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<meta name="DC.Title" content="Postoperative Lumbar Fusion Bone Morphogenic Protein–Related Epidural Cyst Formation" />
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<meta name="DC.Description" content="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.

ALIF
:   anterior lumbar interbody fusion
BMP
:   bone morphogenetic protein
LLIF/XLIF
:   lateral/extreme lateral lumbar interbody fusion
L-spine
:   lumbar spine
PLIF
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PLL
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rhBMP-2
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TLIF
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&lt;p&gt;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.&lt;/p&gt;" />
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<meta name="twitter:title" content="Postoperative Lumbar Fusion Bone Morphogenic Protein–Related Epidural Cyst Formation" />
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<meta name="twitter:description" content="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.

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" />
<meta name="og-title" property="og:title" content="Postoperative Lumbar Fusion Bone Morphogenic Protein–Related Epidural Cyst Formation" />
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<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="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.

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" />
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">F. Abel</span>, <span class="highwire-citation-author" data-delta="1">E.T. Tan</span>, <span class="highwire-citation-author" data-delta="2">D.B. Sneag</span>, <span class="highwire-citation-author" data-delta="3">D.R. Lebl</span> and <span class="highwire-citation-author" data-delta="4">J.L. Chazen</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">March 2023,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">44 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(3) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">351-355; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A7799 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-101424--6199379063" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">F. Abel </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology and Imaging (F.A., E.T.T., D.B.S., J.L.C.)</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Spine Surgery (F.A., D.R.L.), Hospital for Special Surgery, New York, New York</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=F.%2BAbel%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Abel%20F&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AF.%2BAbel%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-8988-6917" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for F. Abel</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">E.T. Tan </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology and Imaging (F.A., E.T.T., D.B.S., J.L.C.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=E.T.%2BTan%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Tan%20E&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AE.T.%2BTan%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-2847-9378" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for E.T. Tan</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">D.B. Sneag </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology and Imaging (F.A., E.T.T., D.B.S., J.L.C.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=D.B.%2BSneag%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Sneag%20D&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AD.B.%2BSneag%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-9105-5415" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for D.B. Sneag</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">D.R. Lebl </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Spine Surgery (F.A., D.R.L.), Hospital for Special Surgery, New York, New York</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=D.R.%2BLebl%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Lebl%20D&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AD.R.%2BLebl%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-2890-5795" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for D.R. Lebl</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">J.L. Chazen </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology and Imaging (F.A., E.T.T., D.B.S., J.L.C.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.L.%2BChazen%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Chazen%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.L.%2BChazen%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-6146-2191" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J.L. Chazen</a></li></ul></div></div></div>  </div>

  
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class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>15363423</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1016/j.spinee.2004.03.025&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=15363423&amp;link_type=MED&amp;atom=%2Fajnr%2F44%2F3%2F351.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">18.</span><a class="rev-xref-ref" href="#xref-ref-18-1" title="View reference 18. in text" id="ref-18">↵</a><div class="cit ref-cit ref-journal" id="cit-44.3.351.18" data-doi="10.1097/BRS.0b013e3182982f8e"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Chrastil</span>  <span class="cit-name-given-names">J</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Low</span>  <span class="cit-name-given-names">JB</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Whang</span>  <span class="cit-name-given-names">PG</span></span>, <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Complications associated with the use of the recombinant human bone morphogenetic proteins for posterior interbody fusions of the lumbar spine</span>. <abbr class="cit-jnl-abbrev">Spine (Phila Pa 1976)</abbr> <span class="cit-pub-date">2013</span>;<span class="cit-vol">38</span>:<span class="cit-fpage">E1020</span>–<span class="cit-lpage">27</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.1097/BRS.0b013e3182982f8e</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span 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class="cit-auth"><span class="cit-name-surname">Malham</span>  <span class="cit-name-given-names">G</span></span>, <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP</span>. <abbr class="cit-jnl-abbrev">J Spine Surg</abbr> <span class="cit-pub-date">2015</span>;<span class="cit-vol">1</span>:<span class="cit-fpage">2</span>–<span class="cit-lpage">18</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>27683674</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=27683674&amp;link_type=MED&amp;atom=%2Fajnr%2F44%2F3%2F351.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li></ol></div></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 44</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 3 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Mar 2023 </div></div>
      
      
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      <div class="highwire-cite-title">Postoperative Lumbar Fusion Bone Morphogenic Protein–Related Epidural Cyst Formation</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">F.</span> <span class="nlm-surname">Abel</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">E.T.</span> <span class="nlm-surname">Tan</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">D.B.</span> <span class="nlm-surname">Sneag</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">D.R.</span> <span class="nlm-surname">Lebl</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">J.L.</span> <span class="nlm-surname">Chazen</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Mar 2023, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">44 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(3) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">351-355; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A7799 </span></div>
  
  
  
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      <div class="highwire-cite-title">Postoperative Lumbar Fusion Bone Morphogenic Protein–Related Epidural Cyst Formation</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">F.</span> <span class="nlm-surname">Abel</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">E.T.</span> <span class="nlm-surname">Tan</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">D.B.</span> <span class="nlm-surname">Sneag</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">D.R.</span> <span class="nlm-surname">Lebl</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">J.L.</span> <span class="nlm-surname">Chazen</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Mar 2023, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">44 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(3) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">351-355; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A7799 </span></div>
  
  
  
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