The Effect of Recombinant Human Bone Morphogenetic Protein-2 in Single-Level Posterior Lumbar Interbody Arthrodesis

Michielsen, Joris; Sys, J.; Rigaux, A; Bertrand, C.

doi:10.2106/jbjs.l.00137

Cited by 38 publications

(31 citation statements)

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“…From the potentially relevant 78 publications, 59 were omitted according to the inclusion criteria. Finally, 19 trials [14]–[32] were included in the meta-analysis (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

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A Meta Analysis of Lumbar Spinal Fusion Surgery Using Bone Morphogenetic Proteins and Autologous Iliac Crest Bone Graft

et al. 2014

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BackgroundBone morphogenetic protein (BMPs) as a substitute for iliac crest bone graft (ICBG) has been increasingly widely used in lumbar fusion. The purpose of this study is to systematically compare the effectiveness and safety of fusion with BMPs for the treatment of lumbar disease.MethodsCochrane review methods were used to analyze all relevant randomized controlled trials (RCTs) published up to nov 2013.Results19 RCTs (1,852 patients) met the inclusion criteria. BMPs group significantly increased fusion rate (RR: 1.13; 95% CI 1.05–1.23, P = 0.001), while there was no statistical difference in overall success of clinical outcomes (RR: 1.04; 95% CI 0.95–1.13, P = 0.38) and complications (RR: 0.96; 95% CI 0.85–1.09, p = 0.54). A significant reduction of the reoperation rate was found in BMPs group (RR: 0.57; 95% CI 0.42–0.77, p = 0.0002). Significant difference was found in the operating time (MD−0.32; 95% CI−0.55, −0.08; P = 0.009), but no significant difference was found in the blood loss, the hospital stay, patient satisfaction, and work status.ConclusionCompared with ICBG, BMPs in lumbar fusion can increase the fusion rate, while reduce the reoperation rate and operating time. However, it doesn’t increase the complication rate, the amount of blood loss and hospital stay. No significant difference was found in the overall success of clinical outcome of the two groups.

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“…From the potentially relevant 78 publications, 59 were omitted according to the inclusion criteria. Finally, 19 trials [14]–[32] were included in the meta-analysis (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

“…In total, 12 of the 19 trials met the criteria for a low RoB [14]–[18], [23], [27]–[32]. 6 studies have adequate methods of randomization [14], [19], [23], [28], [29], [31], and only two studies use both an adequate sequence generation and allocation procedure [29], [31].…”

Section: Resultsmentioning

confidence: 99%

A Meta Analysis of Lumbar Spinal Fusion Surgery Using Bone Morphogenetic Proteins and Autologous Iliac Crest Bone Graft

et al. 2014

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“…A total of 33 studies (seven level I [109][110][111][112][113][114][115] , eight level II [116][117][118][119][120][121][122][123] , eight level III [124][125][126][127][128][129][130][131] , nine level IV [132][133][134][135][136][137][138][139][140] , one unclassified 141 ) were identified pertaining to rhBMP-2 use in the lumbar spine alone. The sheer volume of literature on rhBMP-2 reflects its acceptance and popularity as a widely used fusion enhancer, as well as the controversial nature of this compound associated with specific complication profiles.…”

Section: Recombinant Bone Morphogenic Protein-2 (Rhbmp-2) In Lumbar Smentioning

confidence: 99%

“…After a level I randomized controlled study, Michielsen et al 109 reported results in 40 patients treated with an instrumented single-level posterior lumbar interbody arthrodesis. Interbody arthrodesis was performed using polyether-ether-ketone (PEEK) cages which were filled with 8 mg of rhBMP-2 in the study group and 2.5 mL of autologous bone in the control group.…”

Section: Recombinant Bone Morphogenic Protein-2 (Rhbmp-2) In Lumbar Smentioning

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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“…Evidence of increased cancer incidence is inconclusive" [59]. More recently, Adams et al [60] and Michielsen et al [61] in PLIF using rhBMP-2 versus local bone autograft found an equivalent effect with an increased risk of complication.…”

Section: Graftmentioning

confidence: 99%

Growth factors in orthopaedic surgery: demineralized bone matrix versus recombinant bone morphogenetic proteins

Hinsenkamp

Collard

2014

International Orthopaedics (SICOT)

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During recent decades the utilisation of growth factors, especially BMPs, has received an increasing interest in orthopaedic surgery. For clinical implantation the two main options are demineralised bone matrix (DBM) and recombinant bone morphogenetic proteins (rhBMP). Many clinical studies agree on an equivalent osteoinductive effect between DBM, BMPs and autologous bone graft; however, the different origins and processing of DBM and rhBMP may introduce some fluctuations. Their respective characteristics are reviewed and possible interactions with their effectiveness are analysed. The main difference concerns the concentration of BMPs, which varies to an order of magnitude of 106 between DBM and rhBMPs. This may explain the variability in efficiency of some products and the adverse effects. Currently, considering osteoinductive properties, safety and availability, the DBM seems to offer several advantages. However, if DBM and rhBMPs are useful in some indications, their effectiveness and safety can be improved and more evidence-based studies are needed to better define the indications.

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The Effect of Recombinant Human Bone Morphogenetic Protein-2 in Single-Level Posterior Lumbar Interbody Arthrodesis

Cited by 38 publications

References 1 publication

A Meta Analysis of Lumbar Spinal Fusion Surgery Using Bone Morphogenetic Proteins and Autologous Iliac Crest Bone Graft

A Meta Analysis of Lumbar Spinal Fusion Surgery Using Bone Morphogenetic Proteins and Autologous Iliac Crest Bone Graft

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

Growth factors in orthopaedic surgery: demineralized bone matrix versus recombinant bone morphogenetic proteins

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