The use of bone morphogenetic proteins (BMP) and pseudarthrosis, a literature review

Abstract

Bone morphogenetic proteins (BMP) are multi-functional growth factors to promote bone healing with the proposal of less morbidity compared to the usual methods of bone graft harvest. Pseudoarthrosis occur when the fusion attempt fails, a solid fusion is not achieved, or there is motion across the segment leading to it, and it can be clinically symptomatic as pain, deformity, neurocompression, or hardware failure. BMPs are used at spinal fusion as a tool for the treatment of degenerative, traumatic, neoplastic and infectious conditions of the spine. This review shows that the use of BMPS is effective and secure when compared with iliac crest bone graft (ICGB); however, depending of the location of usage (cervical spine, lumbar spine or sacrum) and the medical status of the patient (presence of comorbidities, tobacco usage), it is more likely to exhibit complications. Therefore, the use of these proteins must be an informed decision of patient and physician preferences.

Exploratory meta-analysis on dose-related efficacy and complications of rhBMP-2 in anterior cervical discectomy and fusion: 1,539,021 cases from 2003 to 2017 studies

“…As the multi-functional growth factors, rhBMPs were introduced to several medical scenarios to promote the bone-healing rate with the proposal of less morbidity [ 10 ]. Presently, there are two rhBMPs, rhBMP-2 and rhBMP-7 (OP-1, Stryker Biotech, Hopkinton, MA), approved by FDA to treat a variety of bone-related conditions including delayed union and nonunion [ 49 ], bringing alternatives to autologous bone graft with significant donor site morbidity.…”

“…rhBMPs, the cytokines with osteoinductive activity, belong to the transforming growth factor β (TGF-β) superfamily, showing better bone healing with the proposal of less morbidity compared to the usual methods of bone graft harvest [ 10 ]. Currently, recombinant human bone morphogenetic protein-2 (rhBMP-2) is recognised as the only bone inducer with level I of clinical evidence [ 10 ]. Additionally, Chau et al.…”

Allogenic Stem Cells in Spinal Fusion: A Systematic Review

“…Pseudoarthrosis can lead to poor clinical outcomes, instrumentation failure, or revision surgery. 1-8 As a result, surgeons and spine researchers are in constant search for the best biological solution or material to help achieve solid arthrodesis in spine fusion cases. While ICBG has been long accepted as the “gold standard” graft material for spine fusion as it possesses osteogenic, osteoinductive, and osteoconductive properties that are critical for spine fusions, 13-18 the use of ICBG is limited by concerns of harvest morbidity, cost, and lack of efficacy in elderly or osteoporotic patients.…”

“…Pseudoarthrosis can lead to poor clinical outcomes, instrumentation failure, or revision surgery. [1][2][3][4][5][6][7][8] As a result, surgeons and spine researchers are in constant search for the best biological solution or material to help achieve solid arthrodesis…”

“…Without it, patients can have poor postsurgical outcomes, develop painful pseudoarthrosis, and may require revision surgeries. [1][2][3][4] Nevertheless, achieving solid arthrodesis in complex spine surgeries can be a daunting task as pseudoarthrosis rate for adult spinal deformity surgery can range from 0% to 25% 2,3,[5][6][7][8] and pseudoarthrosis for spine tumors can range from 0% to 43%. [9][10][11][12] The use of autologous iliac crest bone graft (ICBG) has been considered the "gold standard" for spine fusion.…”