RhBMP-2 Is Superior to Iliac Crest Bone Graft for Long Fusions to the Sacrum in Adult Spinal Deformity

Kim, Hee Jin; Buchowski, Jacob M.; Zebala, Lukas P.; Dickson, Douglas D.; Koester, Linda A.; Bridwell, Keith H.

doi:10.1097/brs.0b013e31828b656d

Cited by 57 publications

(36 citation statements)

References 28 publications

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“…In the current study, TCcorrection averaged 39 % and LC-correction 50 %. Review of the literature shows that TC-correction ranges from 30 to 68 % and about 45 % on average [6,7,19,22,30], LC-correction ranges from 30 to 55 % and about 45 % on average [7,[30][31][32], and major curve correction ranges from 43 to 55 % [29,33]. Correction rates do not compare well with those achieved in adolescent scoliosis.…”

Section: Deformity Correctionmentioning

confidence: 63%

“…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: 97%

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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: Deformity Correctionmentioning

confidence: 63%

Section: Non-union and Revision Surgerymentioning

confidence: 97%

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

et al. 2015

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“…Although the present study did not demonstrate any significant associations between the use of BMP-2 and the occurrence of rod fracture, there are several previous reports that have demonstrated significantly higher fusion rates with use of this osteobiologic. 18,22 It is possible that the apparent lack of a protective effect of BMP-2 on rod fracture through promotion of arthrodesis may relate to subtleties of application or dosing that are beyond the scope of the present study. In addition, that many of the rod fractures occurred relatively early in the postoperative course before a robust arthrodesis may have been expected suggests that these failures may relate, at least in part, to mechanical compromise of the instrumentation.…”

Section: Discussionmentioning

confidence: 77%

Prospective multicenter assessment of risk factors for rod fracture following surgery for adult spinal deformity

Smith

Shaffrey

Klineberg

et al. 2014

SPI

216

174

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Object Improved understanding of rod fracture (RF) following adult spinal deformity (ASD) surgery could prove valuable for surgical planning, patient counseling, and implant design. The objective of this study was to prospectively assess the rates of and risk factors for RF following surgery for ASD. Methods This was a prospective, multicenter, consecutive series. Inclusion criteria were ASD, age > 18 years, ≥5 levels posterior instrumented fusion, baseline full-length standing spine radiographs, and either development of RF or full-length standing spine radiographs obtained at least 1 year after surgery that demonstrated lack of RF. ASD was defined as presence of at least one of the following: coronal Cobb angle ≥20°, sagittal vertical axis (SVA) ≥5 cm, pelvic tilt (PT) ≥25°, and thoracic kyphosis ≥60°. Results Of 287 patients who otherwise met inclusion criteria, 200 (70%) either demonstrated RF or had radiographic imaging obtained at a minimum of 1 year after surgery showing lack of RF. The patients' mean age was 54.8 ± 15.8 years; 81% were women; 10% were smokers; the mean body mass index (BMI) was 27.1 ± 6.5; the mean number of levels fused was 12.0 ± 3.8; and 50 patients (25%) had a pedicle subtraction osteotomy (PSO). The rod material was cobalt chromium (CC) in 53%, stainless steel (SS), in 26%, or titanium alloy (TA) in 21% of cases; the rod diameters were 5.5 mm (in 68% of cases), 6.0 mm (in 13%), or 6.35 mm (in 19%). RF occurred in 18 cases (9.0%) at a mean of 14.7 months (range 3–27 months); patients without RF had a mean follow-up of 19 months (range 12–24 months). Patients with RF were older (62.3 vs 54.1 years, p = 0.036), had greater BMI (30.6 vs 26.7, p = 0.019), had greater baseline sagittal malalignment (SVA 11.8 vs 5.0 cm, p = 0.001; PT 29.1° vs 21.9°, p = 0.016; and pelvic incidence [PI]–lumbar lordosis [LL] mismatch 29.6° vs 12.0°, p = 0.002), and had greater sagittal alignment correction following surgery (SVA reduction by 9.6 vs 2.8 cm, p < 0.001; and PI-LL mismatch reduction by 26.3° vs 10.9°, p = 0.003). RF occurred in 22.0% of patients with PSO (10 of the 11 fractures occurred adjacent to the PSO level), with rates ranging from 10.0% to 31.6% across centers. CC rods were used in 68% of PSO cases, including all with RF. Smoking, levels fused, and rod diameter did not differ significantly between patients with and without RF (p > 0.05). In cases including a PSO, the rate of RF was significantly higher with CC rods than with TA or SS rods (33% vs 0%, p = 0.010). On multivariate analysis, only PSO was associated with RF (p = 0.001, OR 5.76, 95% CI 2.01–15.8). Conclusions Rod fracture occurred in 9.0% of ASD patients and in 22.0% of PSO patients with a minimum of 1-year follow-up. With further follow-up these rates would likely be even higher. There was a substantial range in the rate of RF with PSO across centers, suggesting potential variations in technique that warrant future investigation. Due to higher rates of RF with PSO, alternative instrumentation strategies should be considered for these cases.

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“…Two level II 152,153 , two level III 154,155 and one level IV 156 studies investigating the efficacy of rhBMP-2 for adult spinal deformity correction were found. All groups related reliable fusion rates with rhBMP-2, ranging 93.5% to 100%, suggesting equivalence to autologous iliac crest bone.…”

Section: Recombinant Bone Morphogenic Protein-2 (Rhbmp-2) For Deformimentioning

confidence: 99%

“…All groups related reliable fusion rates with rhBMP-2, ranging 93.5% to 100%, suggesting equivalence to autologous iliac crest bone. A level III study by Kim et al 154 further concluded that rhBMP-2 is in fact superior to ICBG in achieving fusion in long constructs for adult spinal deformity.…”

Section: Recombinant Bone Morphogenic Protein-2 (Rhbmp-2) For Deformimentioning

confidence: 99%

Bone substitutes and expanders in Spine Surgery: A review of their fusion efficacies

et al. 2016

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Study Design A narrative review of literature. ObjectiveThis manuscript intends to provide a review of clinically relevant bone substitutes and bone expanders for spinal surgery in terms of efficacy and associated clinical outcomes, as reported in contemporary spine literature. Summary of Background DataEver since the introduction of allograft as a substitute for autologous bone in spinal surgery, a sea of literature has surfaced, evaluating both established and newly emerging fusion alternatives. An understanding of the available fusion options and an organized evidence-based approach to their use in spine surgery is essential for achieving optimal results. MethodsA Medline search of English language literature published through March 2016 discussing bone graft substitutes and fusion extenders was performed. All clinical studies reporting radiological and/or patient outcomes following the use of bone substitutes were reviewed under the broad categories of Allografts, Demineralized Bone Matrices (DBM), Ceramics, Bone Morphogenic proteins (BMPs), Autologous growth factors (AGFs), Stem cell products and Synthetic Peptides. These were further grouped depending on their application in lumbar and cervical spine surgeries, deformity correction or other miscellaneous procedures viz. trauma, infection or tumors; wherever data was forthcoming. Studies in animal populations and experimental in vitro studies were excluded. Primary endpoints were radiological fusion rates and successful clinical outcomes. ResultsA total of 181 clinical studies were found suitable to be included in the review. More than a third of the published articles (62 studies, 34.25%) focused on BMP. Ceramics (40 studies) and Allografts (39 studies) were the other two highly published groups of bone substitutes. Highest radiographic fusion rates were observed with BMPs, followed by allograft and DBM. There were no significant differences in the reported clinical outcomes across all classes of bone substitutes. ConclusionsThere is a clear publication bias in the literature, mostly favoring BMP. Based on the available data, BMP is however associated with the highest radiographic fusion rate. Allograft is also very well corroborated in the literature. The use of DBM as a bone expander to augment autograft is supported, especially in the lumbar spine. Ceramics are also utilized as bone graft extenders and results are generally supportive, although limited. The use of autologous growth factors is not substantiated at this time. Cell matrix or stem cell-based products and the synthetic peptides have inadequate data. More comparative studies are needed to evaluate the efficacy of bone graft substitutes overall.keywords: bone substitutes, allografts, demineralized bone matrix (dbm), spine fusion, ceramics, β tricalcium phosphate (β-tcp), hydroxyapatite, rhbmp-2, osteogenic protein-1 (op-1), autologous growth factors, i-factor, synthetic peptides volume 10 article 33

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RhBMP-2 Is Superior to Iliac Crest Bone Graft for Long Fusions to the Sacrum in Adult Spinal Deformity

Abstract: 3.

Cited by 57 publications

References 28 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

Prospective multicenter assessment of risk factors for rod fracture following surgery for adult spinal deformity

Bone substitutes and expanders in Spine Surgery: A review of their fusion efficacies

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