and discusses these complications.