• Mark Kayanja and Robert Douglas Orr.
• *Department of Orthopaedics, Cleveland Clinic, Cleveland, OH; and †Center for Spine Health, Lutheran Hospital, Cleveland, OH.
• Spine. 2014 Mar 1;39(5):374-80.

Study DesignRetrospective cohort.ObjectiveTo determine the incidence of resorption after anterior lumbar interbody fusion (ALIF) and its effect on outcome.Summary Of Background DataRecombinant human bone morphogenetic protein-2 (rhBMP-2) used in ALIF has been associated with a 0.5% to 82% incidence of resorption. This has been described as either a complication or part of the natural history. We postulate that early resorption (≤4 mo) in ALIF using femoral ring allograft augmented with rhBMP-2 supplemented with posterior instrumentation has no effect on outcome.MethodsInstitutional review board-approved retrospective 60 chart cohort study of ALIF using femoral ring allograft-augmented rhBMP-2 supplemented with posterior instrumentation from May 5, 2005, to April 6, 2010. Two groups were based upon the presence or absence of early graft resorption (≤4 mo). Patients were seen prior to surgery and postoperatively until 29 ± 20 months (last visit). Follow-up visual analogue scale pain scores and radiographical evidence of fusion were measured and compared between the 2 groups.ResultsSixty patients, 27 females and 33 males had follow-up for 29 ± 20 months. Group 1 (33 patients, 45 levels) and group 2 (27 patients, 36 levels) were identical in age (P = 0.62), sex distribution (P = 0.43), preoperative pain score (P = 0.63), and in the rhBMP-2 dose per level (P = 0.77). There were no significant group differences in postoperative visual analogue scale scores but a trend to higher fusion rate in group 1 was seen (P = 0.07) at 6 months. There was a 40% incidence of early resorption with no significant differences in visual analogue scale scores or fusion rate between both groups.ConclusionThere is a 40% incidence of early resorption (≤4 mo) that had no significant effect on pain score or fusion rate. Resorption should be considered part of the fusion process and not necessarily a complication.Level Of Evidence3.

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