Introduction: Linking basic science data to clinical results can be difficult. Published studies demonstrate osteogenic properties and low inflammation with micron-textured titanium surfaces, even without the addition of exogenous biologic additives. Interbody implants with these surface characteristics may be able to actively stimulate a portion of the fusion integration, potentially reducing surgeons’ reliance on the more expensive and inflammatory biologic additives.
Methods: 137 patients undergoing anterior lumbar interbody fusions were enrolled consecutively and followed for 24 months. All patients received implants with a unique micron-scale textured surface. Group 1: 75 patients received rhBMP-2. Group 2: 62 patients received a bone graft extender (DBM+AGF or ceramic). Clinical outcomes (VAS/ ODI) were collected for 2 years after surgery. Cost savings analysis was performed using manufacturer’s list pricing.
Results: Both groups achieved similar and clinically significant improvements at all time points compared to pre-op baseline. Leg pain was higher at all time points in the BMP cohort (Group 1), compared to the non-BMP cohort (Group 2) reaching statistical significance at 2 years. Cost savings between high and low cost biologics was $2565 (1 level), $2373 (2 level), and $2103 (3 level).
Conclusions: Biological activity of bone graft extenders may be less relevant in the presence of an osteogenic fusion implant. There was no measurable clinical benefit realized by using BMP or DBM+GF with this specific implant. The patients in the non-BMP group trended towards better clinical outcomes at all time points with statistically significant lower residual leg pain at 2 years, compared to the BMP group. This study demonstrates that excellent clinical outcomes and significant cost savings can be achieved in these cases without the need for the most expensive or inflammatory biologics.
Patient Care: Finding the proper balance between the biological activities of the bone graft, the host, and the interbody implant would be relevant to clinical fusion outcomes. This study presents and alternative to inflammatory biologic additives by coupling micron-scale textured titanium implants with bone graft extenders.
Learning Objectives: To determine if comparable clinical outcomes and cost savings opportunities can be realized in ALIF fusions with a micron-surface titanium implant, comparing 3 different bone graft substitutes of variable biological potencies.