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Wanderman N, Carlson B, Robinson W, Bydon M, Yaszemski M, Huddleston P, Freedman B. Does Recombinant Human Bone Morphogenic Protein 2 Affect Perioperative Blood Loss after Lumbar and Thoracic Spinal Fusion? Asian Spine J 2018; 12:880-886. [PMID: 30213171 PMCID: PMC6147887 DOI: 10.31616/asj.2018.12.5.880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 01/09/2018] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN Retrospective cohort design. PURPOSE This study aimed to determine whether recombinant human bone morphogenic protein 2 (rhBMP-2) reduces total perioperative blood loss during lumbar and thoracic fusion. OVERVIEW OF LITERATURE Previous studies on rhBMP-2 versus iliac crest bone grafting in thoracic and lumbar fusions have yielded mixed results regarding reductions in blood loss and have largely neglected the postoperative period when analyzing total blood loss. Additionally, these studies have been limited by heterogeneity and sample size. METHODS We analyzed the blood loss patterns of 617 consecutive adult patients undergoing lumbar and/or thoracic fusions requiring subfascial drain placement at a single institution from January 2009 to December 2016. Patients were divided into BMP and non-BMP cohorts, and a propensity score analysis was conducted to account for the differences between cohorts. RESULTS At a per-level fused basis, the BMP group exhibited a significant reduction in the intraoperative (66.1 mL per-level fused basis; 95% confidence interval [CI], 127.9 to 4.25 mL; p =0.036) and total perioperative blood loss (100.7 mL per-level fused basis; 95% CI, 200.9 to 0.5 mL; p =0.049). However, no significant differences were observed in an analysis when not controlling for the number of levels or when examining the postoperative drain output. CONCLUSIONS RhBMP-2 appears to reduce both intraoperative and total blood loss during lumbar and thoracic fusions on a per-level fused basis. This total reduction in blood loss was achieved via intraoperative effects because RhBMP-2 had no significant effect on the postoperative drain output.
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Affiliation(s)
- Nathan Wanderman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Bayard Carlson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - William Robinson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Mohamad Bydon
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Paul Huddleston
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Brett Freedman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Litrico S, Langlais T, Pennes F, Gennari A, Paquis P. Lumbar interbody fusion with utilization of recombinant human bone morphogenetic protein: a retrospective real-life study about 277 patients. Neurosurg Rev 2017; 41:189-196. [DOI: 10.1007/s10143-017-0834-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 01/29/2017] [Accepted: 02/20/2017] [Indexed: 11/28/2022]
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Polyelectrolyte Complex Carrier Enhances Therapeutic Efficiency and Safety Profile of Bone Morphogenetic Protein-2 in Porcine Lumbar Interbody Fusion Model. Spine (Phila Pa 1976) 2015; 40:964-73. [PMID: 25893351 DOI: 10.1097/brs.0000000000000935] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Porcine lumbar interbody fusion model. OBJECTIVE This study evaluates the effect of polyelectrolyte complex (PEC) carrier in enhancing the therapeutic efficiency and safety profile of bone morphogenetic protein-2 (BMP-2) in a large animal model. SUMMARY OF BACKGROUND DATA Extremely large amounts of BMP-2 are administered to achieve consistent spinal fusion, which has led to complications. Heparin-modified PEC carrying reduced BMP-2 doses of 0.5 μg was demonstrated to achieve consistent spinal fusion with reduction of complications in rodent model. The purpose of this study was to evaluate whether PEC could improve the therapeutic efficiency of BMP-2 in porcine model. METHODS Three-segment (L3-L6) anterior lumbar interbody fusions with instrumentation were performed on 6 pigs using 3 different doses of BMP-2, namely, (1) 50 μg, (2) 150 μg, and (3) 300 μg. The BMP-2 was delivered using heparin-modified alginate microbeads loaded into biodegradable cage. Fusion performance was evaluated after 3 months. RESULTS Manual palpation and micro-computed tomography showed consistent fusion in all experimental groups. Heterotopic bone formation beyond the cage implant area was more evident in group 2 and group 3 than in group 1. Similarly, superior bone microstructure was observed in the new bone with the lowered BMP-2 dose. Biomechanical evaluation revealed enhanced stiffness of the operated segments compared with nonoperated segments (P < 0.05). Mechanical stability was maintained despite dose reduction of BMP-2. Although the mineral apposition rate was higher in group 3, unsatisfactory bony microstructure with decreased trabecular number was observed in group 3 compared with group 1. CONCLUSION PEC carrying low doses of BMP-2 achieved consistent interbody fusion. We observed dose-related reduction in heterotopic ossification without compromising the stability of the fused segments. PEC carrier reduces the efficacious doses of BMP-2. This could enhance the safety profile of BMP-2 and reduce dose- and carrier-related complications. LEVEL OF EVIDENCE N/A.
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Yu X, Suárez-González D, Khalil AS, Murphy WL. How does the pathophysiological context influence delivery of bone growth factors? Adv Drug Deliv Rev 2015; 84:68-84. [PMID: 25453269 PMCID: PMC4401584 DOI: 10.1016/j.addr.2014.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 08/29/2014] [Accepted: 10/07/2014] [Indexed: 02/08/2023]
Abstract
"Orthobiologics" represents an important category of therapeutics for the regeneration of bone defects caused by injuries or diseases, and bone growth factors are a particularly rapidly growing sub-category. Clinical application of bone growth factors has accelerated in the last two decades with the introduction of BMPs into clinical bone repair. Optimal use of growth factor-mediated treatments heavily relies on controlled delivery, which can substantially influence the local growth factor dose, release kinetics, and biological activity. The characteristics of the surrounding environment, or "context", during delivery can dictate growth factor loading efficiency, release and biological activity. This review discusses the influence of the surrounding environment on therapeutic delivery of bone growth factors. We specifically focus on pathophysiological components, including soluble components and cells, and how they can actively influence the therapeutic delivery and perhaps efficacy of bone growth factors.
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Affiliation(s)
- Xiaohua Yu
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Darilis Suárez-González
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, 53705, USA
| | - Andrew S Khalil
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - William L Murphy
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI 53705, USA; Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, 53705, USA.
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Saulle D, Fu KMG, Shaffrey CI, Smith JS. Multiple-Day Drainage when Using Bone Morphogenic Protein for Long-Segment Thoracolumbar Fusions Is Associated with Low Rates of Wound Complications. World Neurosurg 2013; 80:204-7. [DOI: 10.1016/j.wneu.2012.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Revised: 03/27/2012] [Accepted: 08/13/2012] [Indexed: 10/27/2022]
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Siu RK, Lu SS, Li W, Whang J, McNeill G, Zhang X, Wu BM, Turner AS, Seim HB, Hoang P, Wang JC, Gertzman AA, Ting K, Soo C. Nell-1 protein promotes bone formation in a sheep spinal fusion model. Tissue Eng Part A 2011; 17:1123-35. [PMID: 21128865 PMCID: PMC3063712 DOI: 10.1089/ten.tea.2010.0486] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 12/03/2010] [Indexed: 11/12/2022] Open
Abstract
Bone morphogenetic proteins (BMPs) are widely used as bone graft substitutes in spinal fusion, but are associated with numerous adverse effects. The growth factor Nel-like molecule-1 (Nell-1) is mechanistically distinct from BMPs and can minimize complications associated with BMP therapies. This study evaluates the efficacy of Nell-1 combined with demineralized bone matrix (DBM) as a novel bone graft material for interbody spine fusion using sheep, a phylogenetically advanced animal with biomechanical similarities to human spine. Nell-1+sheep DBM or Nell-1+heat-inactivated DBM (inDBM) (to determine the osteogenic effect of residual growth factors in DBM) were implanted in surgical sites as follows: (1) DBM only (control) (n=8); (2) DBM+0.3 mg/mL Nell-1 (n=8); (3) DBM+0.6 mg/mL Nell-1 (n=8); (4) inDBM only (control) (n=4); (5) inDBM+0.3 mg/mL Nell-1 (n=4); (6) inDBM+0.6 mg/mL Nell-1 (n=4). Fusion was assessed by computed tomography, microcomputed tomography, and histology. One hundred percent fusion was achieved by 3 months in the DBM+0.6 mg/mL Nell-1 group and by 4 months in the inDBM+0.6 mg/mL Nell-1 group; bone volume and mineral density were increased by 58% and 47%, respectively. These fusion rates are comparable to published reports on BMP-2 or autograft bone efficacy in sheep. Nell-1 is an independently potent osteogenic molecule that is efficacious and easily applied when combined with DBM.
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Affiliation(s)
- Ronald K. Siu
- Dental and Craniofacial Research Institute, University of California, Los Angeles, California
- Department of Bioengineering, School of Medicine, University of California, Los Angeles, California
| | - Steven S. Lu
- Dental and Craniofacial Research Institute, University of California, Los Angeles, California
- Department of Neonatology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Weiming Li
- Dental and Craniofacial Research Institute, University of California, Los Angeles, California
- Department of Orthopaedics, First Clinical Hospital, Harbin Medical University, Harbin, China
| | - Julie Whang
- Dental and Craniofacial Research Institute, University of California, Los Angeles, California
- Section of Orthodontics, School of Dentistry, University of California, Los Angeles, California
| | - Gabriel McNeill
- Group in Biostatistics, University of California, Berkeley, California
| | - Xinli Zhang
- Dental and Craniofacial Research Institute, University of California, Los Angeles, California
| | - Benjamin M. Wu
- Dental and Craniofacial Research Institute, University of California, Los Angeles, California
- Department of Bioengineering, School of Medicine, University of California, Los Angeles, California
| | - A. Simon Turner
- Department of Veterinary Sciences, Colorado State University, Fort Collins, Colorado
| | - Howard B. Seim
- Department of Veterinary Sciences, Colorado State University, Fort Collins, Colorado
| | - Paul Hoang
- Section of Orthodontics, School of Dentistry, University of California, Los Angeles, California
| | - Jeffrey C. Wang
- Department of Orthopaedic Surgery, School of Medicine, University of California, Los Angeles, California
| | | | - Kang Ting
- Dental and Craniofacial Research Institute, University of California, Los Angeles, California
- Section of Orthodontics, School of Dentistry, University of California, Los Angeles, California
| | - Chia Soo
- Department of Orthopaedic Surgery, School of Medicine, University of California, Los Angeles, California
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