Interbody fusion with allograft and rhBMP-2 leads to consistent fusion but early subsidence

Abstract

We carried out a prospective study to determine whether the addition of a recombinant human bone morphogenetic protein (rhBMP-2) to a machined allograft spacer would improve the rate of intervertebral body fusion in the spine. We studied 77 patients who were to undergo an interbody fusion with allograft and instrumentation. The first 36 patients received allograft with adjuvant rhBMP-2 (allograft/rhBMP-2 group), and the next 41, allograft and demineralised bone matrix (allograft/demineralised bone matrix group). Each patient was assessed clinically and radiologically both pre-operatively and at each follow-up visit using standard methods. Follow-up continued for two years. Every patient in the allograft/rhBMP-2 group had fused by six months. However, early graft lucency and significant (> 10%) subsidence were seen radiologically in 27 of 55 levels in this group. The mean graft height subsidence was 27% (13% to 42%) for anterior lumbar interbody fusion, 24% (13% to 40%) for transforaminal lumbar interbody fusion, and 53% (40% to 58%) for anterior cervical discectomy and fusion. Those who had undergone fusion using allograft and demineralised bone matrix lost only a mean of 4.6% (0% to 15%) of their graft height. Although a high rate of fusion (100%) was achieved with rhBMP-2, significant subsidence occurred in more than half of the levels (23 of 37) in the lumbar spine and 33% (6 of 18) in the cervical spine. A 98% fusion rate (62 of 63 levels) was achieved without rhBMP-2 and without the associated graft subsidence. Consequently, we no longer use rhBMP-2 with allograft in our practice if the allograft has to provide significant structural support.

Nanocomposite therapy as a more efficacious and less inflammatory alternative to bone morphogenetic protein‐2 in a rodent arthrodesis model

“…Since clinical data demonstrate a host response to rhBMP-2 after implantation, 13,14,17,27,28 four animals in the TrioMatrix 1 and rhBMP-2 groups underwent a modification of the posterolateral arthrodesis protocol followed by magnetic resonance imaging (MRI) evaluation of the lumbar spine to assess localized host response during the bone healing process at the 7-day time point. 29 In addition to arthrodesis, 1.06 AE 0.17 cc 3 of paraspinal muscle compartment was excised bilaterally to create an adjacent space next to the site of fusion.…”

“…[10][11][12] In the lumbar spine, reports have demonstrated radiculitis, pseudarthrosis, seroma/hematoma formation, and heterotopic ossification with rhBMP-2 use. [13][14][15][16][17] DBMs, which are derived from human cadaveric bone through an acid extraction process, 18 have been associated with a widely variable osteoinductive potency in vivo. [18][19][20][21][22] Ceramic carriers have shown promise in their clinical use as bone graft extenders, 23 but when used alone, provide no exogenous osteoinductivity.…”

Novel Wnt Regulator NEL-Like Molecule-1 Antagonizes Adipogenesis and Augments Osteogenesis Induced by Bone Morphogenetic Protein 2

“…gov/MedicalDevices/Safety/AlertsandNotices/PublicHealth Notifications/ucm062000.htm, last accessed September 28, 2011), 23 osteoclastogenesis, 24 and inconsistent bone formation. 25 Thus, improving the safety and efficacy of BMP2-based skeletal repair is crucial. Although NELL-1 is being developed as a standalone osteoinductive therapeutic, we previously performed studies of NELL-1 and BMP2 in animals in an effort to better understand the molecular and cellular bases of NELL-1 and/or BMP2 osteoinductivity.…”

The O-C2 angle established at occipito-cervical fusion dictates the patient’s destiny in terms of postoperative dyspnea and/or dysphagia

“…Proposed causes include pharyngeal edema, transient local nerve palsy, use of plate fixation, plate prominence, the use of recombinant human bone morphogenetic protein-2, and severe pain [14][15][16][17][18]. The incidence of dysphagia was reported to be 50-56% at 1 month after ACF, but the symptoms resolved gradually over the first few months.…”