High-Dose rhBMP-2 for Adults: Major and Minor Complications

Mesfin, Addisu; Buchowski, Jacob M.; Zebala, Lukas P.; Bakhsh, Wajeeh; Aronson, Adam B.; Fogelson, Jeremy L.; Hershman, Stuart H.; Kim, Hee Jin; Ahmad, Azeem; Bridwell, Keith H.

doi:10.2106/jbjs.l.01730

Cited by 96 publications

(59 citation statements)

References 44 publications

(59 reference statements)

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“…Recent studies showed that the off-label use of a high dose (more than 40 mg) of rhBMP-2 was associated with an increased risk of new cancer. We should therefore, further evaluate the potential risk of cancers in patients receiving high-dose rhBMP2 [31], [32].…”

Section: Discussionmentioning

confidence: 99%

Recombinant Human Bone Morphogenetic Protein-2 in Debridement and Impacted Bone Graft for the Treatment of Femoral Head Osteonecrosis

Sun

Gao

et al. 2014

PLoS ONE

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The purpose of this study was to compare the clinical outcomes of impacted bone graft with or without recombinant human bone morphogenetic protein-2 (rhBMP-2) for osteonecrosis of the femoral head (ONFH). We examined the effect of bone-grafting through a window at the femoral head-neck junction, known as the “light bulb” approach, for the treatment of ONFH with a combination of artificial bone (Novobone) mixed with or without rhBMP-2. A total of 42 patients (72 hips) were followed-up from 5 to 7.67 years (average of 6.1 years). The patients with and without BMP were the first group (IBG+rhBMP-2) and the second group (IBG), respectively. The clinical effectiveness was evaluated by Harris hip score (HHS). The radiographic follow-up was evaluated by pre-and postoperative X-ray and CT scan. Excellent, good, and fair functions were obtained in 36, 12, and 7 hips, respectively. The survival rate was 81.8% and 71.8% in the first and second group, respectively. However, the survival rate was 90.3% in ARCO stage IIb, c, and only 34.6% in ARCO stage IIIa(P<0.05). It was concluded that good and excellent mid-term follow-up could be achieved in selected patients with ONFH treated with impacted bone graft operation. The rhBMP-2 might improve the clinical efficacy and quality of bone repair.

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Section: Discussionmentioning

confidence: 99%

Recombinant Human Bone Morphogenetic Protein-2 in Debridement and Impacted Bone Graft for the Treatment of Femoral Head Osteonecrosis

Sun

Gao

et al. 2014

PLoS ONE

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“…While attempts to identify optimal formulations and methods of delivery are ongoing, the use of BMP-2 in spine surgery remains controversial due to reports of safety issues. 1,3,7,9,11,12,14,16,17,19 Although the basic mechanisms underlying BMP-2-induced vertebral fusion and heterotopic ossification are largely understood, [4][5][6]13,15 the parameters for optimal imaging of these complications are still being identified.…”

Section: Discussionmentioning

confidence: 99%

Imaging symptomatic bone morphogenetic protein-2–induced heterotopic bone formation within the spinal canal: case report

Chryssikos¹,

Crandall²,

Sansur³

2016

SPI

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Heterotopic bone formation within the spinal canal is a known complication of bone morphogenetic protein–2 (BMP-2) and presents a clinical and surgical challenge. Imaging modalities are routinely used for operative planning in this setting. Here, the authors present the case of a 59-year-old woman with cauda equina syndrome following intraoperative BMP-2 administration. Plain film myelographic studies showed a region of severe stenosis that was underappreciated on CT myelography due to a heterotopic bony lesion mimicking the dorsal aspect of a circumferentially patent thecal sac. When evaluating spinal stenosis under these circumstances, it is important to carefully consider plain myelographic images in addition to postmyelography CT images as the latter may underestimate the true degree of stenosis due to the potentially similar radiographic appearances of evolving BMP-2–induced heterotopic bone and intrathecal contrast. Alternatively, comparison of sequentially acquired noncontrast CT scans with CT myelographic images may also assist in distinguishing BMP-2–induced heterotopic bony lesions from the thecal sac. Further studies are needed to elucidate the roles of the available imaging techniques in this setting and to characterize the connection between the radiographic and histological appearances of BMP-2–induced heterotopic bone.

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“…46 Despite the positive results achieved with the use of rhBMPs in spine fusion, some serious negative fi ndings have recently emerged concerning the lack of clinical evidence of the advantage of rhBMP-2 over bone grafts and its possible link with important cancer risks. [47][48][49][50][51] For this reason, the authors of this article considered the combination of osteoinductive and osteoconductive materials such as DBM as a valid alternative to autologous/homologous bone, thus perhaps overcoming the limitation of current therapeutic strategies. 30 , 32 ,52,53 DBM is available in various formulations produced by numerous manufacturers, containing varying amounts of osteogenic factors.…”

Section: ➢ Key Pointsmentioning

confidence: 99%