192 - Retrograde Ejaculation in Anterior Lumbar Surgery with use of rhBMP-2...

#192 Retrograde Ejaculation in Anterior Lumbar Surgery with use of rhBMP-2

Oral Posters: Quality of Spine Care

Presented by: S. Brau

Author(s):

S.A. Brau (1)

(1) Spine Access Surgery Associates, Los Angeles, CA, USA

Abstract

Purpose: To try to determine if there is a relationship between rhBMP2 (BMP) and retrograde ejaculation (RE) in male patients undergoing anterior lumbar interbody fusion (ALIF) at L5-S1.

Methods: 598 male patients had an ALIF performed at L5-1, either as a single level fusion or as part of a multilevel fusion, with the use of BMP, between Sept. 16, 2002 and July 30, 2011. Their records were retrospectively reviewed. The majority was involved in IDE studies of either BMP itself or the device being implanted. In others, the office records were reviewed to see if RE was reported or not. The author performed all the approaches through an open, retroperitoneal approach and used his technique, previously published, to avoid injury to the superior hypogastric plexus.[1]

Findings: Two patients had RE prior to the ALIF. One had a radical prostatectomy and one had pelvic lymph node dissection for testicular cancer. One patient expired 2 days post op due to a massive pulmonary embolus. In the remaining 595 patients RE was reported only once and it was permanent.

Conclusions: A report by Carragee in 2011 “confirms previous reports of a higher rate of RE in ALIF procedures using rhBMP-2”.[2] The flaws in this report are that, first, the IDE only documented episodic rates of RE, and second, since RE can occur due to a surgical injury in both cohorts you can't compare the groups when the same variable occurs in both. How can you tell that the RE is related to the use of BMP as opposed to a surgical injury when both can be present in the same patient? Lindley, et. al., however, reported in 2012 that in their study “RE occurred at a similar rate in patients treated with ADR and ALIF with BMP”.[3] Ghanayem has also reported “no statistical difference related to the BMP dose” in 141 patients with an overall permanent rate of RE of 0.7 percent.[4] Oral communications with six access surgeons in the United States who perform hundreds of ALIF's a year using BMP indicate that they have found no correlation between BMP and retrograde ejaculation. This study goes a step further in demonstrating that such correlation does not exist. BMP does not cause RE.

[1] Brau SA, Exposure Issues in Lumbar Disc Replacement Surgery, in Heller JG edition, Seminars in Spine Surgery, Vol 18, No 2, June 2006, Elsevier

[2] Carragee EJ, Mitsunaga KA, Hurwitz EL, et. al., Retrograde ejaculation after anterior lumbar interbody fusion using rhBMP-2: a cohort controlled study. Spine J. 2011 Jun; 11(6):511-6

[3] Lindley EM, McBeth ZL, Henry SE, et. al. Retrograde ejaculation following anterior lumbar spine surgery, Spine, 2012 Apr 2 (Epub)

[4] Ghanayem AJ, AAOS Now, Aug 2012