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

Abstract

<jats:p>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.</jats:p>

Multiplane osteotomy of the clavicle for symptomatic malunion: a case report of augmentation of healing with bone morphogenetic protein-2

“…17 Potential complications associated with rhBMP-2 treatment include inflammation, local edema, osteolysis, neuropathy, and heterotopic bone formation. [18][19][20][21] The purpose of this report was to describe the use of a multiplane osteotomy of the clavicle for a complex malunion and the use of rhBMP-2 combined with autologous bone grafting to augment healing of the clavicular osteotomy. This case report was approved by the institutional review board (IRB) of the Hospital for Special Surgery (IRB# 2019-1487, and informed consent was obtained from the patient for being included in the study.…”

“…Currently data are limited regarding the use of rhBMP-2 to augment osteotomy healing 17. Potential complications associated with rhBMP-2 treatment include inflammation, local edema, osteolysis, neuropathy, and heterotopic bone formation 18–21…”