Complications due to the use of BMP/INFUSE in spine surgery: The evidence continues to mount

Epstein, Nancy E.

doi:10.4103/2152-7806.114813

Cited by 220 publications

(159 citation statements)

References 27 publications

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“…[87] Despite good effects on bone formation, there are concerns that BMP treatment may have adverse effects such as seroma formation, neurologic deficits and heterotopic induction of bone. [88] Moreover, the potential roles of use of recombinant BMPs in neoplasia are not fully understood.…”

Section: Recombinant Human Bmpmentioning

confidence: 99%

The role of bone morphogenetic proteins in myeloma cell survival

Holien

Sundan

2014

Cytokine & Growth Factor Reviews

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Section: Recombinant Human Bmpmentioning

confidence: 99%

The role of bone morphogenetic proteins in myeloma cell survival

Holien

Sundan

2014

Cytokine & Growth Factor Reviews

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“…Several literature reviews, meta-analyses, and letters to editors have been published regarding the results from the above mentioned studies [16][17][18]. However, Mroz et al emphasized a very important question regarding the association between rhBMP-2 and RE.…”

Section: Discussionmentioning

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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“…J Spine Surg 2016;2(1):9-12 jss.osspress.com complications including seroma, infection, heterotopic bone growth, new radiculopathy and bone resorption around fixation devices have been reported (8,10,11). Additionally, it is unknown whether the long-term effects in children may include an increased future risk of cancer.…”

Section: Literature Reviewmentioning

confidence: 99%

“…The manufacturers of BMP-2 consider its use in children less than 18 years of age or in those that lack epiphyseal closure to be a contraindication. There are also some serious drawbacks related to the use of BMP-2, including a high cost and increased rates of reported complications (8)(9)(10). For example, postoperative © OSS Press Ltd. All rights reserved.…”

Section: Literature Reviewmentioning

confidence: 99%

Bone morphogenetic protein in pediatric spine fusion surgery

Molinari¹,

Kerr²,

Kerr³

2016

J. Spine Surg.

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Background: There is a paucity of literature describing the use of bone graft substitutes to achieve fusion in the pediatric spine. Outcomes and complications involving the off-label use of bone morphogenetic protein 2 (BMP-2) in the pediatric spine are not clearly defined. The purpose of this study is to review the existing literature with respect to reported outcomes and complications involving the use of low-dose BMP-2 in pediatric patients.Methods: A Medline and PubMed literature search was conducted using the words bone morphogenetic protein, BMP, rh-BMP-2, bone graft substitutes, and pediatric spine.Results: To date, there are few published reports on this topic. Complications and appropriate BMP-2 dosage application in the pediatric spine remain unknown.Conclusions: This report describes the potential for BMP-2 to achieve successful arthrodesis of the spine in pediatric patients. Usage should be judicious as complications and long-term outcomes of pediatric BMP-2 usage remain undefined in the existing literature.

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Complications due to the use of BMP/INFUSE in spine surgery: The evidence continues to mount

Cited by 220 publications

References 27 publications

The role of bone morphogenetic proteins in myeloma cell survival

The role of bone morphogenetic proteins in myeloma cell survival

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

Bone morphogenetic protein in pediatric spine fusion surgery

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