Quantitative study of parathyroid hormone (1-34) and bone morphogenetic protein-2 on spinal fusion outcomes in a rabbit model of lumbar dorsolateral intertransverse process arthrodesis

Ioan A. Lina, Varun Puvanesarajah, Jason A. Liauw, Sheng Fu L Lo, David R. Santiago-Dieppa, Lee Hwang, Annie Mao, Ali Bydon, Jean Paul Wolinsky, Daniel M. Sciubba, Ziya Gokaslan, Christina Holmes, Timothy F. Witham*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

17 Scopus citations

Abstract

STUDY DESIGN.: A posterolateral rabbit spinal fusion model was used to evaluate the effects of recombinant human bone morphogenetic protein-2 (rhBMP-2) and teriparatide (PTH [1-34]) used individually and in combination on spinal fusion outcomes. OBJECTIVE.: To test the efficacy of parathyroid hormone on improving spinal fusion outcomes when used with BMP-2. SUMMARY OF BACKGROUND DATA.: Of the more than 250,000 spinal fusion surgical procedures performed each year, 5% to 35% of these will result in pseudarthrosis. Growing controversy on the efficacy and cost of rhBMP-2 for improving spinal fusion outcomes has presented a challenge for clinicians. Research into PTH as an adjunct therapy to rhBMP-2 for spinal fusion has not yet been investigated. METHODS.: Forty-eight male New Zealand white rabbits underwent bilateral posterolateral intertransverse process arthrodesis surgery at the L5-L6 level. Animals were divided into 6 groups. Two groups were treated with autograft alone or autograft and PTH (1-34), whereas the other 4 groups were treated with low-dose rhBMP-2 alone, high-dose rhBMP-2 alone, or either dose combined with PTH (1-34). All animals were euthanized 6 weeks after surgery. The L4-L7 spinal segment was removed and assessed using manual palpation, computed tomography (CT), and biomechanical testing. RESULTS.: CT assessments revealed fusion in 50% of autograft controls, 75% of autograft PTH (1-34) animals, 87.5% in the 2 groups treated with low-dose rhBMP-2, and 100% in the 2 groups treated with high-dose rhBMP-2. CT volumetric analysis demonstrated that all groups treated with biologics had fusion masses that were on average significantly larger than those observed in the control group (P < 0.0001). Biomechanical data demonstrated no statistical difference between controls, PTH (1-34), and low-dose rhBMP-2 in any testing orientation. PTH (1-34) did not increase bending stiffness when used adjunctively with either low-dose or high-dose rhBMP-2. CONCLUSION.: Although intermittent teriparatide administration results in increased fusion mass volume, it does not improve biomechnical stiffness over use of autograft alone. When delivered concurrently with high-and low-dose rhBMP-2, teriparatide provided no statistically significant improvement in biomechanical stiffness.Level of Evidence: N/A

Original languageEnglish (US)
Pages (from-to)347-355
Number of pages9
JournalSpine
Volume39
Issue number5
DOIs
StatePublished - Mar 1 2014

Keywords

  • 4-point bending stiffness
  • bone graft substitute
  • hydroxyapatite
  • parathyroid hormone
  • posterolateral spinal fusion
  • pseudarthrosis
  • rabbit model
  • recombinant human bone morphogenetic protein-2
  • tricalcium phosphate
  • volumetric analysis

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

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