Neurospine

Bone Biology and Osteoporosis Special Issue

The Combined Effects of RhBMP-2 and Systemic RANKL Inhibitor in Patients With Bone Density Loss Undergoing Posterior Lumbar Interbody Fusion: A Retrospective Observational Analysis With Propensity Score Matching: Seungjun Ryu, Seon-Jin Yoon, Chang Kyu Lee, Seong Yi, Keung-Nyun Kim, Yoon Ha, Dong Ah Shin; Neurospine 2023;20(4):1186-1192. Published online December 31, 2023; DOI: https://doi.org/10.14245/ns.2346702.351

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The Combined Effects of RhBMP-2 and Systemic RANKL Inhibitor in Patients With Bone Density Loss Undergoing Posterior Lumbar Interbody Fusion: A Retrospective Observational Analysis With Propensity Score Matching

Neurospine. 2023;20(4):1186-1192. Published online December 31, 2023

DOI: https://doi.org/10.14245/ns.2346702.351

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Neurospine. 2023;20(4):1186-1192. Published online December 31, 2023

DOI: https://doi.org/10.14245/ns.2346702.351

Objective
The risks of nonunion and subsidence are high in patients with bone density loss undergoing spinal fusion surgery. The internal application of recombinant human bone morphogenic protein 2 (rhBMP-2) in an interbody cage improves spinal fusion; however, related complications have been reported. Denosumab, a human monoclonal antibody targeting the receptor activator of nuclear factor kappa B ligand (RANKL), hinders osteoblast differentiation and function. Therefore, this study aimed to observe the combined effect of the local application of rhBMP-2 in a lumbar cage and systemic RANKL inhibition on postoperative spinal fusion in patients with bone density loss undergoing posterior lumbar interbody fusion (PLIF).
Methods
This retrospective observational study included 251 consecutive patients with spinal stenosis who underwent PLIF at a single center between 2017 and 2021. Clinical outcomes were assessed, and radiographic evaluations included lumbar flexion, extension, range of motion, and subsidence. Statistical analyses were conducted to identify the combined effect of the treatment and the subsidence and spinal fusion status.
Results
One hundred patients were included in the final analysis. Denosumab treatment significantly reduced the rate of osteolysis (p = 0.013). When denosumab was administered in combination with rhBMP-2, the fusion status remained similar; however, the incidences of postoperative osteolysis and postoperative oozing day decreased.
Conclusion
The combined use of rhBMP-2 and RANKL inhibition in patients with bone density loss can enhance bone formation after PLIF with fewer complications than rhBMP-2 alone.

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Delayed Bilateral C5 Palsy following Circumferential Decompression and Fusion in Patient with Cervical Spondylotic Myelopathy: Hyeong-Seok Jeon, Keung-Nyun Kim; Korean J Spine 2015;12(3):200-203. Published online September 30, 2015; DOI: https://doi.org/10.14245/kjs.2015.12.3.200

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Delayed Bilateral C5 Palsy following Circumferential Decompression and Fusion in Patient with Cervical Spondylotic Myelopathy

Korean J Spine. 2015;12(3):200-203. Published online September 30, 2015

DOI: https://doi.org/10.14245/kjs.2015.12.3.200

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Delayed Bilateral C5 Palsy following Circumferential Decompression and Fusion in Patient with Cervical Spondylotic Myelopathy

Korean J Spine. 2015;12(3):200-203. Published online September 30, 2015

DOI: https://doi.org/10.14245/kjs.2015.12.3.200

C5 palsy is a common complication after cervical decompressive surgery, which have 0 to 30% complication rate. A 61-year-old female patient with cervical spondylotic myelopathy showed bilateral C5 palsy following circumferential decompression and fusion. Unexpectedly, bilateral C5 palsy was noted in different time points on postoperative day 2 and 8, respectively. Steroid injection and physical therapy were performed, and her motor function is recovering. Surgeons should make an effort to prevent possible C5 palsy when performing cervical decompression surgery.

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Case Reports in Orthopedics.2016; 2016: 1. CrossRef