BMP-Any known problems?

[Sherie]

My daughter is having surgery in Nov., her dr. wants to use BMP. I was surprised and wasn't prepared with questions because I had heard it was only used on adults. Now I'm trying to find out more since we won't be going back until Oct.

Has anyone here had it used for their fusions and are there any know complications or side effects?

If you've had it, were you happy with the results and did you fuse well?

I did find one negative study when used for anterior fusions, they compared patients who had BMP vs. a bone matrix. On the patients who had BMP, the space between the vertebraes where the fusion took place became compressed over time and they described the fused bone as having lucency (less bone mass?). Since she's having a posterior, I'm not sure what kind of implications this could have. The authors of this study said they will no longer use BMP for anterior fusions. I wonder if anyone has heard of this?

Thanks

[Shari]

Sorry this sounds stupid, but what is BMP???

Shari

[trulyaries]

"Bone morphogenetic protein" - I believe it's basically a synthetic bone graft material used instead of your own donated bone material, usually from the iliac crest.

If you go to www.spineuniverse.com and do a search for BMP, there's several explanations/articles/studies.

I will be having my third surgery and in all cases the docs are using bone graft from my iliac crest. Unlike some others, I have not noticed any particular continuing pain from the graft.

[brynnski]

My surgeon, Dr. Behrooz Akbarnia of San Diego, will be using BMP bone graphs for both my anterior and posterior fusions. His associate told me that he hasn't used iliac crest bone graphs for about 9 months, since he has had a better result with BMP graphs than bone graphs from the patient. The info on spineuniverse.com appears to support this. I'm very happy myself, since I would like to avoid having bone harvested from my iliac crest. Some people have pain from this years after surgery. Children, of course, are less likely to suffer long-range pain from having bone harvested than adults do. Also, studies I've read say that blood loss and recovery times are less with BMP graphs than with bone graphs from the patient.

Brynn

[laurieg6]

Is BMP the same as fusion material from a bone bank? One of the surgeons my husband & I are considering for our son's fusion (he's 12) is going to use bone bank material for the fusion. Please let me know if these are the same thing. I need to read more about it but have not done so yet.
Thanks, Laurie

[joeb-z]

When I brought up the subject of BMP with Dr. Boachie he fell silent. This is his way, in my opinion, of saying he doesn't use it/ think it is worth the risk etc. Dr. Boachie uses tried and true approaches and if bone needs to be harvested or blood bank bone used, that is that. The problem with BMP is that you are unnaturally stimulating bone growth and no one really knows what that means 15 years down the line.

[flowerpower]

Laurie,

The fusion material from a bone bank is cadaver bone. BMP is synthetic form of something found naturally in human body that converts regular cells to bone-forming cells.

Renee

[Sherie]

Thanks for the input from everyone.

Joeb-z, those are exactly my concerns. Initially, I was happy to hear they wouldn't be using auto or allograft, but after I read that study, I started wondering about the long term implications.

I guess there are concerns with any method that's used. The lingering pain of autograft is a huge concern. Not sure of the risks of allograft besides non-fusion, is there a chance of disease transference?

I would still be interested in hearing from someone who's used this and had the complications/risks discussed with the doctor.

[brynnski]

Dear Sherie,

Can the study you refer to be read on the Internet? If so, will you please send us the link?

Thanks,

Brynn

[Sherie]

Hi Brynn

Here's the link, I'm interested in how others interpret the data.


http://www.jbjs.org.uk/cgi/content/abstract/89-B/3/342

[brynnski]

Dear Sherie,

I put in a call for one of Dr. Akbarnia's associates to speak with me about BMP graphs. One thing I've noticed in my research is that there are a number of types that are evolving over time. The article you sent refers to BMP2. There is also BMP7, and other numbers. It may be that the problems mentioned in the article do not happen with some other types of BMP. On the website that Trulyaries mentions on this thread there are studies that contradict the findings of your article, saying that BMP graphs are stronger than patient bone. I'll see what I can find out from my surgeons.

Brynn

[Sherie]

Hi Brynn

I will be anxious to hear what your doctor says. I'll also try to find out which one he uses so I can do more specific research.

Thanks

[brynnski]

Dear Sherie,

I just got finished speaking with my surgeon's associate. He'll be assisting with my surgery. My surgeon, Dr. Akbarnia, is apparently one of the greats, on par with even Dr. Boachie, who is a friend and associate. He was surprised that Dr. Boachie was mute about BMP graphs, since his impression was that he was using them. I don't know. But he said that they've learned a lot about the best way to use BMP-2 in the last several years. It used to be that they put too much in, and this sometimes caused uncontrolled bone growth. There are studies about this on spineuniverse. Now they put in just the right amount during anterior procedures, within the cages that are used to replace the discs taken out. He also said that the lack of compression between vertebra was taken care of by the use of cages. BMP-2 is best used during the anterior fusion, when they put it inside the cages. When they do posterior fusions (I'm having both) they use patient bone. In my case they won't have to harvest any bone from my iliac crest because they will be using BMP graphs during the anterior procedure, then using the bone they remove when they do this procedure to do the posterior graphs. I feel confident about what he told me. I don't know if this is relevant to your daughter's case or not. I hope it is, since it would be great if she didn't have to have her own bone harvested. If they do, though, I think she'll do OK since she is young. My son had a spinal fusion when he was 14. They removed a rib and harvested from his iliac crest. Although he was sore at first he is fine now.

Take care,
Brynn

[Janet]

Bone Grafts

Brynn,

I asked Dr. Boachie on April 16 if he would use just my own bone; his reply was both my own and cadaver bone. He said nothing about BMPs. So it sounds like Dr. B is now staying away from them.

[brynnski]

Dear Janet,

I'd be interested to know why Dr. Boachie is staying away from BMP graphs. I do trust my surgeon, though, so I have no objection to having them be a part of my fusions.

Brynn