title: Bone morphogenetic protein for salvage fusion in an infant with Down syndrome and craniovertebral instability. Case report.
abstract: The authors describe the use of bone morphogenetic protein (BMP) to promote bone fusion in an infant with craniovertebral instability after two attempts at arthrodesis had failed. To their knowledge, this is the first such report. Management of craniovertebral instability remains challenging in infants with Down syndrome. Surgical treatment may result in nonunion in this patient population. The authors report on a 4-month-old boy with Down syndrome who suffered a high cervical spinal cord injury secondary to craniovertebral instability. Two attempts to fuse and stabilize the craniovertebral junction resulted in nonunion. Finally, the use of BMP led to a stable fusion construct within 6 months without encroachment on the spinal canal. At 4 years of follow up, the patient has a solid fusion mass. The case suggests a role for the use of BMP to promote fusion in this patient population.
authors.affiliation: Department of Neurological Surgery, University of California San Francisco, USA.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Lu
authors.forename: Peter P
authors.initials: PP
authors.lastname: Sun
mesh_terms: D001269:Atlanto-Occipital Joint / Q000000981:diagnostic imaging / Q000473:pathology; D055396:Bone Morphogenetic Protein 2; D019485:Bone Morphogenetic Proteins / Q000627:therapeutic use*; D002574:Cervical Vertebrae / Q000473:pathology; D004314:Down Syndrome / Q000150:complications*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007593:Joint Instability / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D011184:Postoperative Period; D011994:Recombinant Proteins / Q000627:therapeutic use; D012086:Reoperation; D016879:Salvage Therapy; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000209:etiology; D013119:Spinal Cord Injuries / Q000209:etiology; D013123:Spinal Fusion; D014057:Tomography, X-Ray Computed; D016212:Transforming Growth Factor beta / Q000627:therapeutic use*; D017211:Treatment Failure
chemical_list: C525718:BMP2 protein, human; D055396:Bone Morphogenetic Protein 2; D019485:Bone Morphogenetic Proteins; D011994:Recombinant Proteins; D016212:Transforming Growth Factor beta