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BMPs continue to emerge as tool to treat degenerative lumbar scoliosis
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AMSTERDAM — Biologics, particularly bone morphogenetic proteins, are gaining increased attention and adoption for the treatment of degenerative lumbar scoliosis, according to a recent presentation at SpineWeek 2012.
Steven D. Glassman, MD, noted that biologics, and more specifically bone morphogenetic proteins (BMPs), should complement the surgeon’s plan for deformity correction and achieving sagittal balance in these cases.
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“If adjunctive technologies improve your outcomes, then you should use them. But newer, is not necessarily better,” Glassman, of Louisville, Ky., said at the meeting.
In an instructional course, he reviewed the benefits and disadvantages to using BMPs for adult scoliosis surgery.
“This is something that is controversial now,” he said, noting that BMP is primarily gaining ground as a way to enhance fusion and avoid the use of iliac crest bone graft (ICBG).
“Cost is clearly a disadvantage. Eventually, that will change,” Glassman said, explaining the more levels at which BMP is used, the higher the per-case cost rises.
In terms of the safety and efficacy of BMPs for multilevel fusions in an older population compared to ICBG, Glassman cited his group’s independent 2008 study of patients without scoliosis. The study showed a higher fusion rate and fewer revisions in the BMP cohort than the ICBG group.
“I think that makes sense in a population with multiple levels of fusion and older bone graft,” he said.
The results also included low rates of radiculopathy and ectopic bone formation, but higher rates of psoas hematoma, “which may have to do with the BMP, if you violate the membrane a little bit,” Glassman said.
“But, by and large, [what] we reported for posterolateral fusion looked like good safety.”
Touching on recent reports of increased cancer risk with some applications of BMPs in orthopaedics, Glassman said, “Over the next couple of years, we will get real data [that] at high doses, is that an issue. In the low doses that are clinically used and in the large national databases, it has not seemed to be an issue. But, there are studies going on now that are going to clarify that. Is this a fundamental change? Well, the jury is out.”
References:
- Glassman SD, Carreon LY, Djurasovic M, et al. RhBMP-2 versus iliac crest bone graft for lumbar spine fusions: A randomized, controlled trial in patients over sixty years of age. Spine. 2008;33:2843-2849.
- Glassman SD. Degenerative deformity surgery – A critical review. Instructional lecture 10. Presented at SpineWeek 2012. May 28-June 1. Amsterdam.
- Disclosure: Glassman is a consultant to and receives royalties from Medtronic that are not related to biologics. He also receives research support from Norton Healthcare and Nuvasive.
