Fusion - BMP vs autologous bone

[Tim]

Mark
Sorry to re-post this but it was buried inside another post and probably got lost..
I know we spoke briefly about this recently but I just want to ask a quick question following on from your comment in Fuzzy's thread that "There is motiviation not to use BMP, growth factors and other fusion accelerators in hybrid procedures because you don't want to risk causing fusion at the ADR level".
Is this your own thinking or does this come direct from Dr Z.?
Do you feel then that the use of BMP is positively contra-indicated in any hybrid surgery be that a combined ADR + fusion primary surgery or a later secondary fusion surgery above or below an existing adjacent ADR?
I know in my case Dr Bertagnoli was proposing using BMP as is my current consultant in London - all very confusing..
As you know this is an issue I am currently very much trying to understand.

All the best
Tim

[rosedee]

Interesting issue Tim, but yet another area of differing opinions which adds to the difficulties in our decision-making as patients. Hope others will be able to provide more helpful postings for you than mine!

[fuzzy]

Ok its hurts a little bit but I don't have a problem with that in exchange for using my own bone which I prefer. Its a rather non scientific comment, is the auto bone graft a risky procedure compared to BMP?

[Tim]

Hi Rosedee and Fuzzy
Many thanks for your replies.
BMP reportedly speeds fusion by as much as 50% and reduces the risk of pseudarthrosis. With this in mind one would expect it to be universally used in all fusion procedures. This is why I picked up on Marks comment - "There is motiviation not to use BMP, growth factors and other fusion accelerators in hybrid procedures because you don't want to risk causing fusion at the ADR level".
I also recently read an article which concluded that:
The placement of BMP-2 within the disc space inside and around an interbody cage placed via a transforaminal approach significantly increased the incidence of post-operative radiculitis. Whether this is due to BMP-induced exuberant new bone formation near the nerve root sleeve/foramina, or strictly due to the direct inflammatory effects of the BMP on the nearby neural elements is a subject of future study
It appears to me that the use of BMP is contentious.. Speed of fusion, eliminating the possibility of iliac donor site pain and possibly even more importantly reduction in risk of non-fusion are all very attractive but the possibility of increased risk of radiculitus and/or excessive bone growth are a worry.
Just trying to get to the bottom of this. It might well be that any potential risks are greatly minimised by an experienced surgeon being meticulous in his preperation and placement of the graft..

All the best
Tim