RhBMP-2 Is superior to iliac crest bone graft for long fusions to the sacrum in adult spinal deformity

Han Jo Kim, Jacob M. Buchowski, Lukas P. Zebala, Douglas D. Dickson, Linda Koester, Keith H. Bridwell

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Study Design. Matched cohort comparison. Objective. To compare the use of bone morphogenetic protein (BMP) or iliac crest bone graft (ICBG) on the long-term outcomes in patients undergoing long fusions to the sacrum for adult spinal deformity. Summary of Background Data. No long-term studies beyond a 2-year follow-up have been performed comparing the use of BMP versus ICBG for fusion rates in long fusions to the sacrum in adult spinal deformity. Methods. A total of 63 consecutive patients, from 1997-2006, comprised of 31 patients in the BMP group and 32 patients in the ICBG group, operated on at a single institution with a minimum 4-year follow-up (4-14 yr) were analyzed. Inclusion criteria were ambulators who were candidates for long fusions (thoracic as the upper level) to the sacrum. Exclusion criteria were revisions, neuromuscular scoliosis, ankylosing spondylitis, and patients who had both BMP and ICBG used for fusion. Oswestry Disability Index and 3 domains of the Scoliosis Research Society score were used to assess outcomes. Results. The 2 groups were similar with respect to age, sex, smoking history, comorbidities, BMI, number of fusion levels and Cobb angles. Eight patients in the BMP group underwent a posterior only, whereas 23 underwent combined anterior and posterior (A/P) surgery. All 32 patients in the ICBG had A/P fusion. The average BMP level was 11.1 mg (3-36 mg). The rate pseudarthrosis was 6.4% (2/31) in the BMP and 28.1% (9/32) in the ICBG group ( P = 0.04) using Fisher exact test and odds ratio = 5.67. The fusion rates for BMP group were 93.5% and 71.9% for the ICBG group. Oswestry Disability Indexes were similar between groups. However, the BMP group demonstrated superior sum composite Scoliosis Research Society scores in pain, self-image and function domains ( P = 0.02). Conclusion. BMP is superior to ICBG in achieving fusion in long constructs in adult deformity surgery. The rate of pseudarthrosis was signifi cantly higher in the ICBG group than BMP group. The concentration and dosage of recombinant human bone morphogenetic protein 2 (rhBMP-2) used seems to have an effect on the rate of fusion and pseudarthrosis rate because no patient receiving more than 5 mg per level had apparent or detected pseudarthroses (n = 20/20).

Original languageEnglish (US)
Pages (from-to)1209-1215
Number of pages7
JournalSpine
Volume38
Issue number14
DOIs
StatePublished - Jun 15 2013
Externally publishedYes

Fingerprint

Sacrum
Bone Morphogenetic Proteins
Transplants
Bone and Bones
Pseudarthrosis
Scoliosis
Growth Differentiation Factor 2
Ankylosing Spondylitis
Research
Comorbidity
Thorax
Smoking
History
Odds Ratio
Pain

Keywords

  • Adult deformity
  • Bone morphogenetic protein
  • Complications
  • Fusion
  • Pseudarthrosis

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

RhBMP-2 Is superior to iliac crest bone graft for long fusions to the sacrum in adult spinal deformity. / Kim, Han Jo; Buchowski, Jacob M.; Zebala, Lukas P.; Dickson, Douglas D.; Koester, Linda; Bridwell, Keith H.

In: Spine, Vol. 38, No. 14, 15.06.2013, p. 1209-1215.

Research output: Contribution to journalArticle

Kim, Han Jo ; Buchowski, Jacob M. ; Zebala, Lukas P. ; Dickson, Douglas D. ; Koester, Linda ; Bridwell, Keith H. / RhBMP-2 Is superior to iliac crest bone graft for long fusions to the sacrum in adult spinal deformity. In: Spine. 2013 ; Vol. 38, No. 14. pp. 1209-1215.
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AU - Kim, Han Jo

AU - Buchowski, Jacob M.

AU - Zebala, Lukas P.

AU - Dickson, Douglas D.

AU - Koester, Linda

AU - Bridwell, Keith H.

PY - 2013/6/15

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N2 - Study Design. Matched cohort comparison. Objective. To compare the use of bone morphogenetic protein (BMP) or iliac crest bone graft (ICBG) on the long-term outcomes in patients undergoing long fusions to the sacrum for adult spinal deformity. Summary of Background Data. No long-term studies beyond a 2-year follow-up have been performed comparing the use of BMP versus ICBG for fusion rates in long fusions to the sacrum in adult spinal deformity. Methods. A total of 63 consecutive patients, from 1997-2006, comprised of 31 patients in the BMP group and 32 patients in the ICBG group, operated on at a single institution with a minimum 4-year follow-up (4-14 yr) were analyzed. Inclusion criteria were ambulators who were candidates for long fusions (thoracic as the upper level) to the sacrum. Exclusion criteria were revisions, neuromuscular scoliosis, ankylosing spondylitis, and patients who had both BMP and ICBG used for fusion. Oswestry Disability Index and 3 domains of the Scoliosis Research Society score were used to assess outcomes. Results. The 2 groups were similar with respect to age, sex, smoking history, comorbidities, BMI, number of fusion levels and Cobb angles. Eight patients in the BMP group underwent a posterior only, whereas 23 underwent combined anterior and posterior (A/P) surgery. All 32 patients in the ICBG had A/P fusion. The average BMP level was 11.1 mg (3-36 mg). The rate pseudarthrosis was 6.4% (2/31) in the BMP and 28.1% (9/32) in the ICBG group ( P = 0.04) using Fisher exact test and odds ratio = 5.67. The fusion rates for BMP group were 93.5% and 71.9% for the ICBG group. Oswestry Disability Indexes were similar between groups. However, the BMP group demonstrated superior sum composite Scoliosis Research Society scores in pain, self-image and function domains ( P = 0.02). Conclusion. BMP is superior to ICBG in achieving fusion in long constructs in adult deformity surgery. The rate of pseudarthrosis was signifi cantly higher in the ICBG group than BMP group. The concentration and dosage of recombinant human bone morphogenetic protein 2 (rhBMP-2) used seems to have an effect on the rate of fusion and pseudarthrosis rate because no patient receiving more than 5 mg per level had apparent or detected pseudarthroses (n = 20/20).

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KW - Bone morphogenetic protein

KW - Complications

KW - Fusion

KW - Pseudarthrosis

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