Bone Morphogenetic Protein-2 and Bone Marrow Aspirate With Allograft as Alternatives to Autograft in Instrumented Revision Posterolateral Lumbar Spinal Fusion

Taghavi, Cyrus E.; Lee, Kwang-Bok; Keorochana, Gun; Tzeng, Shiau-Tzu; Yoo, Jeong Hyun; Wang, Jeffrey C.

doi:10.1097/brs.0b013e3181bb5203

Cited by 45 publications

(35 citation statements)

References 52 publications

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“…In the autograft group, Several studies also documented the use of BMP-2 in the spine, noting superior fusion rates for lumbar fusion when comparing BMP-2 and bone marrow aspirate with allograft as an alternative to auotograft. 39 Rogozinski et al 40 showed that BMP-2 is safe and effective in augmenting posterolateral lumbar spinal fusion when added to autograft. This study reported a healing rate of 100% in 16 patients.…”

Section: A B E1054mentioning

confidence: 99%

BMP-7 Versus BMP-2 for the Treatment of Long Bone Nonunion

Conway¹,

Shabtai²,

Bauernschub³

et al. 2014

Orthopedics

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The authors compared the results of treating nonunion with either bone morphogenetic protein (BMP)-7 or BMP-2. Between 2001 and 2009, 214 limb segments were treated for nonunion with either BMP-7 or BMP-2 at the authors' institution. Sixty-three subjects received 76 units of BMP-7. Radiographic healing occurred in 70% of limb segments at an average of 30 weeks after surgery, and 75% of limb segments were weight bearing at an average of 23 weeks after surgery. In 15.8%, persistent nonunion necessitated additional surgery. Average follow-up was 32 months. One hundred twelve subjects received 138 units of BMP-2. Radiographic healing occurred in 93% of limb segments at an average of 19 weeks after surgery, and 88% were weight bearing at an average of 15 weeks after surgery. In 6.25%, persistent nonunion necessitated additional surgery. Average follow-up was 17 months. Several significant differences were observed. Patients in both BMP-7 and BMP-2 groups were able to fully weight bear at an average of 23 and 15 weeks, respectively (P<.001). Further, both BMP-7 and BMP-2 groups healed at an average of 30 and 19 weeks, respectively (P<.001). Additionally, healing occurred in more limb segments in the BMP-2 group (93%) than in the BMP-7 group (70%) (P<.001). No difference in the complication rate was seen between groups. Patients who received BMP-2 for the treatment of nonunion had a higher rate of radiographic healing, achieved radiographic healing more quickly, and were able to bear weight sooner than those who underwent treatment with BMP-7.

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Section: A B E1054mentioning

confidence: 99%

BMP-7 Versus BMP-2 for the Treatment of Long Bone Nonunion

Conway¹,

Shabtai²,

Bauernschub³

et al. 2014

Orthopedics

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“…BMA supplementation of rhBMP-2 in a murine fusion model has a synergistic effect resulting in greater fusion mass than BMP alone (Rao et al, 2009). A clinical series reported a 100% union rate utilizing BMA with allograft in single level revision lumbar cases, equivalent to rhBMP-2 and autograft (Taghavi et al, 2010).…”

Section: Principles Of Bone Formation In Fusionmentioning

confidence: 98%

Challenges to bone formation in spinal fusion

Reid

Johnson

Wang

2011

Journal of Biomechanics

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“…MSCs can be either autogenous or allogeneic, and are commonly found in bone marrow, periosteum, muscle, and adipose tissue. [36][37][38][39] In a prospective study, BMA and allograft were compared with both BMP and ICBG in single-level and 2-level revision posterolateral spinal fusions. 34 Bone marrow aspiration (BMA) of the vertebral body pedicle or the iliac crest can yield MSCs.…”

Section: Mesenchymal Stem Cells (Mscs)mentioning

confidence: 99%

“…25 Advantages of MSCs include ease of isolation and "ex vivo" expansion, which preserve their potential for plasticity and self-renewal. 39 Like DBM, BMA poses the challenge of substantial variability in processing. A study by Muschler et al 35 demonstrated osteogenic progenitor cell concentration of vertebral pedicle aspirates to be 71% higher than that of iliac crest.…”

Section: Mesenchymal Stem Cells (Mscs)mentioning

confidence: 99%

Bone Graft Extenders Are Not Needed

Varthi¹,

Whang²

2015

Journal of Spinal Disorders & Techniques

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Spine fusion is a tool used in the treatment of spine trauma, tumors, and degenerative disorders. Poor outcomes related to failure of fusion, however, have directed the interests of practitioners and scientists to spinal biologics that may impact fusion at the cellular level. These biologics are used to achieve successful arthrodesis in the treatment of symptomatic deformity or instability. Historically, autologous bone grafting, including iliac crest bong graft harvesting, had represented the gold standard in spinal arthrodesis. However, due to concerns over potential harvest site complications, supply limitations, and associated morbidity, surgeons have turned to other bone graft options known for their osteogenic, osteoinductive, and/or osteoconductive properties. Current bone graft selection includes autograft, allograft, demineralized bone matrix, ceramics, mesenchymal stem cells, and recombinant human bone morphogenetic protein. Each pose their respective advantages and disadvantages and are the focus of ongoing research investigating the safety and efficacy of their use in the setting of spinal fusion. Rh-BMP2 has been plagued by issues of widespread off-label use, controversial indications, and a wide range of adverse effects. The risks associated with high concentrations of exogenous growth factors have led to investigational efforts into nanotechnology and its application in spinal arthrodesis through the binding of endogenous growth factors. Bone graft selection remains critical to successful fusion and favorable patient outcomes, and orthopaedic surgeons must be educated on the utility and limitations of various biologics in the setting of spine arthrodesis.

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Bone Morphogenetic Protein-2 and Bone Marrow Aspirate With Allograft as Alternatives to Autograft in Instrumented Revision Posterolateral Lumbar Spinal Fusion

Abstract: rhBMP-2 may be an appropriate alternative to autogenous bone graft in both single- and multilevel revision PLF, whereas BMAA may be appropriate as a substitute in single-level revision PLF. The use of BMAA in single-level revisions may be a more cost-effective option than rhBMP-2.

Cited by 45 publications

References 52 publications

BMP-7 Versus BMP-2 for the Treatment of Long Bone Nonunion

BMP-7 Versus BMP-2 for the Treatment of Long Bone Nonunion

Challenges to bone formation in spinal fusion

Bone Graft Extenders Are Not Needed

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