Treatment of pediatric spinal deformity with use of recombinant human bone morphogenetic protein-2

Abstract

In pediatric spine surgery nonunion is a challenging issue. Instability may cause neurological impairment and lead to numerous surgeries in order to achieve fusion. The use of rhBMP-2 for pediatric spinal fusion has not been widely reported. In this study, a series of 13 children (14 procedures) that underwent spinal rhBMP-2 application were analyzed in order to measure clinical and radiographic outcome. Therefore, patient data, diagnosis, construct of instrumentation, type of bone graft, quantity of BMP used, and fusion outcome were reviewed. The study cohort included four female and nine male patients with a mean age of 11.2 years (range 2.6-19.2 years) at the time of rhBMP-2 application. Rh-BMP-2 was used in both primary (n = 6) and revision surgery (n = 8) in patients with a high risk for the development of nonunion. The mean follow-up was 51 months (range 12-108 months). Fusion occurred in 11 patients. Complications that may be due to application of rhBMP-2 were seen after four operations. Three patients had an increased body temperature and in one case prolonged wound secretion was evident, treated by local wound care or observation. In one of these patients an extensive postoperative hematoma occurred, necessitating surgical treatment. In conclusion, we could detect high fusion rates following the use of rhBMP-2 in pediatric spine surgery without an increased complication rate attributable to its application. Therefore we consider recombinant human BMP-2 to be an option in selected pediatric spinal procedures, especially in cases with compromised bone healing due to congenital, systemic, or local conditions.

Relationship between BMP2/9 Levels and Spinal Function and Quality of Life in Patients with Severe Scoliosis after PVCR

“…BMP can induce bone formation and irreversibly promote the differentiation of mesenchymal cells into chondrocytes and bone cells [12]. Among all BMP protein families, BMP2 and BMP9 have the strongest osteogenic ability; they can also induce the formation and deposition of calcium phosphate in bone, which is conducive to repairing bone and joint damage [13,14]. e higher the level of BMP2 and BMP9, the better the degree of bone graft fusion and damage repair [15].…”

A Clinical Study on the Effect of Different Ratios of Recombinant Human Bone Morphogenetic Protein-2 Compound to Autogenous Bone on Cervical Interbody Fusion Based on Smart Healthcare

“…Generally, patients can achieve relatively desirable outcomes after ACDF, but several studies in recent years have reported that many factors affect the prognosis of such patients, and if the surgical segments cannot achieve effective fusion, problems such as loosening of internal fixation will occur and then seriously affect the postoperative recovery. Therefore, selecting the appropriate fusion material is the key to improving the rate of cervical interbody fusion for ACDF [ 4 – 6 ]. At present, the fusion materials commonly used in practice are mainly the autogenous or alloplastic bone, in which the autogenous bone is limited in extraction and the alloplastic bone may elevate the possibility of ACDF failure, so both of them do not have good application conditions.…”

“…erefore, selecting the appropriate fusion material is the key to improving the rate of cervical interbody fusion for ACDF [4][5][6]. At present, the fusion materials commonly used in practice are mainly the autogenous or alloplastic bone, in which the autogenous bone is limited in extraction and the alloplastic bone may elevate the possibility of ACDF failure, so both of them do not have good application conditions.…”

Application of BMP in Bone Tissue Engineering

“…The traditional surgical method has a low cure rate and can cause many complications. Therefore, whether rhBMP treatment can increase the cure rate and reduce complications has an important impact on the development of spinal surgery ( Meisel et al, 2008 ; Annis et al, 2015 ; Sayama et al, 2015 ; Stiel et al, 2018 ).…”

“…Therefore, it is very important to find a treatment method that can replace ABG or reduce the number or amount of bone grafts. Currently, ABG combined with BMP is used to achieve spinal fusion and has received increasing attention ( Singh et al, 2013 ; Sayama et al, 2015 ; Stiel et al, 2018 ). In one study, 13 children with spinal deformities were treated with rhBMP-2 during spinal fusion, with an average follow-up of 51 months.…”