Document Detail


Use of bone morphogenetic protein-2 for adult spinal deformity.
MedLine Citation:
PMID:  16138058     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY DESIGN: Prospective, single-center, nonblinded clinical and radiographic analysis of consecutive adult deformity patients treated with recombinant human bone morphogenetic protein-2 (rhBMP-2) without iliac or rib bone graft supplementation. OBJECTIVES: To determine the ability of rhBMP-2 to achieve both anterior and posterior spinal fusion in patients undergoing multilevel fusions for adult spinal deformity. SUMMARY OF BACKGROUND DATA: The literature concerning one-level anterior fusions, and potentially one-level posterior fusions, using rhBMP-2 has demonstrated clinical efficacy. No published data exist on the use of rhBMP-2 in multilevel spine fusions. METHODS: Prospective analysis of patients treated with rhBMP-2 in multilevel anterior and posterior fusions with a minimum 1-year follow-up. There were a total of 95 patient samples (70 total patients; 25 patients had rhBMP-2 used circumferentially): 46 anterior fusions (Group 1), 41 posterior fusions (Group 2), and 8 patients were "compassionate use" fusions (Group 3). In the anterior fusion group (n = 46), mean rhBMP-2/level was 10.8 mg in titanium mesh cages without any bone graft or other substance. The posterior fusion group had only local bone graft, no harvested rib or iliac bone graft (n = 41). The mean rhBMP-2/level was 13.7 mg. The "compassionate use" group (n = 8 patients) consisted of patients who had prior surgeries, prior iliac harvesting, and substantial comorbidities and therefore a higher concentration and different carrier was used. No local bone graft, no harvested bone was used. The mean rhBMP-2/level was 28.6 mg. The median dose was 40 mg for Group 3. RESULTS: For the anterior fusion group (n = 46), operative levels were deemed fused in 89 of the 93 (96%) levels. For the posterior fusion group (n = 41), a solid fusion was assessed in 110 of the 118 (93%) operative levels. For the "compassionate-use" patients, the overall fusion rate was 100% (52 of 52 operative levels). CONCLUSIONS: With the use of rhBMP-2, a high rate of apparent fusion was observed for anterior (96%) and posterior (93%) fusions in adult spinal deformity patients. Use of rhBMP-2 results in a promising early fusion rate without the graft harvest site morbidity.
Authors:
Scott J Luhmann; Keith H Bridwell; Ivan Cheng; Toshihiro Imamura; Lawrence G Lenke; Mario Schootman
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Spine     Volume:  30     ISSN:  1528-1159     ISO Abbreviation:  Spine     Publication Date:  2005 Sep 
Date Detail:
Created Date:  2005-09-02     Completed Date:  2006-03-02     Revised Date:  2009-07-09    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S110-7     Citation Subset:  IM    
Affiliation:
Spinal Deformity Service, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Bone Morphogenetic Proteins / therapeutic use*
Bone Regeneration / drug effects*
Female
Humans
Lumbar Vertebrae / drug effects,  radiography,  surgery
Male
Middle Aged
Osteogenesis
Prospective Studies
Recombinant Proteins / therapeutic use*
Scoliosis / drug therapy*,  radiography,  surgery*
Spinal Fusion / methods*
Transforming Growth Factor beta / therapeutic use*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Bone Morphogenetic Proteins; 0/Recombinant Proteins; 0/Transforming Growth Factor beta; 0/recombinant human bone morphogenetic protein-2

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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