Comparison of Radiographic and Clinical Outcomes Between Bone Morphogenetic Protein-2 and β-Tricalcium Phosphate Combined With Iliac Crest Bone Graft in Single-Level Extreme Lateral Interbody Fusion: An Ambidirectional Cohort Study
- 1Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
- 2Division of Orthopaedics, Golden Jubilee Medical Center, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Abstract
Background: Extreme lateral lumbar interbody fusion (XLIF) requires reliable graft material for arthrodesis. Bone morphogenetic protein-2 (BMP-2) is osteoinductive but costly and may cause complications. β-Tricalcium phosphate (β-TCP) combined with iliac crest bone graft (ICBG) may provide an alternative. This study compared the radiographic and clinical outcomes of BMP-2 versus β-TCP + ICBG in single-level XLIF.
Material/Methods: This ambidirectional observational cohort included 79 consecutive patients who underwent single-level XLIF from 2014 to 2024 (BMP-2, 45; β-TCP + ICBG, 34). The Oswestry Disability Index (ODI), EuroQol 5-Dimension 5-Level (EQ-5D-5L), and EuroQol Visual Analog Scale (EQ-VAS) were assessed preoperatively and at 24 months. Radiographic alignment was evaluated preoperatively and at 24 months. Fusion was assessed at 12 and 24 months using computed tomography-supported criteria supplemented by dynamic radiographs.
Results: Baseline characteristics and surgical indications were similar between groups. Fusion rates at 12 months were 75.6% with BMP-2 and 55.9% with β-TCP + ICBG (P = 0.065), increasing to 100% and 97.1%, respectively, at 24 months (P = 0.247). Both groups showed substantial improvements in ODI and EQ-5D-5L, without significant between-group differences at 24 months. Intervertebral disc height significantly increased in both groups, whereas foraminal height was maintained. Complication rates were comparable.
Conclusions: Both grafting strategies produced favorable radiographic and clinical outcomes at 24 months. BMP-2 showed a numerically higher 12-month fusion rate, whereas β-TCP + ICBG achieved a similar final fusion rate. Given the observational design and limited sample size, these findings support β-TCP + ICBG as a potential alternative but do not establish equivalence.
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BibTeX
@article{sutipornpalangkul2026comparison,
title = {{Comparison of Radiographic and Clinical Outcomes Between Bone Morphogenetic Protein-2 and β-Tricalcium Phosphate Combined With Iliac Crest Bone Graft in Single-Level Extreme Lateral Interbody Fusion: An Ambidirectional Cohort Study}},
author = {Werasak Sutipornpalangkul and Apicha Leardthanadee and Monchai Ruangchainikom and Ekkapoj Korwutthikulrangsri and Panlop Tirawanish},
journal = {Medical Science Monitor: International Medical Journal of Experimental and Clinical Research},
year = {2026},
month = oct,
doi = {10.12659/msm.953610},
url = {https://doi.org/10.12659/msm.953610},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Comparison of Radiographic and Clinical Outcomes Between Bone Morphogenetic Protein-2 and β-Tricalcium Phosphate Combined With Iliac Crest Bone Graft in Single-Level Extreme Lateral Interbody Fusion: An Ambidirectional Cohort Study
AU - Werasak Sutipornpalangkul
AU - Apicha Leardthanadee
AU - Monchai Ruangchainikom
AU - Ekkapoj Korwutthikulrangsri
AU - Panlop Tirawanish
PY - 2026
DA - 2026/10/30
JO - Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
DO - 10.12659/msm.953610
UR - https://doi.org/10.12659/msm.953610
AB - Background: Extreme lateral lumbar interbody fusion (XLIF) requires reliable graft material for arthrodesis. Bone morphogenetic protein-2 (BMP-2) is osteoinductive but costly and may cause complications. β-Tricalcium phosphate (β-TCP) combined with iliac crest bone graft (ICBG) may provide an alternative. This study compared the radiographic and clinical outcomes of BMP-2 versus β-TCP + ICBG in single-level XLIF. Material/Methods: This ambidirectional observational cohort included 79 consecutive patients who underwent single-level XLIF from 2014 to 2024 (BMP-2, 45; β-TCP + ICBG, 34). The Oswestry Disability Index (ODI), EuroQol 5-Dimension 5-Level (EQ-5D-5L), and EuroQol Visual Analog Scale (EQ-VAS) were assessed preoperatively and at 24 months. Radiographic alignment was evaluated preoperatively and at 24 months. Fusion was assessed at 12 and 24 months using computed tomography-supported criteria supplemented by dynamic radiographs. Results: Baseline characteristics and surgical indications were similar between groups. Fusion rates at 12 months were 75.6% with BMP-2 and 55.9% with β-TCP + ICBG (P = 0.065), increasing to 100% and 97.1%, respectively, at 24 months (P = 0.247). Both groups showed substantial improvements in ODI and EQ-5D-5L, without significant between-group differences at 24 months. Intervertebral disc height significantly increased in both groups, whereas foraminal height was maintained. Complication rates were comparable. Conclusions: Both grafting strategies produced favorable radiographic and clinical outcomes at 24 months. BMP-2 showed a numerically higher 12-month fusion rate, whereas β-TCP + ICBG achieved a similar final fusion rate. Given the observational design and limited sample size, these findings support β-TCP + ICBG as a potential alternative but do not establish equivalence.
SN - 1234-1010
SN - 1643-3750
ER -