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Thread: BMP reduces re-operation risk

  1. #1
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    BMP reduces re-operation risk

    Use of Recombinant Bone Morphogenetic Protein is Associated with Reduced Risk of Reoperation after Spine Fusion for Adult Spinal Deformity.
    Paul, Justin C.; Lonner, Baron S.; Vira, Shaleen; More
    Spine., Post Author Corrections: September 1, 2015

    Study Design. retrospective review.

    Objective. This study follows the inpatient stay administrative data collected for a cohort of thousands of patients who had spine fusion surgery in the state of New York. We sought to examine adult spinal deformity (ASD) for reoperation events with and without the use of BMP.

    Summary of Background Data. Randomized controlled trials have suggested that bone morphogenetic protein (BMP) may increase the likelihood of solid arthrodesis in spinal surgery. This would imply fewer reoperations for pseudarthrosis, but small cohort sizes are inadequate to monitor these events.

    Methods. The 2008-2011 New York State Inpatient Database was queried using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Patients age 21 and older with a diagnosis of scoliosis and an index fusion of greater than 2 spinal motion segments were included. Patient identifiers and linkage variables were used to identify revisits. The relative risk of reoperation was calculated. The use of BMP at the initial inpatient stay was used to define the two cohorts for relative risk assessment.

    Results. A total of 3,751 cases of ASD were identified in 2008. The use of BMP at the initial visit was performed at a rate of 37.6% for ASD. For posterior fusion cases longer than 8 levels, the rate of reoperation for a pseudarthrosis was 23.4%. For ASD fusions greater than 8 levels, the rate of reoperation for pseudarthrosis after using BMP at the index surgery was 5% and 33.9% when BMP was not used, a relative risk of 7.5 (p < 0.001).

    Conclusion. Using relevant in-hospital patient records from the New York State Inpatient Sample, we found a 7.5-fold decrease in the risk of reoperation for pseudarthrosis after long fusions when using BMP. Decreased reoperation rates are likely due to the improved fusion with use of BMP. If subsequent unnecessary hospitals stays can be avoided, the economics of BMP use should be re-examined.

    Level of Evidence: 4
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

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  2. #2
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    Sharon, did I read this correctly? This is a retrospective NON-RANDOMIZED study?
    Susan
    Adult Onset Degenerative Scoliosis @65, 25* T & 36* L w/ 11.2 cm coronal balance; T kyphosis 90*; Severe disc degen T & L stenosis

    2013: T3- S1 Fusion w/ ALIF L4-S1/XLIF L2-4, PSF T4-S1 in 2 surgeries
    2014: Hernia @ ALIF repaired; Emergency screw removal surgery for Spinal Cord Injury at T4,5 sec to PJK
    2015: Revision Broken Bil T & L rods and no fusion: 2 revision surgeries; hardware P. Acnes infection
    2016: Ant/Lat Lumbar diskectomy w/ 4 cages + BMP + harvested bone + prayer

  3. #3
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    Susan they considered every case that fit the stated criteria from 2008. To the extent 2008 is a "random" year, the study is randomized as far as I understand these terms. If 2008 is atypical then it wouldn't be random.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  4. #4
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    I'm not sure you can classify it as randomized or non-randomized, as there's no way to really be certain. They used a state database, where the data are entirely dependent on billing coders. I think the non-BMP group pseudoarthrosis rate is actually much higher than what we're seeing at UCSF. Anyway, with that said, the difference in the groups is so significant that even if the logic for selection was really flawed, it would almost certainly still be a significant result, if any incorrect data were all corrected.

    The result is not surprising to me. When I had my revision surgery in 2011, the BMP controversy was just starting to heat up. Even knowing what we knew, it was generally agreed that the BMP risks were greatly outweighed by the lowered risk of pseudoarthrosis, especially at the L5-S1 level.

    --Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Dilbert
    I'm sarcastic... what's your super power? --Unknown
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    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation
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  5. #5
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    Responses from 10 surgeons on BMP....(Oct 2011)

    http://www.beckersspine.com/spine/it...eon-responses=

    Ed
    49 yr old male, now 59, the new 55...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  6. #6
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    Quote Originally Posted by titaniumed View Post
    Responses from 10 surgeons on BMP....(Oct 2011)

    http://www.beckersspine.com/spine/it...eon-responses=

    Ed
    Ti Ed, thanks so much for posting that. It is very valuable hearing from so many surgeons who are discussing the issues that control their usage of BMP. It seems like if you can get the right dosage and the costs down, it would be a clear net positive to use it in the right cases.

    I note one surgeon called harvesting bone from the iliac crest "a brutal procedure". I continue to be glad I was not confronted with that with my twins and feel like we dodged a huge bullet.

    The other thing I thought came through in those testimonials was that most of those guys are doing very short fusions and therefore not treating scoliosis which we knew anyway.... the vast majority of spinal fusions are for other issues besides scoliosis as far as I know.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  7. #7
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    BMP is the glue that keeps me together.
    Susan
    Adult Onset Degenerative Scoliosis @65, 25* T & 36* L w/ 11.2 cm coronal balance; T kyphosis 90*; Severe disc degen T & L stenosis

    2013: T3- S1 Fusion w/ ALIF L4-S1/XLIF L2-4, PSF T4-S1 in 2 surgeries
    2014: Hernia @ ALIF repaired; Emergency screw removal surgery for Spinal Cord Injury at T4,5 sec to PJK
    2015: Revision Broken Bil T & L rods and no fusion: 2 revision surgeries; hardware P. Acnes infection
    2016: Ant/Lat Lumbar diskectomy w/ 4 cages + BMP + harvested bone + prayer

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