Evidence map›Paper›PMID 41315069›Full record

ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026

Efficacy of low-dose Escherichia coli-derived recombinant human bone morphogenetic protein-2 in minimally invasive transforaminal lumbar interbody fusion.

Tae Hoon Kang, Jeongwoon Han, Minjoon Cho, Jae Hyup Lee

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Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Tae Hoon KangDepartment of Orthopedic Surgery, College of Medicine, Seoul National University, Seoul, Republic of Korea.
Jeongwoon HanDepartment of Orthopedic Surgery, College of Medicine, Seoul National University, Seoul, Republic of Korea.
Minjoon ChoDepartment of Orthopedic Surgery, College of Medicine, Seoul National University, Seoul, Republic of Korea.
Jae Hyup LeeDepartment of Orthopedic Surgery, College of Medicine, Seoul National University, Seoul, Republic of Korea. spinelee@snu.ac.kr.

Funding

Seoul Metropolitan Government Seoul National University Boramae Medical Center 04-2024-0020the National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) No. 2022R1A2C1010962.)
6 · The paper itself

Abstract

purposeMinimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) offers advantages over open procedures but is limited by the reduced availability of autologous bone. Escherichia coli-derived recombinant human bone morphogenetic protein-2 (E.BMP-2) has emerged as a scalable osteoinductive alternative, though its application in MIS-TLIF remains unstudied. This study aimed to evaluate the efficacy and safety of E.BMP-2 combined with hydroxyapatite (HA) carriers in the context of MIS-TLIF.

methodsSeventy patients (85 fusion levels) who underwent one- or two-level MIS-TLIF for degenerative lumbar conditions between 2016 and 2024 were included, with a minimum follow-up of one year. The E.BMP-2 group (34 patients, 39 levels) received local bone graft and allogenic cancellous bone graft along with a fixed dose of 1 mg E.BMP-2. The control group (36 patients, 46 levels) received local bone graft and allogenic cancellous bone graft only. Fusion was assessed using dynamic radiographs and CT imaging. Solid fusion on radiographs was defined as segmental motion < 3°, and on CT as continuous trabecular bone bridging between the upper and lower endplates. Clinical outcomes were evaluated using the visual analog scale (VAS) for back and leg pain, the Oswestry Disability Index (ODI), and the Functional Rating Index (FRI). Perioperative and delayed complications-including fever, elevated inflammatory markers, seroma formation, heterotopic ossification, and cage subsidence-were assessed via imaging and medical records.

resultsThe E.BMP-2 group demonstrated significantly higher fusion rates (radiographs: 97.4% vs. 78.3%, p = 0.001; CT: 89.7% vs. 63.0%, p = 0.005) without an increase in complications. No cases of seroma, heterotopic ossification, or reoperation were observed in the E.BMP-2 group. A standardized application protocol using 1 mg of E.BMP-2 per patient, combined with a containment technique, likely contributed to these favorable outcomes. Although clinical improvements were similar between groups, the rate of cage subsidence was significantly lower in the E.BMP-2 group at 6 and 12 months.

conclusionLow-dose E.BMP-2 appears to be a safe and effective osteoinductive adjunct for MIS-TLIF, particularly in cases with limited autologous bone. Appropriate carrier selection, dosing, and containment techniques are key to optimizing outcomes.

Indexed as

Bone Morphogenetic Protein 2Lumbar VertebraeMinimally Invasive Surgical ProceduresSpinal FusionTransforming Growth Factor betaAdultAgedBone TransplantationEscherichia coliFemaleHumansMaleMiddle AgedRecombinant ProteinsTreatment OutcomeBone Morphogenetic Protein 2recombinant human bone morphogenetic protein-2Recombinant ProteinsTransforming Growth Factor betaCage subsidenceE.BMP-2E.coli-derived rhBMP-2Lumbar interbody fusion rateMIS-TLIFRhBMP-2

Identifiers

PMID41315069

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.