Biologics and Minimally Invasive Approach to TLIFs: What Is the Risk of Radiculitis?
Publication/Presentation Date
10-1-2020
Abstract
BACKGROUND: Bone morphogenetic protein (BMP) and allograft containing mesenchymal stem cells (live cell) are popular biologic substitutes for iliac crest autograft used in transforaminal lumbar interbody fusion (TLIF). Use of these agents in the pathogenesis of postoperative radiculitis remains controversial. Recent studies have independently linked minimally invasive (MIS) TLIF with increased radiculitis risk compared to open TLIF. The purpose of this study was to assess the rate of postoperative radiculitis in open and MIS TLIF patients along with its relationship to concurrent biologic adjuvant use.
METHODS: Patients ≥18 years undergoing single-level TLIF from June 2012 to December 2018 with minimum 1-year follow-up were included. Outcome measures were rate of radiculitis, intra- and postoperative complications, revision surgery; length of stay (LOS), and estimated blood loss (EBL).
RESULTS: There were 397 patients: 223 with open TLIFs, 174 with MIS TLIFs. One hundred and fifty-nine surgeries used bone morphogenetic protein (BMP), 26 live cell, 212 neither. Open TLIF: higher mean EBL, LOS, and Charlson Comorbidity Index (CCI) than MIS. Postoperative radiculitis in 37 patients (9.32% overall): 16 cases MIS BMP (15.69% of their cohort), 6 MIS without BMP (8.33%), 5 open BMP (8.77%), 10 open without BMP (6.02%). MIS TLIF versus open TLIF: no differences in 1-year reoperation rates, infection/wound complication, pseudarthrosis, or postoperative complication rate. BMP versus non-BMP: no differences in reoperation rates, infection/wound complication, pseudarthrosis, or postoperative complication rate. Multivariate logistic regression found that neither BMP (
CONCLUSION: Neither the MIS approach nor BMP use is an independent risk factor for post-TLIF radiculitis. However, risk of radiculitis significantly increases when they are used in tandem. This should be considered when selecting biological adjuvants for MIS TLIF.
LEVEL OF EVIDENCE: 3.
Volume
14
Issue
5
First Page
804
Last Page
810
ISSN
2211-4599
Published In/Presented At
Wang, E., Stickley, C., Manning, J., Varlotta, C. G., Woo, D., Ayres, E., Abotsi, E., Vasquez-Montes, D., Fischer, C. R., Stieber, J., Quirno, M., Protopsaltis, T. S., Passias, P. G., & Buckland, A. J. (2020). Biologics and Minimally Invasive Approach to TLIFs: What Is the Risk of Radiculitis?. International journal of spine surgery, 14(5), 804–810. https://doi.org/10.14444/7114
Disciplines
Medicine and Health Sciences
PubMedID
33046541
Department(s)
Fellows and Residents
Document Type
Article