Formation of Painful Seroma and Edema After the Use of Recombinant Human Bone Morphogenetic Protein-2 in Posterolateral Lumbar Spine Fusions

Garrett, Mark P.; Kakarla, U Kumar; Porter, Randall W.; Sonntag, Volker K. H.

doi:10.1227/01.neu.0000369517.21018.f2

Cited by 85 publications

(77 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Thereafter, the ABBM bone grafting materials were implanted into 3mm critical size bone defects and investigated for 2 important parameters: 1) for their ability to regenerate appreciable new bone formation and 2) to investigate the immune response of ABBM which incorporate a natural atelocollagen protein within its scaffold [24][25][26]. It was first observed that after a healing period of 4 weeks, appreciable new bone formation took place demonstrating the grafts ability to regenerate new bone in a short period of time [27].…”

Section: Discussionmentioning

confidence: 99%

Novel Natural Bovine Bone Graft with Integrated Atelo-Collagen Type I: Atelocollagen Bovine Bone Mineral (ABBM) Characterization In-vivo

Raouf¹,

Zhang²,

Caballé‐Serrano³

et al. 2017

Periodon Prosthodon

View full text Add to dashboard Cite

Bone grafting materials are routinely utilized in the fields of dental and orthopedic medicine to augment lost or missing bone. While autogenous bone has been considered the gold standard for many years, a variety of alternatives have been proposed including allografts, xenografts and alloplasts to prevent the additional morbidity and limited supply for autografts. Xenografts have frequently been utilized in many countries due to their supporting osteoconductive potential as well as that in many countries, allografts are not permitted.While typically all collagen and growth factors are removed during the processing of xenografts, recently the development of a natural bone mineral containing atelocollagen type I have been proposed utilizing atelopeptidation and lyophilization technologies modifying the collagen components of bone material within bone structure to non-immunogenic atelocollagen. This relatively novel processing technique does not use heat (thermal) processing when manufacturing which has been shown to negatively impact the natural crystalline micro-structure of hydroxyapatite, causing ceramization and destroying collagen components.The lyophilization technique, involves the evaporation of water contained in a product by sublimation -a previously frozen material is placed in a vacuum, which turns the ice directly to vapor. This new processing technique for xenografts has been shown to preserve lyophilized collagen with lower humidity making the bone matrix hydrophilic. These bone grafts contain roughly 2% moisture, 65-75% hydroxyapatite, 25-35% atelo-collagen content and up to 0.1% non-collagenous proteins. Here we investigated these novel atelo-collagenized bovine bone mineral (ABBM) bone grafts using scanning electron microscopy (SEM) and evaluated their bone regenerative potential in a rat femur animal model.

show abstract

Section: Discussionmentioning

confidence: 99%

Novel Natural Bovine Bone Graft with Integrated Atelo-Collagen Type I: Atelocollagen Bovine Bone Mineral (ABBM) Characterization In-vivo

Raouf¹,

Zhang²,

Caballé‐Serrano³

et al. 2017

Periodon Prosthodon

View full text Add to dashboard Cite

show abstract

“…Recently, attempts have been made to attribute the formation of spinal seromas to the use of rhBMP-2, 1,3,4,[13][14][15] which is a recombinant human protein that has been used off label to promote bone arthrodesis in patients undergoing laminectomy and spinal fusion. It is believed to act through cellular, nuclear, and cytokine signaling to induce osteoblast differentiation and thus facilitate new bone growth.…”

Section: Discussionmentioning

confidence: 99%

“…However, there have been several reports demonstrating an association between sterile postsurgical seroma formation and the use of rhBMP-2. 1,3,4,[12][13][14] Traditionally it is believed that these sterile seromas form as a result of trauma-induced inflammatory mediators that cause increased tissue capillary permeability in excess of local lymphatic drainage capacity. Surgical drainage of the fluid collection is often required, particularly in cases of neurological deterioration, and early detection is critical to prevent sequelae from cord compression.…”

mentioning

confidence: 99%

Surgical seroma formation following posterior cervical laminectomy and fusion without rhBMP-2

Yew¹,

Kimball²,

Lu³

2013

SPI

View full text Add to dashboard Cite

Posterior cervical laminectomy and fusion has become a common treatment option for patients with progressive upper-and lower-extremity weakness and MRI evidence of multilevel cervical spondylosis and cord compression. 7,9,11,17 Several agents, including DBM and BMP, have traditionally been used to promote bony fusion in patients at risk for pseudarthrosis. However, there have been several reports demonstrating an association between sterile postsurgical seroma formation and the use of rhBMP-2. 1,3,4,[12][13][14] Traditionally it is believed that these sterile seromas form as a result of trauma-induced inflammatory mediators that cause increased tissue capillary permeability in excess of local lymphatic drainage capacity. Surgical drainage of the fluid collection is often required, particularly in cases of neurological deterioration, and early detection is critical to prevent sequelae from cord compression. Here we describe the first known report of a patient who developed an epidural fluid collection following multilevel laminectomy and fusion with DBM alone. To our knowledge, this is the first case of seroma formation following multilevel laminectomy and fusion that has not been attributed to the use of rhBMP-2. Case ReportHistory. The patient was a 78-year-old female who initially presented with progressive upper-and lowerextremity weakness and severe axial neck pain. Magnetic resonance imaging demonstrated multilevel spondylosis and compression of the cervical spinal cord with associated T2 signal change. Flexion-extension plain radiographs demonstrated instability with anterior subluxation of C-4 on C-5 in flexion, with associated neck pain ( Department of Neurological Surgery, University of California, Los Angeles, CaliforniaSeroma formation following posterior cervical laminectomy and fusion is now recognized as a rare but significant risk. Previous reports have attributed the development of postoperative seromas to the use of recombinant bone morphogenetic protein-2 (rhBMP-2). Here the authors present the case of a 78-year-old female with a history of osteoporosis who developed delayed postoperative neck and shoulder pain following posterior cervical laminectomy and fusion utilizing only autograft bone and demineralized bone matrix (DBM) allograft. Postoperative MRI demonstrated normal hardware placement and a large epidural fluid collection that extended from C-4 to C-6. The patient underwent decompression and drainage of her sterile postoperative seroma. To the authors' knowledge, no case of seroma formation with the use of DBM has been previously reported. This case suggests that although rhBMP-2 is involved in the majority of postoperative seroma developments, other osteoinductive agents such as DBM can contribute to the development of a symptomatic seroma. This report presents an illustrative case study and reviews the current understanding of the development of and treatment for cervical seroma following posterior cervical laminectomy and fusion.

show abstract

“…43 Garrett et al reported on the formation of painful postoperative seromas following the use of rhBMP-2 during posterolateral fusions. 23 Finally, Carragee et al identified a higher incidence of retrograde ejaculation in patients receiving rhBMP-2 during ALIF procedures.…”

Section: Singh Et Al 2006 IIImentioning

confidence: 99%

Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 16: Bone graft extenders and substitutes as an adjunct for lumbar fusion

Kaiser

Groff

Watters

et al. 2014

SPI

View full text Add to dashboard Cite

In an attempt to enhance the potential to achieve a solid arthrodesis and avoid the morbidity of harvesting autologous iliac crest bone (AICB) for a lumbar fusion, numerous alternatives have been investigated. The use of these fusion adjuncts has become routine despite a lack of convincing evidence demonstrating a benefit to justify added costs or potential harm. Potential alternatives to AICB include locally harvested autograft, calcium-phosphate salts, demineralized bone matrix (DBM), and the family of bone morphogenetic proteins (BMPs). In particular, no option has created greater controversy than the BMPs. A significant increase in the number of publications, particularly with respect to the BMPs, has taken place since the release of the original guidelines. Both DBM and the calciumphosphate salts have demonstrated efficacy as a graft extender or as a substitute for AICB when combined with local autograft. The use of recombinant human BMP-2 (rhBMP-2) as a substitute for AICB, when performing an interbody lumbar fusion, is considered an option since similar outcomes have been observed; however, the potential for heterotopic bone formation is a concern. The use of rhBMP-2, when combined with calcium phosphates, as a substitute for AICB, or as an extender, when used with local autograft or AICB, is also considered an option as similar fusion rates and clinical outcomes have been observed. Surgeons electing to use BMPs should be aware of a growing body of literature demonstrating unique complications associated with the use of BMPs.

show abstract

Formation of Painful Seroma and Edema After the Use of Recombinant Human Bone Morphogenetic Protein-2 in Posterolateral Lumbar Spine Fusions

Cited by 85 publications

References 31 publications

Novel Natural Bovine Bone Graft with Integrated Atelo-Collagen Type I: Atelocollagen Bovine Bone Mineral (ABBM) Characterization In-vivo

Novel Natural Bovine Bone Graft with Integrated Atelo-Collagen Type I: Atelocollagen Bovine Bone Mineral (ABBM) Characterization In-vivo

Surgical seroma formation following posterior cervical laminectomy and fusion without rhBMP-2

Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 16: Bone graft extenders and substitutes as an adjunct for lumbar fusion

Contact Info

Product

Resources

About