• Charles-Henri Flouzat-Lachaniette, Amir Ghazanfari, Charlie Bouthors, Alexandre Poignard, Philippe Hernigou, and Jérôme Allain.
• Hôpital Henri MONDOR, AP-HP - UPEC, Institut du Rachis - Service de Chirurgie Orthopédique et Traumatologique, 51, avenue du Maréchal de Lattre de Tassigny, 94010, Creteil Cedex, France, charles-henri.flouzat-lachaniette@hmn.aphp.fr.
• Int Orthop. 2014 Sep 1; 38 (9): 2001-7.

PurposeAutologous iliac crest bone graft (ICBG) is the gold standard material for spinal fusion. Bone graft substitutes, such as recombinant human bone morphogenic protein 2 (rhBMP-2) have been developed to promote spinal fusion and address morbidity issues related to ICBG harvesting. The objective of this study was to compare bone fusion rates after anterior lumbar interbody fusion (ALIF) between ICBG and rhBMP-2 by examining thin-cut computed tomography (CT) images at the one year follow-up.MethodsFifty one patients (62 levels) who underwent single- or two-level ALIF via the video-assisted minimally invasive anterior approach in our institution were assessed. Radiolucent cages were inserted in all cases. Each cage has a middle beam delimiting two chambers. Grafting was performed as follows: one chamber was filled with autologous ICBG, and the other chamber was filled with 6 mg of rhBMP-2. Thin-cut CT-scan multiplanar reconstruction analyses were performed to assess the rate and quality of bone fusion at one year of follow-up.ResultsFusion was observed in 55 levels (88.7 %), with significant differences in fusion rates with rhBMP-2 and ICBG (71 % vs. 88.7 %) (P=0.001). Osteogenesis in the rhBMP-2 chamber had a centripetal pattern in all cases, leaving a central void in 97.7 % of cases representing 38.3 % of the surface of its chamber (range 0-80.3 %). In ICBG chambers, graft resorption was present in 44.4 %, representing 9.8 % of the chamber surface (range 0-52.2 %).ConclusionRhBMP-2 was inferior to ICBG in terms of rate and quality of bone fusion in one- or two-level ALIF.

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