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Thread: Bone morphogenetic protein

  1. #1
    Join Date
    May 2005
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    672

    Bone morphogenetic protein

    I have been trying to do a little research on the use of BMP as an aid to, or in leiu of bone grafting during spinal fusions. From what I have seen so far, it appears to be mainly used (when it is used) in anterior -approach surgeries. From what I understand, it has limited FDA approval, and is not covered by insurance.My son will be having posterior surgery and I was just wondering if anyone out there has any info or experience to share re the use of BMP in posterior fusions, or even just direct me to a good source for current info. I am adding this to a list of questions I am compiling for our dr., but in the mean time I thought I would throw the question out to you all on the forum, my 2nd best source for info.

    Thanks,

    Renee
    Last edited by flowerpower; 09-28-2005 at 08:20 PM.

  2. #2
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    Sep 2003
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    Hi Renee...

    Your son's surgeon can probably give you the low down, but I think it's mainly used for older patients, where the risk of non-fusion is much greater. Kids rarely have a problem with non-fusion.

    Regards,
    Linda

  3. #3
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    May 2005
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    Thanks Linda,

    That's kind of what I figured, just desperately hoping for something, anything that might make this somewhat easier for my son.

    Renee

  4. #4
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    Mar 2005
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    Baltimore
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    BMP has not yet been FDA approved for posterior scoliosis surgery for adolescents. Nonetheless, we did find a doctor at Mercy Hospital in Baltimore who proposed using BMP on a sponge for posterior surgery. That doctor gets excellent results using it in his adult patients. The hospital would have covered the estimated additional cost of $5,000. Not sure about the legalities, but signing a waiver would have been involved if we had chose that method. Another doctor who we spoke with in New York just started using BMP for his thoracoscopic anterior surgeries and claimed excellent results. We chose a different surgeon. We are hopeful that choosing the right surgeon and following doctor's orders will reduce the risk of any non-fusion in our daughter's upcoming surgery.
    Mark & Jane, Parents of Lisa
    Daughter 15 years old
    Posterior surgery was in October, 2005, with Dr. Paul Sponseller at Johns Hopkins. Fused T2-L2 w/4 rib thoracoplasty. Rib and local autograft. All pedicle screw and stainless construct.
    Before: PT 33, MT 63, L 32, kyphosis 46.
    After: PT 7, MT 4, L 15, kyphosis 32.

  5. #5
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    May 2005
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    I know exactly what you mean. Our decisions are based on research, info and a large part INSTINCT.

    Which vertebrae will you daughter have fused? At last appt., our doctor proposed fusing from T5 to L4. Hopefully this will not change, at the rate he is growing and the curves & rotation progressing, I just don't know. Best wishes you both and your daughter -

    Renee

  6. #6
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    Mar 2005
    Location
    Baltimore
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    Renee,

    Lisa's doctor plans to fuse T3-L1. That could possibly vary slightly if the pre-op films indicate the need. Her curve is a Lenke 1AN measuring around 60 degrees from T5-T12.

    We had a huge difference of opinions between the doctors that we have seen. One doctor proposed fusing T4-T12 and was a big advocate for selective fusion. Another doctor proposed fusing T2-L3. That's five more vertebrae! Dortors Sponseller and Lonner both agreed on T3-L1 and seemed to give the best explanation of their decision.

    From what we read, there can be problems associated with fusing too many and fusing too few vertebrae.

    We are definitely paranoid about the fusion taking hold, hence our investigation into BMP. We have also read one study that believed that up to 20% of non-fusions go undiagnosed, as they are hard to detect on regular films. Another doctor opinionated that the surgeon's skill at preparing the graft site was the primary factor in determining good fusion.

    Best of luck to you too.
    Mark & Jane, Parents of Lisa
    Daughter 15 years old
    Posterior surgery was in October, 2005, with Dr. Paul Sponseller at Johns Hopkins. Fused T2-L2 w/4 rib thoracoplasty. Rib and local autograft. All pedicle screw and stainless construct.
    Before: PT 33, MT 63, L 32, kyphosis 46.
    After: PT 7, MT 4, L 15, kyphosis 32.

  7. #7
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    Sep 2005
    Location
    Indianapolis, IN
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    8

    bone protein

    That was a really good question!
    My surgeon has already indicated that he will use the bone protein to aid in my fusion. I'm 24, and will have the posterior/ anterior surgery on December 16 to fuse T4 through L3, with three titanium rods. I asked him about the cost of this technology and whether or not insurance would cover it. He told me that IF there was a problem- the insurance company would charge the hospital, and not me, for the additional cost. The hospital would, in turn, discuss with him (the surgeon) as to whether or not it was necessary. He feels it is neccesary for several reasons; he is going to remove one of my ribs for the grafting and my age falls right on the line of adolescent/ adult, so he thinks that I'll get a better fusion and won't have to wear a post operative brace. I have complete confidence in him- and any method he wants to try.

  8. #8
    Join Date
    Nov 2004
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    216
    Hi Alexandra,

    I'm curious about the use of three titanium rods. I've never heard of three rods. Where will the three rods be attached?

    Kindest Regards,
    Gail

  9. #9
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    May 2005
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    672
    I am also curious about the use of "three" rods, I have never heard of anyone using three before. Exactly where will the third one be placed and why the need for three??

  10. #10
    Join Date
    Sep 2005
    Location
    Indianapolis, IN
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    8

    Three rods

    Well, I guess I'm just special....
    No really, My surgeon explained to me that the most significant portion of my curve resides in my lumbar area, therefore requiring the anterior approach. He's going to start by fusing the lumbar vertebra and implementing a short rod on the FRONT side of my spine, and then he will continue with the posterior fusions all the way up to T4, with two my rods on either side of the back of my spine. He's had great success with this in the past because it allows him to have the most correction with least amount of lumbar fusion. A friend of mine that lives in town here with me has had a revision surgery similar to this and she says that the only limitation she has is that she cannot do backbends! I'm really looking forward to getting 'fixed'!
    Thank you for interest, help and advice! It's really comforting to be able to talk to others about this scary process!

  11. #11
    Join Date
    May 2005
    Posts
    672
    Alexandra,

    Thanks for sharing your situation & good luck with your surgery - 3 days before my son's on Dec. 19, I will be thinking of you. Keep us posted on your surgery & recovery.

    Regards,

    Renee
    Last edited by flowerpower; 11-16-2005 at 11:04 AM.

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