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Use of rhBMP-2 for adult spinal deformity surgery: patterns of usage and changes over the past decade.

Publication ,  Journal Article
Bannwarth, M; Smith, JS; Bess, S; Klineberg, EO; Ames, CP; Mundis, GM; Kim, HJ; Lafage, R; Gupta, MC; Burton, DC; Shaffrey, CI; Schwab, FJ ...
Published in: Neurosurg Focus
June 2021

OBJECTIVE: Recombinant human bone morphogenetic protein-2 (rhBMP-2) has been shown to increase fusion rates; however, cost, limited FDA approval, and possible complications impact its use. Decisions regarding rhBMP-2 use and changes over time have not been well defined. In this study, the authors aimed to assess changes in rhBMP-2 use for adult spinal deformity (ASD) surgery over the past decade. METHODS: A retrospective review of the International Spine Study Group prospective multicenter database was performed to identify ASD patients treated surgically from 2008 to 2018. For assessment of rhBMP-2 use over time, 3 periods were created: 2008-2011, 2012-2015, and 2016-2018. RESULTS: Of the patients identified, 1180 met inclusion criteria, with a mean age 60 years and 30% of patients requiring revision surgery; rhBMP-2 was used in 73.9% of patients overall. The mean rhBMP-2 dose per patient was 23.6 mg. Patients receiving rhBMP-2 were older (61 vs 58 years, p < 0.001) and had more comorbidities (Charlson Comorbidity Index 1.9 vs 1.4, p < 0.001), a higher rate of the Scoliosis Research Society-Schwab pelvic tilt modifier (> 0; 68% vs 62%, p = 0.026), a greater deformity correction (change in pelvic incidence minus lumbar lordosis 15° vs 12°, p = 0.01), and more levels fused (8.9 vs 7.9, p = 0.003). Over the 3 time periods, the overall rate of rhBMP-2 use increased and then stabilized (62.5% vs 79% vs 77%). Stratified analysis showed that after an overall increase in rhBMP-2 use, only patients who were younger than 50 years, those who were smokers, those who received a three-column osteotomy (3CO), and patients who underwent revision sustained an increased rate of rhBMP-2 use between the later two periods. No similar increases were noted for older patients, nonsmokers, primary surgery patients, and patients without a 3CO. The total rhBMP-2 dose decreased over time (26.6 mg vs 24.8 mg vs 20.7 mg, p < 0.001). After matching patients by preoperative alignment, 215 patients were included, and a significantly lower rate of complications leading to revision surgery was observed within the 2012-2015 period compared with the 2008-2011 (21.4% vs 13.0%, p = 0.029) period, while rhBMP-2 was increasingly used (80.5% vs 66.0%, p = 0.001). There was a trend toward a lower rate of pseudarthrosis for patients in the 2012-2015 period, but this difference did not reach statistical significance (7% vs 4.2%, p = 0.283). CONCLUSIONS: The authors found that rhBMP-2 was used in the majority of ASD patients and was more commonly used in those with greater deformity correction. Additionally, over the last 10 years, rhBMP-2 was increasingly used for ASD patients, but the dose has decreased.

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Published In

Neurosurg Focus

DOI

EISSN

1092-0684

Publication Date

June 2021

Volume

50

Issue

6

Start / End Page

E4

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Transforming Growth Factor beta
  • Spinal Fusion
  • Retrospective Studies
  • Recombinant Proteins
  • Prospective Studies
  • Postoperative Complications
  • Neurology & Neurosurgery
  • Middle Aged
  • Humans
 

Citation

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Bannwarth, M., Smith, J. S., Bess, S., Klineberg, E. O., Ames, C. P., Mundis, G. M., … International Spine Study Group (ISSG), . (2021). Use of rhBMP-2 for adult spinal deformity surgery: patterns of usage and changes over the past decade. Neurosurg Focus, 50(6), E4. https://doi.org/10.3171/2021.3.FOCUS2164
Bannwarth, Mathieu, Justin S. Smith, Shay Bess, Eric O. Klineberg, Christopher P. Ames, Gregory M. Mundis, Han Jo Kim, et al. “Use of rhBMP-2 for adult spinal deformity surgery: patterns of usage and changes over the past decade.Neurosurg Focus 50, no. 6 (June 2021): E4. https://doi.org/10.3171/2021.3.FOCUS2164.
Bannwarth M, Smith JS, Bess S, Klineberg EO, Ames CP, Mundis GM, et al. Use of rhBMP-2 for adult spinal deformity surgery: patterns of usage and changes over the past decade. Neurosurg Focus. 2021 Jun;50(6):E4.
Bannwarth, Mathieu, et al. “Use of rhBMP-2 for adult spinal deformity surgery: patterns of usage and changes over the past decade.Neurosurg Focus, vol. 50, no. 6, June 2021, p. E4. Pubmed, doi:10.3171/2021.3.FOCUS2164.
Bannwarth M, Smith JS, Bess S, Klineberg EO, Ames CP, Mundis GM, Kim HJ, Lafage R, Gupta MC, Burton DC, Shaffrey CI, Schwab FJ, Lafage V, International Spine Study Group (ISSG). Use of rhBMP-2 for adult spinal deformity surgery: patterns of usage and changes over the past decade. Neurosurg Focus. 2021 Jun;50(6):E4.

Published In

Neurosurg Focus

DOI

EISSN

1092-0684

Publication Date

June 2021

Volume

50

Issue

6

Start / End Page

E4

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Transforming Growth Factor beta
  • Spinal Fusion
  • Retrospective Studies
  • Recombinant Proteins
  • Prospective Studies
  • Postoperative Complications
  • Neurology & Neurosurgery
  • Middle Aged
  • Humans