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Spine fusion and BMPs

Cath111CCath111 Posts: 3,554
edited 06/11/2012 - 7:26 AM in Back Surgery and Neck Surgery
I've been reading about Bone Morphogenetic Protein (BMP) and was wondering if any of you know if your surgeon used BMP to enhance your fusion or know of someone whose surgeon did?

From what I've been reading, BMP is pretty exciting stuff. BMP is a genetically produced protein that has the ability to stimulate a patient's own cells to make more bone. It also eliminates the need for an autograft (using your own bone), shortens the hospital stay, and lessens post-surgical pain.

In a 1997 clinical trial, BMP was used for the first time in patients undergoing spinal fusion and in all 11 patients successful fusion was achieved within 6 months from the time of surgery. In fact, 10 of the 11 patients achieved their fusions within 3 months of surgery.

In December 2001, doctors at the New Hampshire Spine Institute reported on a series of 22 patients who had undergone lumbar spinal fusion using BMP (specifically, rhBMP-2) through a laparoscopic approach. This research was done as part of a larger study sanctioned by the FDA. The average hospital stay was only 1 day, shorter than for any other reported fusion procedure. Of the 21 patients who completed the study, all of them reported improvement in back pain, leg pain and function. They all achieved a solid fusion by 6 months and all of them were able to return to work. This was the first study on spinal fusion that demonstrated a 100% success rate for both clinical and radiographic outcome.

According to SpineUniverse, with this kind of "wonder-protein", it is entirely likely that spinal fusions will soon be possible as an outpatient procedure.

BMP has received clearance from the FDA for specific uses. According to the North American Spine Society, the FDA has approved the use of BMPs for anterior spinal fusion in the lumbar spine. I don't know how old this information is, so perhaps it has been approved for cervical fusion by now.

I'm going to do some more research, but isn't it encouraging that someday BMPs may be the standard for fusion procedures, reducing post-surgical pain and improving the effectiveness of spinal surgeries? 8>
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Comments

  • Hello Cath,

    Glad you are "moving forward" since your surgery.

    The lead surgeon at the spine institute where I go thinks very highly of BMP. Send me a PM and I'll give you their web site which contains excellent info on BMP and other new procedures and devices. There is also a spinal research foundation associated with the institute.

    At this point in time ESIs are working for me. Next Thursday I go in for another injection after a bit more than 4 months since the last injection.

    Take care, and may 2009 be all you hope it will be.

    RichT

  • On December 10, I had a two level anterior fusion of L4-S1 with instrumentation (posterior). My neurosurgeon used interbody cages with BMP. He told me this has been his standard for this type of surgery for years. In some ways it seems a little surreal that there is such a magic substance as BMP. I am certainly glad to have been able to avoid the bone harvesting procedure that some go through. I am not sure however that I would say my surgical stay was shorter (5 days) or pain less than other fusion procedures. I am very hopeful that BMP will be the magic glue that holds my vertebrae together strongly for years to come.

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  • It's funny that I just discovered this and you both know about it. Geez, I'm out of touch.

    RichT, yes, I'm moving forward, slowly and painfully, but I'm moving forward. Each day is one step closer to that magical day when I don't have any more pain and don't even think about my derned neck. I'm glad the ESI's are working for you. If you don't have to be cut open, that's the best thing. I'll PM you for the info. The person who referred me to my surgeon (who I just love) told me that he added something to the donor bone, but I don't remember what he said it was and forgot to ask my surgeon. I'll ask him at my next appt. Jan 21.

    Susan, wow, the standard for years? I'm very interested to see how you progress in your healing. I'll keep my fingers crossed for ya.

    You both have a great new year and here's to a pain-free 2009!
  • My surgeon used BMP for my fusion. At my 3 month post-op appointment, there was no clear sign of fusion yet in the x-rays, but my surgeon was still pleased with my progress.

    I don't think it shortened my hospital stay (surgery Monday AM, home Wednesday afternoon), which seems to be consistent with other non-BMP patients. I don't know if my pain level was less because BMP was used. My actual surgery was shorter (1.5 hours) because my surgeon used facet bolts instead of rods and screws.

    It seems that BMP can be a very good thing, if used correctly by a trained doctor. However, there are also BMP horror stories where the BMP overgrows the intended area and possibly grows bone on nerves. I think this primary happens when too much BMP is used, or BMP is otherwise misued. It also may happen when untrained doctors try to use it.
  • Holy cow,you sound like a drug rep for BMP! :)

    Seriously, BMP use is not to be taken lightly. In an ealier post, I posted the link to the FDA's website containing the package insert about BMP. You can go to the FDA's website and also read about physician's who have voluntarily reported complications from BMP.

    Whether from using too much, incorrectly applying it, or overpacking the cages, BMP has not caused me to fuse(18 months later) and has caused bone to grow on my nerve roots(I had a two level TLIF.) I attempted to cut off my leg at one point postop fusion because the pain was worse than preop. I was suicidal every day for months. Only the thought of what would happen to my children kept me from killing myself. The pain was horrible, even on max dose of Lyrica.

    On one side of my spine, the BMP induced bone growth had grown a complete boney tunnel completely comressing and flattening my nerve root. Having surgery next week on the other side and one thing will be to attack the bone growth on nerve root on that side, among other things.

    It did not shorten my hospital stay. I am not a smoker. I did not take NSAIDS. I exercised like a fiend. My postop leg pain was entirely GONE until 5 weeks postop when it began returning until it was worse than preop. This is typical of BMP induced bone growth on nerve roots. I have permanent damage now to the nerve in one leg because of this stuff. The surgeon I used for the fusion, well, he didn't believe me when I brought reseach to his attention about this possible complication. Apparently he also doesn't read the package inserts, either, since this is a well known complication. That surgeon is fellowship trained at a famous facility and is board certified.

    I went to a surgeon who had done research on BMP complications. He believed me, but thought I had bone fragments growing on my nerve roots. After surgery, he said he'd never seen BMP induced bone growth so bad before. This is the same good surgeon who is doing my 2nd clean up surgery next week. He does not use BMP.

    I am sure that properly applied, BMP can be beneficial for folks who are at risk for pseudoarthrosis(non-fusion.) However, no matter what I would never get BMP again even though I am not fused at 18 months postop.

    Return of postop leg pain at about 5 weeks which progresses in severity and does not lessen with decreased activity is one of the main symptoms of BMP induced bone growth on nerve roots.

    CANNOT be used in c-spine.

    http://www.fda.gov/cdrh/safety/070108-rhbmp.html

    I try to post every chance I get about BMP. Yeah, I know that everyone does not have complications with it, but what if you ARE that person and your surgeon tells you that you are overdoing it? That you just have to live with the return of leg pain? That you need a spinal cord stimulator when you actually have a mechanical obstruction? That you just need to see a psychologist and accept it? If I can help just one person, I want to try.

    If you are really interested, browse the FDA's website, you will find the package insert warning of this possible complication and also voluntarily reported adverse events from using BMP.




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  • I'm 18 months post op using BMP and i'm so happy with it and my recovery. =D> I hope and pray that everyone is doing as well!

    Evelyn :H
    Had PLIF in 2008 and a Laminectomy. One level fusion, L4-L5.
  • I consulted four docs and they all use BMP. I wonder if it had to do with my specific problem--L5/S1. I believe they had problems with it cervically--but I have no clue what I'm talking about when it comes to some of this stuff--just guessing like most people. I've wondered at times why they didn't just put a cadaver bone in--I suppose if he had used a cadaver and the BMP, THEN the risk of overgrowth would have been present. There must be a reason why all these docs are using it. At this point in my recovery, I just have to hope.

    Chuck
  • Osteoporosis is a good reason to use BMP since osteoporosis puts you at risk for not fusing. If you are 18 months out and fused, then wonderful, those few minutes that BMP was active in your body helped stimulate bone growth in the right places.

    Cadaver bone has nothing to do with BMP complications. Just because a lot of doc use it doesn't mean it's a good thing. Lots of doctors used to use leeches to bleed people for every illness, didn't mean that was the right hting.

    Think about it-studies show it helps bone grow and surgeons want success. How does a surgeon measure success? Some might measure it by quality of life or return to work. But if a surgeon was asked, "What is your successful fusion rate?" his answer is probably based on how many of his patients fuse since that is the question. If BMP will help fusion, then they want it. It sounds like a wonder biological agent.

    Keep in mind recent scandals with one company who manufactures BMP products. Company was accused by whistleblowers of offering physicians incentives to use their products. I'm not saying doctors who use BMP are corrupt and accepted bribes, so don't start flaming. I'm just pointing out that when a new drug or biological passes FDA approval, many jump on the bandwagon and listen to the promotions from the medical companies. It IS documented in the FDA insert about the possible complications.

    My point is just to make people aware and to ask questions of their doctors. Get second opinions if your doc doesn't listen or you have complications or before you ever have surgery. Everyone has to make the right choice for themselves, I just want people to know what can happen to some of us. Like I said, if I can help even one person by sharing my story, I want to do it.

  • I just had surgery on Dec 11 and my surgeon will not do fusion with out it. First he doesnt have to use my bone from hip, less painful. It icrease the rate of fusion from 85% to 98%. He says nothing is 100 percent. He does say that his sucess rate is much better with it. It did not shorten my hospital stay or my pain. But I was never told that it would. I just have done alot of reading before my surgery and feel that anything that gives me that much better odds, why wouldnt you. He is an excellant surgeon and after 2 1/2 years and numerous doctors he is the first one that read my MRI and discovered that I had a sacral tumor. He even drove to Rochester Mn on Memorial Day Weekend to take my MRI to a former colleage at Mayo clinic to look at it becasue he was so concerned about it being cancer. I know of no other Drs that would have done that on their weekend off. So I completely trust him, he has gone over and above for me and I know he wouldnt do anything that wasnt to my benefit.
  • Agree with the others, do your homework. As with any other new medical anything, there are great stories and horror stories and everything in between. Its not approved by the FDA for anything other than lumbar, and I believe only ALIF but I may be out of date. The lawsuits I've read about against Medtronic were regarding "off label" usage (i.e. not FDA approved)

    It is not itself a bone matter that grows but rather a "matrix" that must be mixed with bone (your own or cadaver bone). I don't believe it stands on its own from what I understand from my surgeon and what I have read. But again, I'm no medical expert, don't take my word for it - do your homework ;))
    Jan 2009 L5-S1 ALIF
    May 2017 ALIF L4-L5 with PLF rods added L4-L5-S1
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