Bone Grafting Options in Children

Betz, Randal R.; Lavelle, William F.; Samdani, Amer F.

doi:10.1097/brs.0b013e3181ce8f4b

Cited by 38 publications

(31 citation statements)

References 35 publications

(21 reference statements)

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“…Several surgical techniques can be used, but it is essential to obtain solid arthrodesis at the operated segment [1][2][3][4][5]. Several surgical techniques can be used, but it is essential to obtain solid arthrodesis at the operated segment [1][2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

“…Several surgical techniques can be used, but it is essential to obtain solid arthrodesis at the operated segment [1][2][3][4][5]. However, several complications are described at the donor site, especially pain [4,5,[8][9][10][11][12]. This type of graft is considered the gold standard for presenting excellent osteoconductive and osteoinductive properties, without the risk of disease transmission or immune reactions.…”

Section: Introductionmentioning

confidence: 99%

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Radiographic and functional evaluation of the iliac bone graft in the treatment of adolescent idiopathic scoliosis

Franzin

Gotfryd²,

Neto³

et al. 2014

Journal of Pediatric Orthopaedics B

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This study aimed to assess the impact of the use of an additional iliac bone graft on functional and radiographic results after thoracic spine arthrodesis with pedicle screws in patients with adolescent idiopathic scoliosis. Participants were divided into two groups: a control group that received only local bone (n=19) and a second group that, in addition to this procedure, received an iliac graft (n=22). The evaluations were performed on preoperative, immediate postoperative, and last follow-up (mean 29.7 months; minimum 12 months). Radiographic evaluations included the loss of correction and the presence of nonunion. The functional outcome was evaluated using the Scoliosis Research Society-30 questionnaire. Surgical complications and the presence of iliac donor site pain were also described. There were no significant differences between groups in the pseudoarthrosis rate, loss of correction over time, and quality of life. We concluded that the addition of bone graft from the iliac yielded no benefit in terms of the fusion rate and functional outcomes. The appropriate facetectomy, bed preparation, and filling with a local bone graft must be adequate to achieve an adequate fusion on surgical treatment of adolescent idiopathic scoliosis.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Radiographic and functional evaluation of the iliac bone graft in the treatment of adolescent idiopathic scoliosis

Franzin

Gotfryd²,

Neto³

et al. 2014

Journal of Pediatric Orthopaedics B

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“…Similar to adult patients, there is significant morbidity associated with bone graft harvesting and up to 31 % of adolescent patients complain of persistent harvest site pain 2 years after surgery [57]. The reported success of bone graft substitutes in the adult spine literature has led to the use of rhBMP-2 in pediatric and adolescent patients.…”

Section: Bmp Utilization In Adolescentsmentioning

confidence: 99%

“…Although there are limited published reports, rhBMP-2 appears to be a safe and effective alternative to promote spinal fusion in a selective group of adolescent patients [57]. Fahim et al reported a 100 % fusion rate with rhBMP-2 in cervical, thoracic, and lumbar fusions after a mean 17-25 month follow-up [62].…”

Section: Argument In Favor Of Bmp Utilization In Adolescent Patientsmentioning

confidence: 99%

Point-counter-point debate: the association between recombinant human bone morphogenetic protein utilization and complications in spine surgery

Siemionow

Sundberg

Tyrakowski³

et al. 2014

Curr Rev Musculoskelet Med

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Bone morphogenetic proteins (BMPs) have been utilized in spine surgery for over 10 years as a bone graft substitute. Potential BMP-related adverse effects including retrograde ejaculation and heterotopic neuroforaminal bone formation have been described. Additionally, some studies have suggested an association between BMP and cancer. Inconsistencies exist in the published spine literature with regards to the incidence and association of complications with BMP utilization. In a point-counterpoint format, this article discusses the current evidence concerning the relationship between the utilization of BMP in spinal fusion and the risk of cancer, retrograde ejaculation (RE), neuroforaminal bone formation, and its role in anterior cervical spine surgery and adolescents.Keywords Bone morphogenetic protein . Retrograde ejaculation . Anterior cervical fusion . Neuroforaminal bone growth . Cancer Point-counterpointRetrograde Ejaculation (RE) RE occurs secondary to impaired function of the internal vesicle sphincter muscle. Anterior lumbar approaches, particularly at the L5-S1 level, carry a greater potential for damage to the superior hypogastric sympathetic plexus, which innervates the internal vesicle sphincter muscle. Other etiologies of RE including diabetes, benign prostate hypertrophy and its treatment, multiple sclerosis, pelvic trauma, and pelvic or rectal surgery [1][2][3][4][5][6]. RE following anterior lumbar spine surgery is also purported to be related to the surgical approach [7][8][9].Burkus et al first published a prospective, randomized, nonblinded FDA-approved study concerning the use of rhBMP-2 in ALIF [8]. Six males (4.1 %; 6/146) reported RE following surgery, of which 4 underwent a transperitoneal approach (TPA) (13.3 %; 4 of all 30 males that underwent TPA) and 2 underwent a retroperitoneal approach (RPA) (1.8 %; 2 of 116 males that underwent RPA). Since the difference in RE between the TPA and RPA groups was statistically significant the authors concluded that a TPA was associated with a higher risk of RE. No comparison in RE between the investigational and control group was performed. The reported differences between the 2 approaches persisted at the 2-year follow-up period [10]. However, in 2010 Smoljanovic et al reviewed the data by Burkus et al [11] and reported that all 6 patients with RE had received rhBMP-2. Thus, the prevalence of RE in the investigational group (rhBMP-2) would have been 7.7 % (6/78 males), which was significantly greater than the control group (ICBG). The reason for ignoring the relationship between RE and rhBMP-2 was questioned, which sparked an intense debate over the potential association between the utilization of rhBMP-2 and RE.Correlation between rhBMP-2 utilization and RE Curr Rev Musculoskelet Med (2014) 7:200-207 DOI 10.1007/s12178-014-9219-x patients (7.2 %) in the rhBMP-2 group developed RE while only 1 of 174 patients (0.6 %; 1/69) reported RE in the control group. Significant differences in RE were also evident among patients that underwent a singl...

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“…Several clinical studies have documented favorable results by using adult lumbar spine and anterior cervical spine models. 6,9 Although BMP has been used with some frequency in pediatric oral maxillofacial reconstructions 7,8,[13][14][15]18,26,56 and reported in the treatment of congenital pseudarthrosis of the tibia, 32,46 there have been few reports of rhBMP-2 use 1,4,20,36,37,40 in pediatric spine fusions. One recent study 31 of patients in the pediatric age group in the Nationwide Inpatient Sample database analyzed various factors associated with the use of BMP for specific diagnoses, including adolescent idiopathic scoliosis, Scheuermann kyphosis, congenital kyphosis, spondylolisthesis, and thoracolumbar fracture; procedures related to the occipitocervical and cervical spine were not included in this study.…”

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confidence: 99%

Nationwide practice patterns in the use of recombinant human bone morphogenetic protein–2 in pediatric spine surgery as a function of patient-, hospital-, and procedure-related factors

Lam¹,

Sayama²,

Harris³

et al. 2014

PED

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Object Current national patterns as a function of patient-, hospital-, and procedure-related factors, and complication rates in the use of recombinant human bone morphogenetic protein–2 (rhBMP-2) as an adjunct to the practice of pediatric spine surgery have scarcely been investigated. Methods The authors conducted a cross-sectional study using data from the Healthcare Cost and Utilization Project Kids' Inpatient Database. Univariate and multivariate logistic regression were used to calculate unadjusted and adjusted odds ratios and 95% confidence intervals, and p values < 0.05 were considered to be statistically significant. Results The authors identified 9538 hospitalizations in pediatric patients 20 years old or younger who had undergone spinal fusion in the US in 2009; 1541 of these admissions were associated with rhBMP-2 use. By multivariate logistic regression, the following factors were associated with rhBMP-2 use: patient age 15–20 years; length of hospital stay (adjusted odds ratio [aOR] 1.01, p = 0.017); insurance status (private [aOR 1.49, p < 0.001] compared with Medicaid); hospital type (nonchildren's hospital); region (Midwest [aOR 2.49, p = 0.008] compared with Northeast); spinal refusion (aOR 2.20, p < 0.001); spinal fusion approach/segment (anterior lumbar [aOR 1.73, p < 0.001] and occipitocervical [aOR 1.86, p = 0.013] compared with posterior lumbar); short segment length (aOR 1.42, p = 0.016) and midlength (aOR 1.44, p = 0.005) compared with long; and preoperative diagnosis (Scheuermann kyphosis [aOR 1.56, p < 0.017] and spondylolisthesis [aOR 1.93, p < 0.001]). Conclusions Use of BMP in pediatric spine procedures now comprises more than 10% of pediatric spinal fusion. Patient-related (age, insurance type, diagnosis); hospital-related (children's hospital vs general hospital, region in the US); and procedure-related (redo fusion, anterior vs posterior approach, spinal levels, number of levels fused) factors are associated with the variation in BMP use in the US.

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Bone Grafting Options in Children

Abstract: Although autogenous iliac bone graft remains the benchmark to which bone grafting materials are compared, other options including the placement of no bone graft at all provides similar fusion rates in patients with AIS.

Cited by 38 publications

References 35 publications

Radiographic and functional evaluation of the iliac bone graft in the treatment of adolescent idiopathic scoliosis

Radiographic and functional evaluation of the iliac bone graft in the treatment of adolescent idiopathic scoliosis

Point-counter-point debate: the association between recombinant human bone morphogenetic protein utilization and complications in spine surgery

Nationwide practice patterns in the use of recombinant human bone morphogenetic protein–2 in pediatric spine surgery as a function of patient-, hospital-, and procedure-related factors

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