title: Effects of recombinant human bone morphogenetic protein 2 on surgical infections in a rabbit posterolateral lumbar fusion model.
abstract: Recombinant human bone morphogenetic proteins (rhBMPs) are often used during spine surgery, but their effects on postoperative infections have not been well elucidated. Long-bone studies suggest that BMPs may limit local infection and facilitate bone formation. Until now, rhBMP-2 had not been evaluated in the setting of infected spinal arthrodesis. In the study reported here, we evaluated the safety and efficacy of rhBMP-2 and autograft in inducing fusion in the setting of surgically acquired infection. Sixty rabbits underwent fusion with autograft or rhBMP-2 with coadministration of Staphylococcus aureus or sterile saline. In the noninoculated groups, 4/15 autograft and 13/13 rhBMP-2 rabbits fused (P<.001). In the inoculated groups, 0/14 autograft and 3/12 rhBMP-2 rabbits fused (P = .085). There were 4/14 early deaths caused by infection in the autograft group and 0/12 in the rhBMP-2 group (P = .1). Although the difference in fusion rates and early deaths from infection for rhBMP-2 and autograft did not reach our predetermined alpha error threshold, the data were trending toward significance. Our results demonstrated no increase in morbidity or mortality associated with use of rhBMP-2 in the setting of local infection. Although BMP use with infections remains controversial, these results indicate that rhBMP- 2 could be used in a contaminated environment.
authors.affiliation: Yale University School of Medicine, New Haven, CT 06520-8071, USA.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Miller
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Simpson
authors.forename: Peter G
authors.initials: PG
authors.lastname: Whang
authors.forename: Benjamin P
authors.initials: BP
authors.lastname: Erickson
authors.forename: Walid R
authors.initials: WR
authors.lastname: Waked
authors.forename: James P
authors.initials: JP
authors.lastname: Lawrence
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Grauer
mesh_terms: D000704:Analysis of Variance; D000818:Animals; D001772:Blood Cell Count; D055396:Bone Morphogenetic Protein 2 / Q000627:therapeutic use*; D005260:Female; D008159:Lumbar Vertebrae / Q000187:drug effects / Q000601:surgery*; D011817:Rabbits; D011897:Random Allocation; D013123:Spinal Fusion / Q000379:methods*; D013203:Staphylococcal Infections / Q000188:drug therapy*; D013211:Staphylococcus aureus; D013530:Surgical Wound Infection / Q000188:drug therapy*
chemical_list: C525718:BMP2 protein, human; D055396:Bone Morphogenetic Protein 2