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BMP in fusion surgery

DIFerrisDDIFerris Posts: 86
edited 06/11/2012 - 8:36 AM in Back Surgery and Neck Surgery
When my surgeon discussed my upcoming fusion surgery with me, he mentioned using BMP in the cages that will be used between the vertebrae. I am assuming he meant that it would be used in addition to bone fragments. But I am not sure. Has anyone had this used alone with a fusion? Or is it usually added in addition to bone fragments?

I will definitely need to get clarification on that from him. I thought I had read an article that mentioned that use of the protein alone does not yield a successful fusion, but I can't remember where I read that. Maybe I misread it.

Any thoughts would be appreciated.



  • Hi Deanna, I had BMP mixed with bone fragments from the part of the spine that was removed. I am 25 days post op and have not had an x ray yet so I am not sure of the fusion progress. I will be x rayed at 6 weeks. I think that they always use bone fragment with the BMP. My doc used the fragments from removed spine but some docs get the bone from the hip or pelvis i think. Be prepared for a long recovery. Good luck with your surgery, you will find lots of support here. Keep us posted.
  • Hi Deanna!
    I had an ALIF in July 2006 with 2 cages placed at L5-S1 and I believe my neurosurgeon only used BMP, but I'm not 100% sure. What I do know is that my fusion is very solid. I fell 2 months after my fusion (basically passed out on tile floor onto my butt) and damaged my facet joints at L5-S1 and when I had surgery in June 2008 to replace the facet joints with cadaver bone (fused the facet joints), 3 people in the OR "yanked" on my fusion to make sure it was solid and it was VERY solid, so apparently the BMP worked well. If it wasn't solid, the doc was going to place posterior rods and screws because I didn't have those with the ALIF....thankfully those weren't needed. I have done SO well until recently. Probably I overdid it and have inflamed the nerve roots on a recent trip to Tennessee, but overall I've been improving steadily since the surgery last year.

    Hang in there and God bless!

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  • In case you don't know what BMP actually is here's an analogy. If you put sugar out ants will come. If you put BMP somewhere, it will send out a call for bone building cells to come. That make sense?

    At my last check(haven't checked in last couple of months) BMP for spine use is only FDA approved for 1 level anterior lumbar fusions(it is approved for some leg surgeries and some oral surgeries.) Any other use is off-label. Many surgeons use it, many don't. Many people have successful outcomes and there will always be those who don't. Some docs only use BMP in cases where it is a repeat fusion or if the patient has risk factors making them at risk of not fusing(meaning the vertebrae growing together.)

    What is most important is that you trust your doc and you have an open line of communication and will be followed postop by him. Also, your doc must be very skilled in using this compound. Docs may say, "My fusion rate is 95% with this." but that doesn't mean the patient feels better, just that they have fusion. Fusions can be done with or without BMP, depending on the technique.

    If your doc is not skilled at using BMP or he does not listen to his patients if they have postop complaints, then that's where trouble can come in.

    I did not realize when I signed the consent form that BMP was off label for my fusion type or the complications that can arise from it. If not contained to the cages, it can cause bone to grow on your spinal nerve roots. BMP does not guarantee fusion, either. I had a doc who would not listen to me when my nerve pain returned at 5 weeks postop, and later had many surgeries by another doc to remove the BMP overgrowth on my nerve roots. I am not a spine professional, but the last research I had read stated that the medical community was swinging back to hip grafts yielding the most successful fusion rates. I also understand that the hip graft site can hurt, too.

    My intent is not to scare you, as I said, there will always be complications for every surgery. I am just trying to convey that having a skilled doc who listens to you postop is very important.

    Good luck to you, please post your progress here as we are interested in your success. This site has truly been a lifesaver for me during my journey as people here understand.
  • Hi - looks like you've got some good advice so far - so I'll just tell you my story:

    I had a 2 level S1-L4 fusion surgery in July 2008. 6 screws, 2 rods, 2 pins along with BMP 'bullets'/cages.

    Within about 12 hours of my surgery my right leg started to go numb, and the numbness was spreading rapidly.

    After an emergency MRI & Cat scan in the middle of the night to figure out what why I was going numb, the NS told me that we needed to go back into surgery and 'explore'. He asked about any allergies I had to dairy for some odd reason. I don't have dairy allergies. Anyway - he said that he wanted to go back in and take the BMP out from inside the spinal canal and in general clean things up. I might add that I was losing a lot of blood through my drain and my hematocrit was down.

    So, less than 48 hours after my first surgery I was back in the OR.

    NS took out the BMP from inside the spine - he did LEAVE the BMP cages/bullets that were placed AROUND the spine.

    The second surgery halted the progression of the numbness. A year later the numbness is still there though. The NS never could figure out the direct cause, but whatever he did, he fixed it all up.

    As far as fusion- I fused extremely well. My X-rays show me as completely fused with good bone growth supporting and strengthening the spine even on the sides.

    So, either I was hemorhaging (all that post-op nausea might have ruptured something - I did have to have a transfusion before I could go back on the OR table) or the BMP was causing havoc - I don't know that I'll ever know. In any case, I am very grateful that my NS went back in.

    In the end - I believe BMP has it's uses, it certainly fused me solid. BUT... as with anything, there can be complications. Like ERnurse said: on-label use only, don't 'color outside the lines' with BMP.
  • I really can't add much than what others have said as to the regards of BMP use. BMP was used in one of my cervical surgeries and the swelling that followed the use of it nearly closed my breathing airway. I would tell anyone who is thinking of using it in the cervical area to be as informed as possible. The labels for use in the cervical spine on now on every container of BMP as of July 2008.

    AS Angie, about 5 weeks post surgery the pain began returning only to the opposite side of the original pain. Was it the BMP, not sure yet. My concerns is the surgeons using BMP, don't often recognize when there is a issue with the use of it. As the above poster said she was lucky her surgeon heard her and went back in and fixed it up. That is a great surgeon who says something is wrong and needs to be fixed, in place of letting it escalate, till some permanent damage is done.

    As the others I believe BMP, has it's uses. I have had the bone removed from my hip as well, actually from both hips. Yes it hurt, not going to sugar coat it at all. But in my opinion, will take the pain over a breathing issue any day. As Angie said most surgeons are returning to using the cadaver bone. Some of that may be due to some law suits that have been filled on behalf of those not hear to tell the stories and those who had far worse outcomes with it use. Most of those suits came out of surgeons believing it was so good they would add a little extra. AS the previous poster said "Don't color outside the lines". As in any product there is the good, bad and ugly. My opinion is that it is on the surgeon and there expertise in using the product. You may want to check how many times your surgeon has used it. Ask if you can speak to prior patients who have it as well. Most importantly do your research and make your own decision and feel confident in the surgeon you are using. Keep us posted.
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  • I had ALIF almost two weeks ago using bmp and no bone fragments. I have otseo health issues so the NS did not want to use bone from my hip. The protocol for this particular practice is to use bmp. I know I am only two weeks post op so I can't offer much advice, but so far, so good. I do have quite a bit of numbness in my left leg (thigh mainly) but I'm told that this should go away soon. Only time will tell.
  • My surgery will be a 2-level, L4-S1 fusion. My doctor did say he would use the protein. I will have a conversation with him and hopefully understand why it will be used, and what all my options are. Like everyone, I only want to have this surgery once. I know I will be in for the long haul as far as recovery, and I would really not like to have to do it more than once.

    There is so much to digest with this. Thank you all for the great information! My initial feeling of calm when I was approved and knew the surgery date, changed yesterday to fear. I just need to equip myself with all the knowledge I can get so I can make an informed decision. Thank you for sharing your experiences with me.

  • I had the same fusion last Dec that you are having. My Dr used BMP also. He also used bone fragments from the surgery that he mixed with it. It didnt show much fusion until about 5 months and then it took off. I had harware removed at 9 months and I was fused enough to take it out. Hope this helps. It worked for me, with no problems. I had my fusion Posteriorly.
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