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Research ArticleSpine

Postoperative Lumbar Fusion Bone Morphogenic Protein–Related Epidural Cyst Formation

F. Abel, E.T. Tan, D.B. Sneag, D.R. Lebl and J.L. Chazen
American Journal of Neuroradiology March 2023, 44 (3) 351-355; DOI: https://doi.org/10.3174/ajnr.A7799
F. Abel
aFrom the Departments of Radiology and Imaging (F.A., E.T.T., D.B.S., J.L.C.)
bSpine Surgery (F.A., D.R.L.), Hospital for Special Surgery, New York, New York
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E.T. Tan
aFrom the Departments of Radiology and Imaging (F.A., E.T.T., D.B.S., J.L.C.)
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D.B. Sneag
aFrom the Departments of Radiology and Imaging (F.A., E.T.T., D.B.S., J.L.C.)
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D.R. Lebl
bSpine Surgery (F.A., D.R.L.), Hospital for Special Surgery, New York, New York
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J.L. Chazen
aFrom the Departments of Radiology and Imaging (F.A., E.T.T., D.B.S., J.L.C.)
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Abstract

SUMMARY: Bone morphogenetic protein is broadly used in spinal surgery to enhance fusion rates. Several complications have been associated with the use of bone morphogenetic protein, including postoperative radiculitis and pronounced bone resorption/osteolysis. Bone morphogenetic protein–related epidural cyst formation may represent another complication that has not been described aside from limited case reports. In this case series, we retrospectively reviewed imaging and clinical findings of 16 patients with epidural cysts on postoperative MR imaging following lumbar fusion. In 8 patients, mass effect on the thecal sac or lumbar nerve roots was noted. Of these, 6 patients developed new postoperative lumbosacral radiculopathy. During the study period, most patients were managed conservatively, and 1 patient required revision surgery with cyst resection. Concurrent imaging findings included reactive endplate edema and vertebral bone resorption/osteolysis. Epidural cysts had characteristic findings on MR imaging in this case series and may represent an important postoperative complication in patients following bone morphogenetic protein–augmented lumbar fusion.

ABBREVIATIONS:

ALIF
anterior lumbar interbody fusion
BMP
bone morphogenetic protein
LLIF/XLIF
lateral/extreme lateral lumbar interbody fusion
L-spine
lumbar spine
PLIF
posterior lumbar interbody fusion
PLL
posterior longitudinal ligament
rhBMP-2
recombinant bone morphogenetic protein-2
TLIF
transforaminal lumbar interbody fusion
  • © 2023 by American Journal of Neuroradiology
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American Journal of Neuroradiology: 44 (3)
American Journal of Neuroradiology
Vol. 44, Issue 3
1 Mar 2023
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Postoperative Lumbar Fusion Bone Morphogenic Protein–Related Epidural Cyst Formation
F. Abel, E.T. Tan, D.B. Sneag, D.R. Lebl, J.L. Chazen
American Journal of Neuroradiology Mar 2023, 44 (3) 351-355; DOI: 10.3174/ajnr.A7799

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Postoperative Lumbar Fusion Bone Morphogenic Protein–Related Epidural Cyst Formation
F. Abel, E.T. Tan, D.B. Sneag, D.R. Lebl, J.L. Chazen
American Journal of Neuroradiology Mar 2023, 44 (3) 351-355; DOI: 10.3174/ajnr.A7799
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