title: Assessment of outcome following the use of recombinant human bone morphogenetic protein-2 for spinal fusion in the elderly population.
abstract: BACKGROUND
  Although the use of recombinant human bone morphogenetic protein-2 (rhBMP-2) for spinal fusion has been fairly studied in the general population, relatively little research has been conducted on its use in the elderly patient demographic despite this population's growth. The authors sought to examine the clinical efficacy, complication rate, and cost-effectiveness of rhBMP-2 use in elderly patients undergoing spinal fusion surgery.
  
  
  METHODS
  We conducted a systematic review of the published literature for elderly patients that underwent spinal fusion surgery with the use of rhBMP-2. A systematic search was performed utilizing the PUBMED and MEDLINE databases in order to identify all papers dealing with recombinant human Bone Morphogenic Protein-2 use in patients over the age of 60 years.
  
  
  RESULTS
  Twenty-five papers were identified that met our inclusion criteria. While successful fusion, improvement in pain, and improved quality of life were encountered in elderly patients who were treated with fusions surgery along with rhBMP-2, there were several complications that were encountered including seroma formation, pleural effusions, and bone non-union.
  
  
  CONCLUSIONS
  The literature demonstrated that BMP serves as a potent osteoinductive agent in the elderly with similar efficacy to bone autograft. Although use of BMP showed mixed results and had higher initial costs, when taken into account with complication correction and costs, BMP usage appears to be more economically beneficial overall. Future studies are needed to clarify the clinical significance of the complications encountered in elderly patients treated with rhBMP-2. Future research can assist in developing recommendations which can minimize these risks in the elderly patient demographic.
authors.affiliation: Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA - ddrazin@gmail.com.
authors.forename: Faris
authors.initials: F
authors.lastname: Shweikeh
authors.forename: George
authors.initials: G
authors.lastname: Hanna
authors.forename: Lee
authors.initials: L
authors.lastname: Bloom
authors.forename: Eli T
authors.initials: ET
authors.lastname: Sayegh
authors.forename: John
authors.initials: J
authors.lastname: Liu
authors.forename: Frank L
authors.initials: FL
authors.lastname: Acosta
authors.forename: Doniel
authors.initials: D
authors.lastname: Drazin
mesh_terms: D000375:Aging; D055396:Bone Morphogenetic Protein 2 / Q000627:therapeutic use*; D019485:Bone Morphogenetic Proteins / Q000627:therapeutic use*; D016025:Bone Transplantation / Q000379:methods; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D011994:Recombinant Proteins / Q000627:therapeutic use; D013123:Spinal Fusion; D016212:Transforming Growth Factor beta / Q000627:therapeutic use*
chemical_list: D055396:Bone Morphogenetic Protein 2; D019485:Bone Morphogenetic Proteins; D011994:Recombinant Proteins; D016212:Transforming Growth Factor beta; C499469:recombinant human bone morphogenetic protein-2