Document Detail


RhBMP-2 is Superior to Iliac Crest Bone Graft for Long Fusions to the Sacrum in Adult Spinal Deformity: 4-14 Year Follow-Up.
MedLine Citation:
PMID:  23392417     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
ABSTRACT: Study Design. Matched Cohort ComparisonObjective. To compare the use of BMP or ICBG on the long term outcomes in patients undergoing long fusions to the sacrum for adult spinal deformity.Summary of Background Data. No long term studies beyond a 2 year f/u have been performed comparing the use of Bone Morphogenic Protein (BMP) versus Iliac Crest Bone Graft (ICBG) for fusion rates in long fusions to the sacrum in adult spinal deformity.Methods. A total of 63 consecutive patients from 1997-2006 consisting of 31 patients in the BMP group and 32 patients in the ICBG group, operated on at a single institution with a minimum 4-year follow-up (4-14 years) was analyzed. Inclusion criteria were ambulators who were candidates for long fusions (thoracic as the upper level) to the sacrum. Exclusion criteria were revisions, neuromuscular scoliosis, ankylosing spondylitis and patients who had both BMP and ICBG used for fusion. Oswestry Disability Index (ODI) and three domains of the SRS score were used to assess outcomes.Results. The two groups were similar with respect to age, gender, smoking history, comorbidities, BMI, number of fusion levels and Cobb angles. Eight patients in the BMP group had a posterior only while 23 had combined anterior and posterior (A/P) surgery. All 32 patients in the ICBG had A/P fusion. The average BMP/level was 11.1 mg (3-36 mg). The rate pseudarthrosis was 6.4% (2/31) in the BMP and 28.1% (9/32) in the ICBG group (P = 0.04) using Fisher exact test and odds ratio = 5.67. The fusion rates for BMP group were 93.5% and 71.9% for the ICBG group. ODIs were similar between groups. However, the BMP group demonstrated superior sum composite SRS scores in pain, self-image and function domains (p = 0.02).Conclusion. BMP is superior to ICBG in achieving fusion in long constructs in adult deformity surgery. The rate of pseudarthrosis was significantly higher in the ICBG group than BMP group. The concentration and dosage of rhBMP-2 used appears to have an effect on the rate of fusion and pseudarthrosis rate because no patient receiving >5mg/level had apparent or detected pseudarthroses (n = 20/20).
Authors:
Han Jo Kim; Jacob M Buchowski; Lukas P Zebala; Douglas D Dickson; Linda Koester; Keith H Bridwell
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-2-7
Journal Detail:
Title:  Spine     Volume:  -     ISSN:  1528-1159     ISO Abbreviation:  Spine     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-2-8     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Washington University School of Medicine, Saint Louis, MO 63110.
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