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Sherie
04-27-2007, 04:05 PM
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
04-28-2007, 12:52 AM
Sorry this sounds stupid, but what is BMP???

Shari

trulyaries
04-28-2007, 10:01 AM
"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
04-28-2007, 10:38 PM
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
04-30-2007, 01:14 AM
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
04-30-2007, 08:50 AM
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
04-30-2007, 11:25 AM
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
04-30-2007, 04:03 PM
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
04-30-2007, 06:16 PM
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
04-30-2007, 08:43 PM
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
05-02-2007, 04:42 PM
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
05-02-2007, 08:33 PM
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
05-03-2007, 09:09 PM
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
05-03-2007, 11:40 PM
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
05-04-2007, 02:24 PM
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

Janet
05-04-2007, 03:16 PM
Hi Brynn,

I'm sorry I can't answer your question. I do not know Dr. Boachie's reasoning - I didn't even think to raise the question when I was evaluated.

After reading Forum posts for 3 years, and having consulted with 3 surgeons during that time, I have come to the conclusion that, because there are so many differences among the surgeons as to what to fuse (P-only or A/P incisions, what materials to use, etc. etc.) as well as so many differences among patients (age, type & degree of curves, bone density, other physical conditions, etc.), the only important thing for me is, do I trust my surgeon?

You have indicated in a number of posts that you trust your surgeon and have confidence in him. Personally, I tend to investigate and analyze and re-think whenever I do something of importance, whether it be spine surgery or renovating my bathroom, but I do eventually reach that "moment of truth" when I know in my gut what the right decision is for me.

I know you are making the right choice for you, and I wish you the best. Your big day is coming up very soon, and my thoughts will be with you.

Feel free to contact me - perhaps I will be able to answer a question ;)

Best,

Janet

Celia
05-04-2007, 04:01 PM
I don't know too much about surgical techniques because I'm trying to avoid it at all costs ;) however has anyone seen this article? They discuss BMP and from I can tell, it's still in the experimental stages. The info is under the heading: What's New in Biologic Topics Related to the Spine

http://www.ejbjs.org/cgi/reprint/88/8/1897?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=what%27s+new+in+spine+surgery&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT


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brynnski
05-04-2007, 08:13 PM
Dear Janet,

Thanks for your kind and insightful words. I, too, am the kind of person who feels the need to research and analyze before making a decision. You may have seen that if you've been reading my posts. This week I'm realizing that I'm at the point where I need to let go and trust that the decisions I've made are the right ones. I love this Forum, and can't stay away from it at this point in my life, but I can't let myself get too distracted by trying to out think and even out research my surgeons. I have called Dr. Akbarnia's office so many times with questions, most often coming from info I've learned on the Forum, and each time they've said just the right things to make me feel better. I realize, too, that they are being genuine with me. They aren't simply telling me what I want to hear. So I'm feeling more ready than ever for my upcoming surgery. It's so true that every surgeon has his/her own perspective and approach. I'm sure there are things to be said for each approach. So thanks very much for your input and offer to answer my questions.

Celia:
My Adobe isn't working right now but when I get it fixed I'll at least check out the article. Thanks.

Brynn

Sherie
05-04-2007, 09:51 PM
Hi Brynn

Thanks for posting, I'm glad you found the right answers. I need to call Dr. Lenke's office and start asking questions too. Maybe he'll give me the reassurance I need, if not, I'll just ask him not to use it. We still have some time. I'll post here again if I find out anything new.

Celia
Thanks for that link, it definitely appears to be investigational, especially in pediatric patients. I'm pretty sure it's not been approved by the FDA for pediatric use, although from everything I've read, it appears to be safe if used in the right hands. By the way, I'm very happy for you and your daughter, I hope you have continued success with the Spinecor.

brynnski
05-05-2007, 01:03 AM
Dear Sherie,

I think it's great that you're going to speak to your surgeon! Please let us know what he says and what you decide to do.

Take care,

Brynn

Celia
05-05-2007, 09:29 AM
Sherie,

Dr. Lenke is supposed to be a very good surgeon! Thanks for the well wishes!!!! So far we're doing okay and it may be premature to worry but it's the adolescent growth spurt that has me a little worried but who knows, maybe we'll have this conquered by then.


Brynn,

If you don't have pdf, you can download it for free here:


http://www.adobe.com/products/acrobat/readstep2.html

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cathydownunder
05-05-2007, 07:03 PM
MY fusion was anterior with a cage and using donor bone and BMP. My understanding is only a few mls are used to speed up the fusion process. I showed good fusion started already by the 3 month X ray.
At $6000 for the tiny amount used on me, I would imagine it's used quite sparingly. Insurance would never pay for it otherwise.
Funnily, I wasn't concerned about the BMP till I read this post, I was more interested in knowing how the cadaver bone was treated.
When it comes to our children of course we don't want to make any wrong decision regarding their health and treatment. Trust your instinct.