Study design: To prospectively evaluate the clinical and radiographic outcome of laparoscopic anterior lumbar interbody fusion with rhBMP-2.
Objectives: It was hypothesized that discogenic pain could be treated successfully with an anterior lumbar interbody fusion performed laparoscopically using rhBMP-2 as a replacement for autogenous bone.
Summary of background data: The traditional surgical treatment of discogenic pain involves painful incisions of muscles, with potential loss of integrity and strength. Harvesting of bone graft is associated with significant complications including persistent pain at the donor site.
Methods: Twenty-two consecutive patients were studied prospectively with the surgery performed by one surgeon. Patients were evaluated clinically and radiographically at 6 and 12 months after surgery. An unbiased radiologist read postoperative computed tomography scans for evidence of fusion.
Results: There were 8 male (36%) and 14 female (64%) patients. The average age was 38 years (range, 21-56 years). At 6 and 12 months after surgery 95% (21 of 22) were available for follow-up; 100% were satisfied with treatment at 12 months. Concerning their symptoms, 100% reported relief of back pain, 100% had improvement of leg pain, and 100% described significant functional improvement. Improvements were seen at 6 and 12 months on Oswestry (P < 0.001), functional testing (P < 0.001), and pain analog scale (P < 0.001). Radiographic analysis showed that all of the patients had evidence of a solid fusion at 6 months after operation.
Conclusion: Discogenic low back pain can be effectively treated surgically with a laparoscopic anterior lumbar interbody fusion using rhBMP-2 in place of autogenous bone. The fusion occurs quickly and predictably with no adverse effects identified.