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Recent Research By Dr. Kushwaha

Dr. Kushwaha’s recent scientific article entitled ‘Transforaminal Lumbar Interbody Fusion (TLIF) Augmented with rhBMP-2’ assesses clinical and radiographic outcomes of 77 patients treated with one or two level instrumented transforaminal interbody fusions augmented with interbody recombinent human bone morphogenic protein (rhBMP-2) and allograft for treatment of symptomatic spondylolisthesis or degenerative disc disease.

The article was a two-year clinical evaluation of a surgical strategy and was particularly relevant as at the time of publication there were no studies that previously reported radiographic and clinical results using rhBMP-2 in a TLIF setting with a long term follow-up. Circumferential fusion is becoming increasingly standard to improve the fusion rates and clinical outcomes in lumbar spinal arthrodesis.


Anterior Lumbar Interbody Fusion (ALIF) requires an access surgeon as well as a separate incision which could potentially devastating neurovascular complications. Additionally, Posterior Lumbar Interbody fusion (PLIF)  with PLF mandates bilateral facet exposure with significant retraction of neural elements with significant post-operative radiculitis. PLIF also reduces surface area for fusion and disrupts the posterior ligamentus tension band. However, TLIF allows for a circumferential fusion through a single posterior incision with only slight retraction of the fecal sack and nerve roots which presents less risk for the patient and has a lower cost compared to traditional PLIF and ALIF techniques.

Dr. Kushwaha and colleagues conclude that the use of rhBMP-2, in combination with allograft and bone marrow aspirate, can provide a high fusion rate and good clinical outcomes in a TLIF setting. The morbidity associated with the iliac crest bone graft is avoided, with fusion rates approaching that of a true anterior/posterior circumferential fusion.

Overgrowth of bone into the neural foramen, likely related to the residue of rhBMP-2 at the TLIF entry site, can occur. Care must be taken to place the TLIF cage device and the contained rhBMP-2 into the anterior half of the disc space to minimize the risk of this complication.

Another article on surgical techniques by Dr. Kushwaha and colleagues can be read here.

To learn more about Dr. Kushwaha or to schedule an appointment, contact the office on 713-650-6900.


About Vivek Kushwaha

Vivek P. Kushwaha attended the University of Texas at Austin where he earned his B.A. from the College of Natural Sciences. He then earned his medical degree from the University of Texas Medical School at San Antonio, Texas.

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