5:08107. Transient reduced mineral density associated with BMP-enhanced spinal fusion

McClellan, John W.; Mulconrey, Daniel S.; Forbes, Robert B.; Fullmer, Nancy

doi:10.1016/j.spinee.2005.05.110

Cited by 3 publications

(4 citation statements)

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“…Although there is firm evidence for high fusion rates with the use of rhBMP-2, its use has also been associated with the risk of early osteolysis, which could negatively affect endplate integrity and increase the rate of spacer subsidence or displacement. 21,22 Furthermore, we report significant improvements in PROMs despite including multilevel fusions in a relatively morbid patient population with a high rate of obesity (50%) and previous lumbar procedures (44%). Reoperation rates (10%) were comparable to a prospective, randomized cohort treated with lumbar fusion for spondylolisthesis.…”

Section: Discussionmentioning

confidence: 79%

Expandable Interbody Spacers: A Two-Year Study Evaluating Radiologic and Clinical Outcomes With Patient-Reported Outcomes

et al. 2020

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Background: Posterior and transforaminal lumbar interbody fusion (PLIF and TLIF) have gained significant popularity for management of lumbar degenerative spine over the last 3 decades. Expandable interbody spacers are a newer technology that can increase in size after placement, theoretically minimizing the operative risks of static spacers without sacrificing radiographic correction. The goal of this study is to further evaluate the radiographic and clinical outcomes of expandable spacers.Methods: This was a retrospective analysis of a prospective cohort that underwent elective 1-to 3-level PLIF/ TLIF with expandable interbody spacers from 2014 to 2020 at a single institution. Patient-reported outcome measures (PROMs) Oswestry Disability Index and Visual Analog Scale were collected at 6 weeks, 3 months, 6 months, and 12 months. Imaging was performed at 12 months, with follow up at 24 months in case of nonunion. Retrospective outcomes were computer tomography (CT) based and Bridwell-Lenke classification of fusion, radiographic parameters, and adverse events.Results: A total of 50/53 (94.3%) otherwise eligible patients had 12-month PROMs and CT imaging for analysis. Here, 50% were obese (body mass index . 30), 58% had a smoking history, and 24% had a prior lumbar procedure. Also, 46/50 (92%) patients fused by CT criteria. Significant decrease in PROMs was seen as early as 6 weeks postoperatively. The mean change in preoperative-to-postoperative global lordosis values was 3.88 6 15.68. There were 4 (8%) intraoperative durotomies and 5 (10%) patients requiring reoperation for nonunion.Conclusions: Our study demonstrates the use of expandable spacers in a high comorbidity cohort with low complications, excellent improvement in PROMs despite minimal lordotic improvement, and high rates of fusion without recombinant human bone morphogenetic protein-2 (rhBMP-2) or iliac crest bone graft.Level of Evidence: 4. Clinical Relevance: Expandable interbody fusion can significantly improve outcomes for degenerative lumbar spondylosis, with good safety profile, and high fusion rates.

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Section: Discussionmentioning

confidence: 79%

Expandable Interbody Spacers: A Two-Year Study Evaluating Radiologic and Clinical Outcomes With Patient-Reported Outcomes

et al. 2020

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“…However, BMP‐2 has a short half‐life in vivo and is rapidly cleared by the bloodstream. [ 11 ] For successful bone repair, long‐term presence of BMP‐2 at the defect site is desired, for which a high concentration of BMP‐2 is typically administered, increasing cost and leading to ectopic/heterotopic bone formation, [ 12,13 ] vertebral bone resorption (osteolysis), [ 14 ] nerve root irritation, and/or edema. [ 15 ] Therefore, a scaffold that delivers BMP‐2 slowly but steadily in minute quantities over a longer period is desirable.…”

Section: Introductionmentioning

confidence: 99%

“…Cranial bone defects arise due to injuries inflicted through trauma, infection, encephalic and maxillofacial surgeries, and concentration of BMP-2 is typically administered, increasing cost and leading to ectopic/heterotopic bone formation, [12,13] vertebral bone resorption (osteolysis), [14] nerve root irritation, and/or edema. [15] Therefore, a scaffold that delivers BMP-2 slowly but steadily in minute quantities over a longer period is desirable.…”

Section: Introductionmentioning

confidence: 99%

Functionalized Collagen/Elastin‐like Polypeptide Hydrogels for Craniofacial Bone Regeneration

Pal

Tucci

Fan

et al. 2022

Adv Healthcare Materials

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Critical‐sized cranial bone defects fail to re‐ossify and require the surgical intervention of cranioplasty. To achieve superior bone healing in such cases, a hydrogel consisting of an interpenetrating network of collagen and elastin‐like polypeptide to encapsulate bone morphogenetic protein‐2 (BMP‐2), doxycycline, and 45S5 Bioglass is developed. This hydrogel has an appropriate elastic modulus of 39 ± 2.2 kPa to allow proper handling during implantation. The hydrogel promotes human adipose‐derived stem attachment, proliferation, and differentiation toward the osteogenic lineage, including the deposition of hydroxyapatite particles embedded within a collagenous fibrillar structure after 21 days of in vitro culture. After eight weeks of implantation of the acellular hydrogel in a critical‐sized rat cranial defect model, only a small quantity of various pro‐inflammatory (< 20 pg mg−1) and anti‐inflammatory (< 10 pg mg−1) factors in the adjacent cranial tissue is noticed, indicating the overall biocompatibility of the hydrogel. Scanning electron microscopy evidenced the presence of new fibrous extracellular matrix and mineral aggregates at the defect site, with calcium/phosphorus ratio of 0.5 and 2.0 by eight and twelve weeks, respectively. Microcomputed tomography (Micro‐CT) and histological analyses showed formation of mature mineralized tissue that bridged with the surrounding bone. Taken together, the acellular composite hydrogel shows great promise for superior bone healing after cranioplasty.

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“…Most of these complications have been theorized to result secondarily to an inflammatory response to BMP. [7][8][9][10][11][12] In conjunction with these reports, other studies have correlated complication frequency and severity to use of higher BMP doses and attributed nerve root injury and radiculitis to application of BMP near neural structures. [13][14][15] Nonetheless, most studies have been underpowered, and many have contradicted one another, resulting in varying recommendations regarding the use of BMP in TLIF surgeries.…”

Section: Introductionmentioning

confidence: 99%

Biologics and Minimally Invasive Approach to TLIFs: What Is the Risk of Radiculitis?

et al. 2020

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Background: Bone morphogenetic protein (BMP) and allograft containing mesenchymal stem cells (live cell) are popular biologic substitutes for iliac crest autograft used in transforaminal lumbar interbody fusion (TLIF). Use of these agents in the pathogenesis of postoperative radiculitis remains controversial. Recent studies have independently linked minimally invasive (MIS) TLIF with increased radiculitis risk compared to open TLIF. The purpose of this study was to assess the rate of postoperative radiculitis in open and MIS TLIF patients along with its relationship to concurrent biologic adjuvant use. Methods: Patients 18 years undergoing single-level TLIF from June 2012 to December 2018 with minimum 1-year follow-up were included. Outcome measures were rate of radiculitis, intra-and postoperative complications, revision surgery; length of stay (LOS), and estimated blood loss (EBL). Results: There were 397 patients: 223 with open TLIFs, 174 with MIS TLIFs. One hundred and fifty-nine surgeries used bone morphogenetic protein (BMP), 26 live cell, 212 neither. Open TLIF: higher mean EBL, LOS, and Charlson Comorbidity Index (CCI) than MIS. Postoperative radiculitis in 37 patients (9.32% overall): 16 cases MIS BMP (15.69% of their cohort), 6 MIS without BMP (8.33%), 5 open BMP (8.77%), 10 open without BMP (6.02%). MIS TLIF versus open TLIF: no differences in 1-year reoperation rates, infection/wound complication, pseudarthrosis, or postoperative complication rate. BMP versus non-BMP: no differences in reoperation rates, infection/wound complication, pseudarthrosis, or postoperative complication rate. Multivariate logistic regression found that neither BMP (P ¼ .109) nor MIS (P ¼ .314) was an independent predictor for postoperative radiculitis when controlled for age, gender, body mass index, and CCI. Using paired open and MIS groups (N ¼ 168 each) with propensity score matching, these variables were still not independently associated with radiculitis (P ¼ .174 BMP, P ¼ .398 MIS). However, the combination of MIS with BMP was associated with increased radiculitis risk in both the entire patient cohort (odds ratio [OR]: 2.259 [1.117-4.569], P ¼ .023, N ¼ 397) and PSM cohorts (OR: 2.196 [1.045-4.616], P ¼ .038, N ¼ 336) compared to other combinations of surgical approach and biologic use. Conclusions: Neither the MIS approach nor BMP use is an independent risk factor for post-TLIF radiculitis. However, risk of radiculitis significantly increases when they are used in tandem. This should be considered when selecting biological adjuvants for MIS TLIF.

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5:08107. Transient reduced mineral density associated with BMP-enhanced spinal fusion

Cited by 3 publications

References 0 publications

Expandable Interbody Spacers: A Two-Year Study Evaluating Radiologic and Clinical Outcomes With Patient-Reported Outcomes

Expandable Interbody Spacers: A Two-Year Study Evaluating Radiologic and Clinical Outcomes With Patient-Reported Outcomes

Functionalized Collagen/Elastin‐like Polypeptide Hydrogels for Craniofacial Bone Regeneration

Biologics and Minimally Invasive Approach to TLIFs: What Is the Risk of Radiculitis?

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