Treatment of pediatric spinal deformity with use of recombinant human bone morphogenetic protein-2

TY - JOUR

T1 - Treatment of pediatric spinal deformity with use of recombinant human bone morphogenetic protein-2

AU - Stiel, Norbert

AU - Stücker, Ralf

AU - Kunkel, Philip

AU - Ridderbusch, Karsten

AU - Hagemann, Christian

AU - Breyer, Sandra

AU - Ebert, Nicola

AU - Spiro, Alexander S

PY - 2018/6/25

Y1 - 2018/6/25

N2 - In pediatric spine surgery nonunion is a challenging issue. Instability may cause neurological impairment and lead to numerous surgeries in order to achieve fusion. The use of rhBMP-2 for pediatric spinal fusion has not been widely reported. In this study, a series of 13 children (14 procedures) that underwent spinal rhBMP-2 application were analyzed in order to measure clinical and radiographic outcome. Therefore, patient data, diagnosis, construct of instrumentation, type of bone graft, quantity of BMP used, and fusion outcome were reviewed. The study cohort included four female and nine male patients with a mean age of 11.2 years (range 2.6-19.2 years) at the time of rhBMP-2 application. Rh-BMP-2 was used in both primary (n = 6) and revision surgery (n = 8) in patients with a high risk for the development of nonunion. The mean follow-up was 51 months (range 12-108 months). Fusion occurred in 11 patients. Complications that may be due to application of rhBMP-2 were seen after four operations. Three patients had an increased body temperature and in one case prolonged wound secretion was evident, treated by local wound care or observation. In one of these patients an extensive postoperative hematoma occurred, necessitating surgical treatment. In conclusion, we could detect high fusion rates following the use of rhBMP-2 in pediatric spine surgery without an increased complication rate attributable to its application. Therefore we consider recombinant human BMP-2 to be an option in selected pediatric spinal procedures, especially in cases with compromised bone healing due to congenital, systemic, or local conditions.

AB - In pediatric spine surgery nonunion is a challenging issue. Instability may cause neurological impairment and lead to numerous surgeries in order to achieve fusion. The use of rhBMP-2 for pediatric spinal fusion has not been widely reported. In this study, a series of 13 children (14 procedures) that underwent spinal rhBMP-2 application were analyzed in order to measure clinical and radiographic outcome. Therefore, patient data, diagnosis, construct of instrumentation, type of bone graft, quantity of BMP used, and fusion outcome were reviewed. The study cohort included four female and nine male patients with a mean age of 11.2 years (range 2.6-19.2 years) at the time of rhBMP-2 application. Rh-BMP-2 was used in both primary (n = 6) and revision surgery (n = 8) in patients with a high risk for the development of nonunion. The mean follow-up was 51 months (range 12-108 months). Fusion occurred in 11 patients. Complications that may be due to application of rhBMP-2 were seen after four operations. Three patients had an increased body temperature and in one case prolonged wound secretion was evident, treated by local wound care or observation. In one of these patients an extensive postoperative hematoma occurred, necessitating surgical treatment. In conclusion, we could detect high fusion rates following the use of rhBMP-2 in pediatric spine surgery without an increased complication rate attributable to its application. Therefore we consider recombinant human BMP-2 to be an option in selected pediatric spinal procedures, especially in cases with compromised bone healing due to congenital, systemic, or local conditions.

KW - Adolescent

KW - Biocompatible Materials

KW - Bone Morphogenetic Protein 2

KW - Bone Transplantation

KW - Child

KW - Child, Preschool

KW - Female

KW - Humans

KW - Kyphosis

KW - Male

KW - Materials Testing

KW - Recombinant Proteins

KW - Retrospective Studies

KW - Scoliosis

KW - Spinal Fusion

KW - Treatment Outcome

KW - Young Adult

KW - Journal Article

U2 - 10.1007/s10856-018-6104-y

DO - 10.1007/s10856-018-6104-y

M3 - SCORING: Journal article

C2 - 29938328

VL - 29

SP - 93

JO - J MATER SCI-MATER M

JF - J MATER SCI-MATER M

SN - 0957-4530

IS - 7

ER -