![]() ![]() Īs such, assessment of bone health in spine surgery patients is an important part of perioperative evaluation, and we suggest that reduced bone mineral density (BMD) deserves special consideration in patient selection, preoperative planning, patient counseling, as well as postoperative management. Regardless of the graft material used in stand-alone interbody fusion, bone health remains an important determinant of outcome and complication rates and potentially influences fusion success. Recently, concerns have arisen regarding the safety of BMP-2 as a bone graft substitute in spinal fusion, and it has been suggested that an inflammatory response to BMP-2 used in patients with markedly decreased bone health may even contribute to subsidence, especially with end plate violation in the course of surgery. Since its approval for use in anterior lumbar interbody fusion (ALIF) procedures, recombinant human bone morphogenetic protein-2 (BMP-2 Infuse, Medtronic, Minneapolis, MN) has been used as a biologic adjunct to promote successful fusion in on- and off-label settings, including stand-alone lumbar interbody fusion. LIF has successfully been used in an aging spine surgical population, both in a stand-alone fashion as well as with supplemental posterior instrumentation. Among the advantages associated with minimally invasive LIF are its ability to restore disc height and indirectly decompress the neural elements, preserve anterior and posterior stabilizing elements, and avoid morbidities associated with other approaches. Results from preliminary reports were encouraging, and a growing body of literature on LIF suggests that the technique is safe and effective for achieving lumbar interbody fusion. Due to its minimally invasive approach and other proposed advantages, lateral transpsoas surgery for lumbar interbody fusion (LIF) has been gaining popularity in recent years. ![]()
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