Complications associated with recombinant human bone morphogenetic protein use in pediatric craniocervical arthrodesis

Lindley, Timothy E.; Dahdaleh, Nader S.; Menezes, Arnold H.; Abode-Iyamah, Kingsley

doi:10.3171/2011.2.peds10487

Cited by 45 publications

(28 citation statements)

References 28 publications

(35 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…119 BMP is expensive, and its use has been associated with swelling, seroma formation, hematoma, ectopic bone formation, osteomyelitis and bone resorption, dysphagia, and breathing difficulties. 20,91,93,130,132,136 Our analysis suggests that rigid internal fixation techniques may play a more important role than BMP in promoting fusion when allograft is used; however, our conclusions are limited by the small sample sizes reported and the limitations inherent in a retrospective review of the literature.…”

Section: The Role Of Bmp In Allograft Fusionsmentioning

confidence: 43%

Allograft versus autograft for pediatric posterior cervical and occipito-cervical fusion: a systematic review of factors affecting fusion rates

Reintjes

Amankwah

Rodríguez

et al. 2016

PED

View full text Add to dashboard Cite

OBJECT Fusion rates are high for children undergoing posterior cervical fusion (PCF) and occipito-cervical fusion (OCF). Autologous bone has been widely used as the graft material of choice, despite the risk of donor-site morbidity associated with harvesting the bone, possibly because very low fusion rates were reported with posterior allograft cervical fusions in children several decades ago. Higher overall fusion rates using allograft in adults, associated with improvements in internal fixation techniques and the availability of osteoinductive substances such as bone morphogenetic protein (BMP), have led to heightened enthusiasm for the use of bank bone during pediatric PCF. A systematic review was performed to study factors associated with successful bone fusion, including the type of bone graft used. METHODS The authors performed a comprehensive PubMed search of English-language articles pertaining to PCF and OCF in patients less than 18 years old. Of the 561 abstracts selected, 148 articles were reviewed, resulting in 60 articles that had sufficient detail to be included in the analysis. A meta-regression analysis was performed to determine if and how age, fusion technique, levels fused, fusion substrate, BMP use, postoperative bracing, and radiographic fusion criteria were related to the pooled prevalence estimates. A systematic review of the literature was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. RESULTS A total of 604 patients met the specific inclusion and exclusion criteria. The overall fusion rate was 93%, with a mean age of 9.3 years and mean follow-up of 38.7 months. A total of 539 patients had fusion with autograft (94% fusion rate) and 65 patients with allograft (80% fusion rate). Multivariate meta-regression analysis showed that higher fusion rates were associated with OCF compared with fusions that excluded the occiput (p < 0.001), with the use of autograft instead of allograft (p < 0.001), and with the use of CT to define fusion instead of plain radiography alone. The type of internal fixation, the use of BMP, patient age, and the duration of follow-up were not found to be associated with fusion rates in the multivariate analysis. CONCLUSIONS Fusion rates for PCF are high, with higher rates of fusion seen when autograft is used as the bone substrate and when the occiput is included in the fusion construct. Further study of the use of allograft as a viable alternative to autograft bone fusion is warranted because limited data are available regarding the use of allograft in combination with more rigid internal fixation techniques and osteoinductive substances, both of which may enhance fusion rates with allograft.

show abstract

Section: The Role Of Bmp In Allograft Fusionsmentioning

confidence: 43%

Allograft versus autograft for pediatric posterior cervical and occipito-cervical fusion: a systematic review of factors affecting fusion rates

Reintjes

Amankwah

Rodríguez

et al. 2016

PED

View full text Add to dashboard Cite

show abstract

“…other serious side effects including acute renal insufficiency, supraventricular tachycardia, and confusion are reported in a single patient (20). cases of retropharyngeal swelling are also reported by other authors as well as local inflammatory reactions, transient dysphagia, heterotopic ossification, prevertebral haematoma, and formation of seroma (4,14). Adverse events are supposed to be dose-dependent and are more likely in the region of the cervical than the lumbar spine due to anatomical considerations.…”

Section: Mitogensmentioning

confidence: 88%

Biotechnologies in the Treatment of Degenerative Disc Disease of the Cervical Spine

Ferdinandov

Tsekov

Bussarsky

et al. 2012

Biotechnology & Biotechnological Equipment

View full text Add to dashboard Cite

“…This is concerning particularly due to the reported complications in the adult literature including cancer, ectopic bone formation, and urogenital complications. In addition, the pediatric spine literature has also reported a number of adverse events associated with rhBMP-2 including wound infection, seroma formation causing neurologic damage, and symptomatic ectopic bone formation [60]. Although the largest retrospective reviews analyzing rhBMP-2 in adolescent patients do no report an increased risk of postoperative complications [59,61], these studies are limited to in-hospital outcomes, which disregard the more common long-term complications demonstrated in other reports.…”

Section: Argument Against Bmp Utilization In Adolescent Patientsmentioning

confidence: 96%

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

View full text Add to dashboard Cite

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...

show abstract

Complications associated with recombinant human bone morphogenetic protein use in pediatric craniocervical arthrodesis

Cited by 45 publications

References 28 publications

Allograft versus autograft for pediatric posterior cervical and occipito-cervical fusion: a systematic review of factors affecting fusion rates

Allograft versus autograft for pediatric posterior cervical and occipito-cervical fusion: a systematic review of factors affecting fusion rates

Biotechnologies in the Treatment of Degenerative Disc Disease of the Cervical Spine

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

Contact Info

Product

Resources

About