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Recombinant Human Bone Morphogenetic Protein-2-Augmented Transforaminal Lumbar Interbody Fusion for the Treatment of Chronic Low Back Pain Secondary to the Homogeneous Diagnosis of Discogenic Pain Syndrome: Two-Year Outcomes

Corenman, Donald S. MD, DC*; Gillard, Douglas M. DC; Dornan, Grant J. MS; Strauch, Eric L. PA-C*

doi: 10.1097/BRS.0b013e31829fc56f

Study Design. A retrospective observational study.

Objective. To assess clinical outcomes, perioperative complications, revision surgery rates, and recombinant human bone morphogenetic protein-2 (BMP-2)-related osteolysis, heterotopic bone, and unexplained postoperative radiculitis (BMPP) in a group of patients treated with BMP-2-augmented transforaminal lumbar interbody fusion (bTLIF) for the homogeneous diagnosis of discogenic pain syndrome (DPS) and to put forth the algorithm used to make the diagnosis.

Summary of Background Data. There is a paucity of literature describing outcomes of TLIF for the homogeneous diagnosis of DPS, an old but controversial member of the lumbar degenerative disease family.

Methods. The registry from a single surgeon was queried for patients who had undergone bTLIF for the homogeneous diagnosis of DPS, which was made via specific diagnostic algorithm. Clinical outcomes were determined by analyzing point improvement from typical outcome questionnaires and the data from Patient Satisfaction and Return to Work questionnaires. Independent record review was used to assess all outcomes.

Results. Eighty percent of the cohort (36/45) completed preoperative and postoperative outcome questionnaires at an average follow-up of 41.9 ± 11.9 months, which demonstrated significant clinical improvement: Oswestry Disability Index = 16.4 (P < 0.0001), 12-Item Short Form Health Survey physical component summary score = 10.0 (P < 0.0001), and a Numeric Rating Scale for back pain = 2.3 (P < 0.0001). The median patient satisfaction score was 9.0 (10 = complete satisfaction), and 84.4% (27/32) of the cohort were able to return to their preoperative job, with or without modification. There were 3 perioperative complications, 4 revision surgical procedures, and 11 cases of benign BMPP. There were no incidents of the intraoperative dural tears or nerve root injury, and litigation involvement (11/36, P > 0.17), preoperative depression (15/36, P > 0.19) or prior discectomy/decompression (14/36, P < 0.37) was not a predictor of outcomes.

Conclusion. Although limited by retrospective design and small cohort, the results of this investigation suggest that bTLIF is a reasonable treatment option for patients who experience DPS and affords high patient satisfaction. A larger study is needed to confirm these findings.

Level of Evidence: 4

Forty-five patients from a single-surgeon practice, all of whom underwent transforaminal lumbar interbody fusion for discogenic pain syndrome, were followed for a minimum of two years and standard outcome questionnaire data gathered. Analysis revealed significant point-improvement on all questionnaire data. Perioperative complication rates were low and there were no significant bone morphogenetic protein-2-related complications.

*The Steadman Clinic, Vail, CO; and

Steadman Philippon Research Institute, Vail, CO.

Address correspondence and reprint requests to Douglas M. Gillard, DC, Steadman Philippon Research Institute, 181 W. Meadow Dr, Ste 1000, Vail, CO 81657; E-mail:

Acknowledgment date: February 25, 2013. First Revision date: May 7, 2013. Second revision date: May 28, 2013. Acceptance date: June 6, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Med-Equip Inc. grant funds were received to support this work.

Relevant financial activities outside the submitted work: grants, consultancy, royalties.

© 2013 by Lippincott Williams & Wilkins