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Bone graft from hip vs. BMP...please help!!!

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:26 AM in Back Surgery and Neck Surgery
I'm having a one-level fusion at L5-S1 on February 4th. My doc wanted to do the graft since it's the "gold standard," but I asked for an alternative because I'm scared of the pain from the graft. He said he'd used the InFuse system (BMP) since I'm not a smoker. Now I've read all the horror stories about BMP!

Can you please weigh in on which method you had and let me know how it worked for you??? PLEASE??


  • I am 7 1/2 weeks post op and my doc will only do grafts from bone taken from the patient's body. He tried to use bone spur material from my spine but there wasn't enough so he had to go into the top of my hip and harvest there.

    You may have read that the harvest site can be more painful than the main surgical incision and in my case, that is true. It's not "awful" but it does seem to continue to be more painful than my spinal incision.

    But here's the flip side......since the object is to get a good, solid bone fusion, I'm glad my graft was done from my own bone. At 6 weeks the doc could confirm by xray that I am beginning to fuse which is really good! And because of good, healthy signs of fusion, he has relaxed almost all of my restrictions and told me to let my back set limits for me.

    I'm not that knowledgeable regarding the use of BMP or cadaver bone so I can't speak to either of those.

    Good luck on the surgery. I know there are always lots of things to consider. I know that others on this website do have experience with alternative bone graft methods. Keep us posted on your outcome!!
  • I have heard only negative things about bone grafts from the iliac crest, and how people still have pain in that area decades later. I had BMP in my single level fusion, and I was starting to fuse already at 8 weeks, and am still fusing well now. I don't have to go back for more x-rays for another 6 months. BMP is FDA approved for lumbar surgeries. Nearly all of the horror stories are from off label use, like in cervical fusions. Do a lot of research, don't just trust people on here. I read an amazing article on BMP in a medical journal the other day, and it covered EVERY base... It was the most in depth information I have ever received on the topic, and it made things very clear and logical. I don't know where to find a website of that caliber, but I'm sure if you search hard enough you will find one. The only real risk of BMP in a lumbar surgery is the body having an allergic reaction... But they can figure out if you are at that risk by other factors in your medical history. The risk of overgrowth is ridiculously low when done by a skilled surgeon. In my opinion, you shouldn't worry about the materials a surgeon uses if you trust them... Surgeon's do more damage than materials do...(In my opinion, others are free to have their own) If you trust HIM, then there ya go.
  • My surgeon used a combination of materials for my 2-level ALIF/PLIF/posterolateral fusion: bone that was being removed from my spine anyway, bone from my hip (iliac crest), and BMP.

    He usually just uses bone that's already being removed from the spine as part of the surgery (e.g., spinous process/lamina) and doesn't take any from the hip. But in my case, he wasn't sure there was going to be enough of that spine bone--given all the areas, anterior and posterior, for which they were going to need fusion material, so we decided to do the hip autograft. He definitely needed the extra bone.

    I'm only 11+ weeks post-op, so I really don't know yet how well it's all working. But, at my 6-week follow-up, the X-rays were already showing new bone growth (in the places we want bone). No BMP problems so far.

    I suppose I could have problems in the future from the iliac crest harvest site, but none so far. I had no pain or problems with the harvest site, even immediately post-op. I doubt I would have even realized it was there if I hadn't known about it prior to surgery. There was a separate incision and drain, which is of course another possible source of problems, but that was all pretty minor compared to my large anterior and posterior fusion incisions. The harvest site drain was removed much sooner than the other two. I had no significant post-op problems with either of my 3 incisions, such as infection, unusual pain, etc. And no signs of graft material rejection.

    A few notes based on my own research and what my surgeon told me about graft material:

    - Graft bone from the back of the hip (posterior iliac crest) is better for fusion than from the front of the hip (anterior iliac crest). The posterior iliac crest bone is more cancellous.
    - Pain from anterior iliac crest harvest is usually worse than posterior.
    - My surgeon always uses a combo of bone and BMP, never BMP alone.
    - BMP is only FDA-approved for anterior lumbar fusion, not posterior lumbar, and not cervical. However, the kind of problems that have been reported with BMP use in cervical fusions have not been reported for posterior lumbar fusions.
    - If BMP is used, bone is more likely to grow beyond where you really want it to (about a 2% chance); that doesn't mean you'll have a problem, though. Usually it's a relatively simple microsurgery procedure to trim the bone if it does cause problems (e.g., impinges on a nerve).
    - There does seem to be a greater incidence of bone growing into the spinal canal with posterior lumbar fusions using BMP than those w/o BMP (this apparently seems to be mostly a radiographic issue; i.e., it is seen in images more often than it is actually symptomatic).
    - Using BMP greatly improves the chance of fusion.

    In my surgeon's opinion, the much greater chance of successful fusion using BMP outweighs the slightly increased risk of an overgrowth problem. But, he explained everything to me, answered all my many questions, and ultimately let me decide.

    Here are just a few related articles on spine-health. Search the site and you'll find more.

  • This is a very good question, thanks for asking it. And thanks to you guys for answering with your experiences. It is very helpful, and informative.
  • Maybe you've read my horror stories about BMP? If not, read my previous posts. I just had my second clean up surgery from posterior lumbar fusion with BMP. The fusion surgeon dismissed my complaints and therefore there was a delay in diagnosis and treatment by the second surgery I chose. I was intially leg pain free after fusion surgery and now because of the bmp induced bone growth on nerve roots that the first surgeon did not diagnose, I have permanent nerve damage.

    Ultimately, you and your trusted doctor have to make this decision. I would NEVER have bmp again. My new surgeon does not use BMP. Look at my other posts and I have posted many links, including to the site where surgeons voluntarily report adverse outcomes from BMP.

    It is sometimes difficult to see the BMP growth on nerve roots on CT because the titanium from the hardware creates artifact(interference) and can mask that bone growth.

    Zachback also had surgery yesterday because of BMP overgrowth. Another "oldie" member of SH, Hopey(maybe screenname stillhopeful???) had BMP issues in her lumbar spine as well. There are members here with cervical BMP issues, but I'm specifically speaking of lumbar issues.

    Please think long and hard about this. Your doctor initially advised you to do the hip bone graft, that's what I wish I would have chosen.
  • There are way more horror stories regarding fusion in general than there are for BMP. Also, you hear about BMP issues because it's so rare that when it happens, it's a big deal. The chance of it happening is MUCH less than 1 percent when used in an anterior fusion. Nobody hides underground when there's a thunderstorm, even though there are more people getting struck by lightening every year than there are people having BMP overgrowths. Lol. There are risks to EVERY SINGLE thing in life. EVERYTHING. Even walking out your door... But the benefits far outweigh the cons.... Which is why BMP was FDA approved, and it's been more successful than both allograft and autograft. I'm sorry to anyone who has had issues, but really, whose to say if you would have had different issues with another route? You never know. I think the scientific facts are what people should make their decisions on, not horror stories. There are hundreds of horror stories for every single aspect of life... There always will be. That's just life. Someone is going to have a negative experience with even the best in any given area.
  • I agree, people should base their decision on what a trusted, qualified surgeon recommends AND the research. This incidence is more than 1-2%, the research is there. And just think of how many cases are not reported because the surgeon does not catch it and the poor person just ends up with a spinal cord stimulator or suffering. The surgeon has to report the event in order for it to be in the statistics. In some studies I have found, the number is much more than 1-2%. My surgeon who is cleaning me up participated in research trials on BMP and does clean-ups on many people that others cannot figure out.

    VivaVegas just told me today about BMP issues in Viva's case.

    My original point-you must trust your doctor but do research and try to reduce your complications as much as possible. I agreed in an earlier post that BMP can be helpful for patients with some condition like osteoporosis, etc. Yes, there are horror stories for everything, but a patient needs to be informed and that's what the poster was asking for-people's experiences. I am glad your experience so far has been good, I would not wish complications like I've had(or the many other people) on many people and that's why I feel a duty to educate people on possible complications. She also stated that her surgeon had initially recommened not using BMP.
  • on this site and i found out that what works FOR ME is not to let the doctors take bone from my hip. You may want to research this yourself. I had the BMP myself and i'm happy with it! :) :) :) :)

    Evelyn :H
    Had PLIF in 2008 and a Laminectomy. One level fusion, L4-L5.
  • I hope that anyone contemplating their own bone (autograft) vs BMP will do their research here but largely rely on the comments and recommendations made by medical professionals rather than us here with our anecdotal stories of our personal experiences and what we have heard from others.

    Remember here on spine-health there is only a small fraction of the number of people undertaking fusion surgeries world wide and taking a straw poll of which option is best via the membership here is not exactly scientific - sure, it is useful in your overall research but I would strongly recommend largely relying on your surgeons recommendation. Get a 2nd recommendation if you are uncomfortable with what you are hearing from your surgeon.

    Personally, in my case, I am extremely wary of any foreign matter in my body, whether it be medication, BMP or similar. I used my own bone from my iliac crest and sure, at was a little uncomfortable for a few months after surgery but now i have no issues whatsoever.

    Keep positive!


    ...an old timer here and ex-moderator

  • ...is another factor to consider. In general, and as far as I am aware, BMP is only FDA approved for lumbar surgeries, not cervical. Also as for any drug, implant, etc., FDA approval is granted to specific products on a product by product basis. Just because FDA has approved BMP use for lumbar fusion does not mean that every BMP product is FDA approved.

    So, when considering BMP it would be important to ascertain whether the specific BMP product recommended by your doctor is FDA approved for the specific procedure that your doctor will carry out on you. This point might prove particularly important from a legal/insurance perspective if you did subsequently require remedial surgery due to BMP issues.
    Keep positive!


    ...an old timer here and ex-moderator

  • I had a anterior lumbar fusion last March and have had absolutely no problems with BMP. I have an xray taken monthly to check the level and extent of the fusion. The latest one was taken last week and all looks well. I did a lot of research and chose a very skilled surgeon. I would have this surgery again in a heartbeat. I am so much better off than I was prior to the surgery. B)
  • Hello, I had BMP along with allograft (donor bone matrix) and autograph (my bone from lamina, pedicles, and spinous processes). It was placed inside a Bak Peek cage in my posterior fusion and in the posterior-lateral gutter (making it technally off label-use). I am just over 5 months out and things are going great. Last xray showed early fusion. No problems so far except some tightness over the SI joint area. I went back to work as an RN at 15 weeks post-op. Good-luck with your decision. >:D< Cali-Sue
  • Her surgeon never "not recommended" it... That would be advocating against it... And he wasn't. His first choice was autograft, but in her post she said nothing about him being against BMP, or he obviously wouldn't have offered her the choice after she asked. If he didn't believe in it, he wouldn't use it.

    Different doctors will say different things. You should trust your doctor, so I wouldn't convince you not to believe what he told you. However, my information was from an unbiased source... A medical journal. For me, I'd trust a medical journal and scientific research over a doctor, because a doctor could overplay the risk for his benefit, or underplay it, as well.... You really never know.

    I agree, she wanted experiences, and I'm not disputing your opinion... I am solely offering up scientific information in response to the topic of horror stories. I am not minimizing your terrible experience, or anything of the sort... I just think that she should make her decision on the facts, and not emotions either way... Good OR bad. I also would not wish complications on anyone.

    Anyway, there's really nothing else to say on this topic, nor is there any productive purpose in furthering it, lol. So, that being said... I hope you're doing well now, and I'm glad that you made it through your situation in one piece! Take care :)
  • Yep, I agree, my first step is researching peer-reviewed medical journals and the FDA as well as my surgeon who participated in research trials concerning BMP. I have posted links in many threads about reputable, peer-reviewed articles as well as FDA studies and warnings.

    And yep, there's horror stories for everything including getting a simple pedicure, but the negative data on BMP is out there and is underreported.

    My entire focus has been to share my story and encourage people to do their own research so that they can be informed consumers.
  • Just wanted to say thanks for the link you put on one of these threads about bmp and potential radiculitus. I read it and hope I'm not one of the 23% that takes 13 months (median) to get rid of the nerve irritation; that by the way follows the dermatome of the ChiroGeek link you also posted. I'm only 3 weeks out but there is absolutely no improvement in the leg pain that wasn't there preop. I know time will tell but patience isn't one of my virtues! Hopefully it's not the bmp but I think it is too early to tell. We'll see.
  • My doc used BMP. I also consulted several other surgeons who also recommended BMP. I'm sure the specific diagnosis factors into what they use. I have heard that the hip harvesting site is more painful than the back--which I can't imagine, that would be horrible. I am 2 months in--feel like I may have turned the corner at 8 weeks, still have pain but it is improving every day. My doc gave me information on studies done on BMP--the fusion rate is 98 percent plus, according to his stats. Lumbar only as mentioned.

  • Is your doc giving you the option of cadaver bone? That's what I had for my ACDF and at my 8 week appointment X-rays showed a "textbook perfect" fusion. He even said I may be fused enough to be skiing in March (5 months post-op). The cadaver bone eliminates both the pain of the autograph and the potential complications of BMP. Since BMP is not approved for cervical procedures it wasn't a choice for me. I opted for cadaver bone without hesitation because of the pain and long-term problems with autographs.
  • My doc originally wanted to use my own bone..."the gold standard," he said. When I asked for an alternative to that, he mentioned the InFuse product (BMP). He said there's a better chance of fusion with BMP than there is with cadaver bone, so he doesn't go that route.

    I'm still so confused about this.
  • InFuse is done with LT cages through an anterior incision. This is what has a 98 percent fusion rate, and is basically the most successful technique, STATISTIC-wise. Not everyone is going to have a successful surgery with it, and not everyone with something else will have an unsuccessful one... But using Infuse with LT cages IS FDA approved, and has VERY good results.
  • my own bone taken from the laminectomies (instead of hip) and BMP.
    I have had no problems with the BMP - my Surgeon did say that occassionally it can cause cysts to grow but they fix themselves fairly quickly. I would use this method again if I had my time over.

    I have also had a hip revision where I needed a graft taken from my other hip (so the same as in a fusion) and I had no problems with that either- no excess pain etc.

    Blessings Sara O:)

  • I had an appt with the surgeon today to ask any last-minute questions, and told him that I was still struggling with this issue. Here's what he said...if I want the best chance for a successful fusion, I should do the bone graft from my iliac crest and use my own bone. He said he'd use donor bone (and InFuse/BMP), but he thinks it's much better to endure a little more pain up front than to have to go through another fusion surgery! He said his patients RARELY have severe or long-lasting pain at the graft site! Maybe he's just really good?

    And, by the way, he told me today that he ALWAYS uses BMP, whether using donor bone or own bone!! That part I hadn't understood previously! He said he's had absolutely no problems with BMP. So, problem solved!!
  • thanks for letting us know. All the best for your surgery.
    Blessings Sara
  • Instead of bone from the hip or BMP, my surgeon used blood (bone marrow) from my hip area along with the bone that he took off during the surgery. There was no pain from the bone marrow aspiration since he did it during the surgery. I have read a few articles about this method and I felt very comfortable with my surgeon. I am only 7 weeks out, so I don't know how I am fusing but my surgeon told me that he has only had one person not fuse with this method. I have my next follow-up on February 12 so I will find out then how I am fusing.
  • if he used bmp AND autograft, then the whole debate was fruitless. haha. ironic how that works. the only silly thing is that either bmp or autograft alone is sufficient. it really doesn't increase the success rate using both. either one is good. bmp has the highest success rate, closely followed by autograft. so together you probably will have the success rate of the bmp alone. kind of seems useless to use autograft and make more trauma when there is no actual benefit but hey, everyone's got their own opinions and techniques. just seems silly to me. heh.

    good luck with your recovery!
  • I am curious why most surgeons offer either bone from the iliac crest (painful) or BMP. Mine used only what he removed during surgery mixed with cadaver bone. This way i did not have the additional incision and associated pain and I fused well in five months. So I am satisfied, as it made my recovery much easier.

    Good luck to you,

  • Not every surgery has bone removed. Some have solely disc removal and then hardware insertion.
  • My doc used bone spur material from my own spine rather than from the hip.

  • You have a very smart Dr. I have had it both ways. The hip pain for me was NOTHING like the swelling from MBP. Some Dr.'s get financial rewards for recommending this product. If I had to do it over, I would use my own bone. I am still in pain and may have it taken out. I don't think just because it's FDA approved, that they know the long term effects. I wish I had researched it more 1st. Good Luck.
  • I can say I had the hip graft in 1995 and had no problems with pain in my hip or neck. I cannot say the same for bmp. I will NEVER left that stuff be put in my body again. I will never be pain free unless I have this stuff removed.I'm happy for people who have had good results, but there are just as many with the opposite.
  • had the allograft, mixed with BMP and my own bone marrow. For me, however, my hip hurt like hell, even though it was done during the surgery. I suppose it was better than having them chip some bone off though.


    3 level spinal fusion, L3/4, L4/5, L5/S1, November 2008. Stiff, but I can walk.
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