title: Routine use of recombinant human bone morphogenetic protein-2 in posterior fusions of the pediatric spine and incidence of cancer.
abstract: OBJECT The aim of this study was to determine the safety of recombinant human bone morphogenetic protein-2 (rhBMP-2) use in posterior instrumented fusions in the pediatric population, focusing on cancer risk. In a previous study, the authors reported the short-term (mean follow-up of 11 months) safety and efficacy of rhBMP-2 in the pediatric age group. The present study reports their results with a minimum of 24 months' follow-up. METHODS The authors retrospectively reviewed 57 consecutive cases involving pediatric patients who underwent posterior occiptocervical, cervical, thoracic, lumbar, or lumbosacral spine fusion from October 1, 2007, to June 30, 2011, at Texas Children's Hospital. Seven cases were excluded from further analysis because of loss to follow-up. Three patients died during the follow-up period and were placed in a separate cohort. RESULTS The patients' average age at the time of surgery was 11 years, 4 months (range 9 months to 20 years). The mean duration of follow-up was 48.4 months (range 24-70 months). Cancer status was determined at the most recent encounter with the patient and/or caretaker(s) in person, or in telephone follow-up. Twenty-four or more months after administration of rhBMP-2, there were no cases of new malignancy, degeneration, or metastasis of existing tumors. The cause of death of the patients who died during the study period was not related to BMP or to the development, degeneration, or metastasis of cancer. CONCLUSIONS Despite the large number of adult studies reporting increased cancer risk associated with BMP use, the authors' outcomes with rhBMP-2 in the pediatric population suggest that it is a safe adjunct to posterior spine fusions of the occipitocervical, cervical, thoracic, lumbar, and lumbosacral spine. There were no new cases of cancer, or degeneration or metastasis of existing malignancies in this series.
authors: Neuro-Spine Program, Division of Pediatric Neurosurgery, and.|Department of Neurosurgery, Baylor College of Medicine, Houston, Texas;
authors: Christina
authors: C
authors: Sayama
authors: Neuro-Spine Program, Division of Pediatric Neurosurgery, and.|Department of Neurosurgery, Baylor College of Medicine, Houston, Texas;
authors: Matthew
authors: M
authors: Willsey
authors: Neuro-oncology Program, Division of Hematology-Oncology, Department of Pediatrics, Texas Children's Hospital; and.
authors: Murali
authors: M
authors: Chintagumpala
authors: Neuro-Spine Program, Division of Pediatric Neurosurgery, and.|Department of Neurosurgery, Baylor College of Medicine, Houston, Texas;
authors: Alison
authors: A
authors: Brayton
authors: Neuro-Spine Program, Division of Pediatric Neurosurgery, and.|Department of Neurosurgery, Baylor College of Medicine, Houston, Texas;
authors: Valentina
authors: V
authors: Briceño
authors: Neuro-Spine Program, Division of Pediatric Neurosurgery, and.|Department of Neurosurgery, Baylor College of Medicine, Houston, Texas;
authors: Sheila L
authors: SL
authors: Ryan
authors: Neuro-Spine Program, Division of Pediatric Neurosurgery, and.|Department of Neurosurgery, Baylor College of Medicine, Houston, Texas;
authors: Thomas G
authors: TG
authors: Luerssen
authors: Division of Pediatric Neurosurgery, Floating Children's Hospital; and.|Department of Neurosurgery, Tufts University, Boston, Massachusetts.
authors: Steven W
authors: SW
authors: Hwang
authors: Neuro-Spine Program, Division of Pediatric Neurosurgery, and.|Department of Neurosurgery, Baylor College of Medicine, Houston, Texas;
authors: Andrew
authors: A
authors: Jea
mesh_terms: D000293:Adolescent; D000328:Adult; D001269:Atlanto-Occipital Joint / Q000601:surgery; D055396:Bone Morphogenetic Protein 2 / Q000009:adverse effects / Q000627:therapeutic use*; D002574:Cervical Vertebrae / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D009369:Neoplasms / Q000453:epidemiology*; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012447:Sacrum / Q000601:surgery; D013123:Spinal Fusion / Q000379:methods*; D013781:Texas / Q000453:epidemiology; D013904:Thoracic Vertebrae / Q000601:surgery; D016212:Transforming Growth Factor beta / Q000009:adverse effects / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D055396:Bone Morphogenetic Protein 2; D011994:Recombinant Proteins; D016212:Transforming Growth Factor beta; C499469:recombinant human bone morphogenetic protein-2
keywords: bone morphogenetic protein; cancer; complications; malignancy; neurosurgery; oncology; pediatric spine; rhBMP-2; rhBMP-2 = recombinant human bone morphogenetic protein–2; spinal fusion; spinal instrumentation; technique