Spinal reconstruction and bone morphogenetic proteins: open questions.
Spinal fusion is a proven surgical tool for the treatment of degenerative, traumatic, neoplastic, and infectious conditions of the spine. Traditional grafting techniques using autogenous bone graft or allograft have inherent drawbacks including varying pseudoarthrosis rates and well recognized bone graft harvest site complications. Bone morphogenetic proteins (BMPs) offer the exciting prospect of enhanced union rates equal to or greater than autograft and potentially eliminate graft harvest site complications. Many studies have clearly demonstrated the efficacy of BMP products for various applications in spine surgery. BMP has proven effective in achieving union in anterior and posterior lumbar surgery and recently in anterior cervical surgery. Despite the reported success, the universal adoption of BMP is tempered by high costs and lingering safety concerns with reported complications specific to BMP use including vertebral osteolysis, ectopic bone formation, radiculitis and cervical soft tissue swelling. Ongoing clinical and basic-science research is focused on clearly defining guidelines for BMP use in spine surgery and on developing more affordable BMP formulations with dosing that predictably results in spine fusion yet minimizes the possible side effect profile.
Shimer
Adam L
AL
University of Virginia Medical Center, Charlottesville, VA, USA.
Oner
F Cumhur
FC
Vaccaro
Alexander R
AR
D000818:Animals; D055396:Bone Morphogenetic Protein 2; D055419:Bone Morphogenetic Protein 7 / Q000627:therapeutic use; D019485:Bone Morphogenetic Proteins / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D001862:Bone Resorption / Q000139:chemically induced; D016025:Bone Transplantation / Q000379:methods; D003680:Deglutition Disorders / Q000209:etiology; D004195:Disease Models, Animal; D006406:Hematoma / Q000209:etiology; D006801:Humans; D007085:Ilium / Q000637:transplantation; D008875:Middle Aged; D010019:Osteomyelitis / Q000188:drug therapy / Q000382:microbiology; D011843:Radiculopathy / Q000209:etiology; D011994:Recombinant Proteins / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D019651:Plastic Surgery Procedures / Q000379:methods; D013122:Spinal Diseases / Q000628:therapy*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013131:Spine / Q000601:surgery*; D020858:Tissue and Organ Harvesting / Q000009:adverse effects; D016212:Transforming Growth Factor beta / Q000627:therapeutic use
C525819:BMP7 protein, human; D055396:Bone Morphogenetic Protein 2; D055419:Bone Morphogenetic Protein 7; D019485:Bone Morphogenetic Proteins; D011994:Recombinant Proteins; D016212:Transforming Growth Factor beta; C511401:osteogenic protein 1 putty, recombinant human; C499469:recombinant human bone morphogenetic protein-2