Long Adult Spinal Deformity Fusion to the Sacrum Using rhBMP-2 Versus Autogenous Iliac Crest Bone Graft

Maeda, Takeshi; Buchowski, Jacob M.; Kim, Yongjung J.; Mishiro, Takuya; Bridwell, Keith H.

doi:10.1097/brs.0b013e3181b0485c

Cited by 67 publications

(25 citation statements)

References 37 publications

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“…Even though advanced lumbopelvic instrumentation has been utilized in several studies, the rate of non-union or 'mechanical failure' at L5-S1 remains 5-10 % [38,42]. For example the use of BMP was shown to increase fusion rates in long adult deformity fusion by about 20 % [33,43]. Thus, the appropriate method of lumbosacral stabilization for the range of severities of adult deformity has yet to be defined.…”

Section: Non-union and Revision Surgerymentioning

confidence: 96%

Factors influencing radiographic and clinical outcomes in adult scoliosis surgery: a study of 448 European patients

et al. 2015

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In the current study, the magnitude of deformity correction in the sagittal and coronal planes was shown to have significant impact on radiographic and clinical outcomes as well as revision rates. Findings indicate that risks for complications might be reduced by restoration of sagittal balance, appropriate deformity correction and advanced lumbosacral fixation. The use of preoperative LIV-TO and LIV-TO on bending/traction-films were shown to be useful for surgical planning, selection of the LIV and prediction of follow-up-TO, respectively. Parameters of sagittal balance rather than coronal deformity predicted ASD.

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Section: Non-union and Revision Surgerymentioning

confidence: 96%

Factors influencing radiographic and clinical outcomes in adult scoliosis surgery: a study of 448 European patients

et al. 2015

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“…11 Similarly, much less rhBMP-2 was used posteriorly than the 10-40 mg per level reported by other groups performing instrumented posterolateral fusions. 8,22 Given the successful fusion achieved in our series with much lower dosing of rhBMP-2 per level, further studies are probably warranted to determine the minimum effective dose of rhBMP-2 necessary to achieve a successful arthrodesis.…”

Section: Discussionmentioning

confidence: 99%

Mid-term to long-term clinical and functional outcomes of minimally invasive correction and fusion for adults with scoliosis

Anand¹,

Rosemann²,

Khalsa

et al. 2010

FOC

208

136

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Object The goal of this study was to assess the operative outcomes of adult patients with scoliosis who were treated surgically with minimally invasive correction and fusion. Methods This was a retrospective study of 28 consecutive patients who underwent minimally invasive correction and fusion over 3 or more levels for adult scoliosis. Hospital and office charts were reviewed for clinical data. Functional outcome data were collected at each visit and at the last follow-up through self-administered questionnaires. All radiological measurements were obtained using standardized computer measuring tools. Results The mean age of the patients in the study was 67.7 years (range 22–81 years), with a mean follow-up time of 22 months (range 13–37 months). Estimated blood loss for anterior procedures (transpsoas discectomy and interbody fusions) was 241 ml (range 20–2000 ml). Estimated blood loss for posterior procedures, including L5–S1 transsacral interbody fusion (and in some cases L4–5 and L5–S1 transsacral interbody fusion) and percutaneous screw fixation, was 231 ml (range 50–400 ml). The mean operating time, which was recorded from incision time to closure, was 232 minutes (range 104–448 minutes) for the anterior procedures, and for posterior procedures it was 248 minutes (range 141–370 minutes). The mean length of hospital stay was 10 days (range 3–20 days). The preoperative Cobb angle was 22° (range 15–62°), which corrected to 7° (range 0–22°). All patients maintained correction of their deformity and were noted to have solid arthrodesis on plain radiographs. This was further confirmed on CT scans in 21 patients. The mean preoperative visual analog scale and treatment intensity scale scores were 7.05 and 53.5; postoperatively these were 3.03 and 25.88, respectively. The mean preoperative 36-Item Short Form Health Survey and Oswestry Disability Index scores were 55.73 and 39.13; postoperatively they were 61.50 and 7, respectively. In terms of major complications, 2 patients had quadriceps palsies from which they recovered within 6 months, 1 sustained a retrocapsular renal hematoma, and 1 patient had an unrelated cerebellar hemorrhage. Conclusions Minimally invasive surgical correction of adult scoliosis results in mid- to long-term outcomes similar to traditional surgical approaches. Whereas operating times are comparable to those achieved with open approaches, blood loss and morbidity appear to be significantly lower in patients undergoing minimally invasive deformity correction. This approach may be particularly useful in the elderly.

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“…One major spinal deformity center published results for patients undergoing long spinal deformity fusion to the sacrum. They report a pseudoarthrosis rate of 28% in patients who received iliac crest bone graft versus only 4% of patients who were treated with rhBMP-2 [17]. In another study, Dimar, et.…”

Section: Biologics In Adult Spinal Deformity Surgerymentioning

confidence: 91%

Adult spine deformity

Good

Auerbach

O'Leary

et al. 2011

Curr Rev Musculoskelet Med

101

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Adult spinal deformity may occur as the result of a number of conditions and patients may present with a heterogeneous group of symptoms. Multiple etiologies may cause spinal deformity; however, symptoms are associated with progressive and asymmetric degeneration of the spinal elements potentially leading to neural element compression. Symptoms and clinical presentation vary and may be related to progressive deformity, axial back pain, and/or neurologic symptoms. Spinal deformity is becoming more common as adults 55-64 years of age are the fastest growing proportion of the U.S. population. As the percentage of elderly in the United States accelerates, more patients are expected to present with painful spinal conditions, potentially requiring spinal surgery. The decision between operative and nonoperative treatment for adult spinal deformity is based on the severity and type of the patient's symptoms as well as the magnitude and risk of potential interventions.

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Long Adult Spinal Deformity Fusion to the Sacrum Using rhBMP-2 Versus Autogenous Iliac Crest Bone Graft

Abstract: The pseudarthrosis rate in the BMP group compares favorably to pseudarthrosis rate in ICBG group, suggesting that the use of rhBMP-2 without iliac harvesting leads to a competitive fusion rate in long adult spinal deformity surgery, while avoiding ICBG harvest site morbidity.

Cited by 67 publications

References 37 publications

Factors influencing radiographic and clinical outcomes in adult scoliosis surgery: a study of 448 European patients

Factors influencing radiographic and clinical outcomes in adult scoliosis surgery: a study of 448 European patients

Mid-term to long-term clinical and functional outcomes of minimally invasive correction and fusion for adults with scoliosis

Adult spine deformity

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