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Bone Morphogenic Protein

Hi - My husband has been offered a surgery where BMP would be used. It is for a lumbar fusion. He had a failed fusion at that level previously and it is a re-do. Does anyone have any experiences with BMP they would like to share with me?
Thank you.


  • Hi Jim,

    I am sorry to hear that you ahve had problems with your third surgery. What kind of problems are you having? What was the kind of surgery?

    Did your first surgery go well with the bone harvested from the hip?

    My husband has been in severe chronic pain since (and prior to) his surgery in 2001. He is looking for some relief now and I am afraid of doctors - that they make him worse. That is why I am asking so many questions. It is really tough.

    Best, Cec
  • A lot depends on how they use the BMP. I had it used in my fusion and haven't had any problems, but my surgeon put it in the right way. Patients get in trouble with BMP if their doctors put it in posteriorly. It should only be installed with the cages through an anterior procedure. Also some people have a sensitivity to the BMP which causes issues.

    If you would like more info on BMP, search BMP and ERNURSE on this forum. She has a nightmare story and did a lot of research regarding BMP that many people have learned from.

    Also, ask the surgeon about how many times he has done the recommended procedure and how often he has used BMP.

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
  • I have never seen anywhere that said BMP should only be installed through the anterior.... do you have a reputable website? I'd love to take a look.
    33yo mom of two. My surgical history...preadolescence scoliosis, kyphosis, and a hot mess.... 5 spine surgeries and lots of items added I wasn't born with (titanium, peek, surgical steel). Guess cremation is out. TSA loves me.
  • AllMetalAAllMetal Posts: 1,189
    edited 09/20/2013 - 10:09 PM
    Link removed, solicitation not permitted
    Post Edited by The Spine-Health Moderator Team to just post the specific article

    DURHAM, N.C. -- Using a certain bone grafting material for spinal fusion, one of the most common procedures for people with painful vertebral deteriorations, does not appear to result in higher rates of cancer, according to researchers at Duke Medicine.

    However, the researchers found that the bone promoter known as recombinant human bone morphogenetic protein 2, or BMP, is associated with a higher rate of benign tumors in the brain and nervous system.

    Reported in the September 2013, print edition of the journal Neurosurgery, the finding provides a better understanding of the long-term outcomes of spinal fusions using BMP. Recent studies have suggested that the growth factor is associated with harmful effects, including increased rates of cancer when used in high doses, leading to a decision by the U.S. Food and Drug Administration to reject approval of the higher dosage formulation.

    Although BMP is approved only for use in the lower spine with anterior approaches for surgery, it has been widely used “off-label” in cervical fusions, posterior lumbar procedures, and minimally invasive approaches.

    “Given the widespread use of BMP, there has been a tremendous need for better data about its effects,” said lead author Nandan Lad, M.D., Ph.D., assistant professor in the division of neurosurgery at Duke University School of Medicine. “Our study is the largest to date examining the association between BMP use and cancer.”

    Using national claims data from commercial insurers, Medicaid and Medicare, Lad and colleagues conducted a large, retrospective analysis of more than 4,600 patients who had undergone spinal fusions with BMP and matched them against similar patients who had the procedure without the bone growth material. They examined the association between BMP and the general risk of cancer, as well as the risk of developing cancer in different tissues.

    Overall, the Duke-led team found that 9.4 percent of spinal fusion patients receiving BMP developed malignant cancers, compared to 8.4 percent of patients not receiving the growth factor – a difference that was not statistically significant.

    For benign tumors, there was a significantly higher risk. After adjusting to better match patients in both groups to eliminate selection bias, the researchers found that those who received BMP were 31 percent more likely to be diagnosed with benign tumors than those who did not receive the graft material. These tumors included non-malignant growths in the brain and nervous system.

    “While the absolute risks were small overall, the increased risk for soft tissue tumors and those lining the nervous system among patients receiving BMP may be caused by the large local dose of BMP that is administered to the spine, and warrants further study,” Lad said.

    Lad said findings should be viewed with caution, noting that the limitations of the study include its retrospective design. However, the ethical and practical complications of prospectively enlisting patients in a head-to-head comparison of BMP against no growth factor made a large, retrospective study the next-best approach. Lad said the study also relies on accurate and timely diagnoses of cancer and benign tumors among the study population.

    “We believe this study is the first to specifically investigate the association between the use of BMP and cancer risk in a systematic manner, and apply it to the general population of patients undergoing spinal fusion in the United States,” Lad said.

    In addition to Lad, study authors include Jacob H. Bagley, Isaac O. Karikari, Ranjith Babu, Beatrice Ugiliweneza, Maiying Kong, Robert E. Isaacs, Carlos A. Bagley, Oren N. Gottfried, Chirag G. Patil, and Maxwell Boakye.

    The study received support from the National Cancer Institute (KM1CA156687).

    33yo mom of two. My surgical history...preadolescence scoliosis, kyphosis, and a hot mess.... 5 spine surgeries and lots of items added I wasn't born with (titanium, peek, surgical steel). Guess cremation is out. TSA loves me.
  • BMP
    This is a area that anyone thinking about do a lot of research. I would start with the lawsuits and the reasons for them.
    In 2007 I participated in a trial with BMP on a lumbar fusion. I had two levels needing fusion.
    They did one with and one without. The one with fused faster and more solid then the one without. This stuff promotes bone growth.
    Down side is in a few cases the bone doesn't stop growing.
    Oddly enough a few years later I had three nerve roots that were compressed in that same area. Another surgery was done to clear out this bone growth. So far so good.
    In my research I found it's FDA approved only for the lumbar area and not to be used elsewhere. It has come up that doctors may use it if the patient is told of the risk and agree to it. It has been used in the cervical area for many people who had major problems and most of them are no longer alive. In the neck there isn't room for all the extra bone growth if it doesn't stop.

    Keep in mind it has worked for some that had trouble with fusion.
    In the lumbar it has helped many who could not fuse and had prior surgeries that didn't work.
    In my opinion when used right for those with problems it has a advantage. When used just for a new person it may not be needed.
    I would ask my doctor why he needs it, what the possible issues years down the road are and get hard fact numbers of people it did help.
    Again months ago when I was looking over this it was approved for lumbar use only.
    I have learned that the big FDA everyone thinks does nothing really does look out for us in their own slow way.
  • jlrfryejjlrfrye ohioPosts: 1,110
    My cervical area was a non fixable mess. There was no choice for me, it had to tried. It has been successful and I have had no issues as of yet. That has been about 5 years ago. Fingers crossed that things continue the way they are
  • used bmp and now I am stuck literally ( well the dura is) at three levels in my lumbar spine. If I had known , there is no way that I would have allowed it. It was used during the PLIF/TLIF revision/salvage op and has caused severe compression of the canal, amongst other issues.......
  • RickilalasRRickilalas Posts: 559
    edited 09/22/2013 - 6:32 PM
    You mention compression is this from bone. growth.
    And I am Interested if it also caused the problems with the dura.
    If you don't mind. I am just wondering what else to look for.
    I already had major over growth of bone in the lumbar area.

  • Yes, the bmp caused the dura to attach to the roof of the canal ( posterior of the vertebral canal) and to the back of the vertebre as well. I really should find the disc and add the images so that you could see the extent of it......According to what I was told, he used too much bmp, and in the gutter and in between the vertebre in the device as well so the overgrowth is everywhere, hence the three level involvement. I am going to ask for another CT scan to see how much further things have gotten since my last one- which actually scares me to even think of doing since there wasn't much room left after the last time they did the imaging. I can only imagine how bad it is now. The only thing that they did differently was to change the parameters of the image slices so they were much smaller than others that I have had done previously. When they did this last CT scan, the image slices were at the largest 2.5 mm , many were less than that.
  • ADRJenAADRJen Posts: 211
    edited 09/23/2013 - 1:41 AM
    My surgery is Friday and when I expressed my concerns to my doctor about BMP he said that now they don't use near as much as a couple of years ago. Hopefully he's correct and it won't cause new problems for me. He's one of the best spine surgeons in this area.
    Artificial disc at L5S1 for 10 years. Had 3 Level lumbar fusion and Laminectomy on Sept 27, 2013. It was an OLIF (Oblique Lumbar Interbody Fusion) with cages, BMP, rods & screws. Norco, Plaquenil
  • I believe that bmp is still only supposed to be used from an anterior approach, unless you sign the waiver for it's use posteriorly. I hope that your surgeon is correct but if I had to do it all over again, I would steer clear of it's use.
    BMP scares me after all of this.
  • My surgeon uses a mix of my bone, cadaver bone, and the synthetic material. He said he finds the best success by using this combo. So far, things are going great for me and I'm coming up on 4 months post-op on Sept 30th.
  • RangerRRanger on da rangePosts: 805
    I never knew my surgeon used bmp in my cervical fusion until about 4-5 years later when I read the surgical report.
    Surgeon never discussed it with me at all, just said he ground up the bone from the corpectomy, stuck it in a cage.
    By the way, it was installed from the posterior. It's been 6 years now and don't think there is a problem.
    Am I concerned about it? You betcha!
  • Unfortunately , there are many of us like you and I, who had bmp used and we weren't told about it.....many surgeons in previous years used it and unfortunately used it incorrectly, either too much or in places where it was used 'off label' such as in cervical areas and only later do we find out there was a huge problem with them doing this.
  • EMS GuyEEMS Guy Posts: 920
    edited 09/24/2013 - 2:21 AM
    One thing to clarify with your surgeons is if they are using BMP-2 or another variant. There have been other variant's developed since BMP-2 started causing all kinds of issues. I think I've read something about BMP-7 being used now which is essentially a reformulation. It has been quite a while since I've looked at the BMP info though and may have that wrong.

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
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