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Reoperation Rates After Long Posterior Spinal Fusion: Use of Recombinant Bone Morphogenetic Protein in Idiopathic and Non-idiopathic Scoliosis

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Abstract

Introduction

Bone morphogenetic protein (BMP) can increase the likelihood of solid arthrodesis in spinal surgery. This would imply fewer reoperations for pseudarthrosis, but small cohort sizes are inadequate to monitor these events. We sought to examine adolescent idiopathic (AIS) and non-idiopathic scoliosis (NIS) for reoperation events with and without the use of BMP using a large statewide database.

Methods

The 2008–2011 New York State Inpatient Database was queried using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Patients age 10 and older with a diagnosis of scoliosis and an index fusion of greater than 2 spinal motion segments were included. Patient identifiers and linkage variables were used to identify revisits. The relative risk of reoperation was calculated. The use of BMP at the initial inpatient stay was used to define the two cohorts for relative risk assessment.

Results

A total of 2,658 and 2,431 cases were identified of AIS and NIS, respectively. The use of BMP at the initial visit was performed at a rate of 4.5% for AIS and 21.0% for NIS fusion surgery. For posterior fusion cases longer than eight levels, the reoperation rate for pseudarthrosis was 1.0% in AIS and 18.4% in NIS (p <.001). For NIS fusions greater than eight levels, the rate of reoperation for pseudarthrosis after using BMP at the index surgery was 5% and 22% when BMP was not used, a relative risk of 4.0 (p <.001). For AIS, there was no substantial increase in risk when not using BMP for fusion greater than eight levels (p <.001).

Conclusion

We found a significant decrease in the risk of reoperation for pseudarthrosis after long fusions when using BMP in the case of NIS. In contrast, use of BMP does not benefit the AIS population.

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References

  1. Boden SD, Kang J, Sandhu H, et al. Use of recombinant human bone morphogenetic protein-2 to achieve posterolateral lumbar spine fusion in humans: a prospective, randomized clinical pilot trial: 2002 Volvo Award in clinical studies. Spine 2002;27:2662–73.

    Article  Google Scholar 

  2. Glassman SD, Dimar JR, Carreon LY, et al. Initial fusion rates with recombinant human bone morphogenetic protein-2/compression resistant matrix and a hydroxyapatite and tricalcium phosphate/collagen carrier in posterolateral spinal fusion. Spine 2005;30:1694–8.

    Article  Google Scholar 

  3. Vaccaro AR, Patel T, Fischgrund J, et al. A pilot study evaluating the safety and efficacy of OP-1 Putty (rhBMP-7) as a replacement for iliac crest autograft in posterolateral lumbar arthrodesis for degenerative spondylolisthesis. Spine 2004;29:1885–92.

    Article  Google Scholar 

  4. Dimar JR, Glassman SD, Burkus KJ, et al. Clinical outcomes and fusion success at 2 years of single-level instrumented posterolateral fusions with recombinant human bone morphogenetic protein-2/compression resistant matrix versus iliac crest bone graft. Spine 2006;31:2534–9; discussion 2540.

    Article  Google Scholar 

  5. Glassman SD, Carreon LY, Djurasovic M, et al. RhBMP-2 versus iliac crest bone graft for lumbar spine fusion: a randomized, controlled trial in patients over sixty years of age. Spine 2008;33:2843–9.

    Article  Google Scholar 

  6. Burkus JK, Gornet MF, Dickman CA, et al. Anterior lumbar interbody fusion using rhBMP-2 with tapered interbody cages. J Spinal Disord Tech 2002;15:337–49.

    Article  Google Scholar 

  7. Mulconrey DS, Bridwell KH, Flynn J, et al. Bone morphogenetic protein (RhBMP-2) as a substitute for iliac crest bone graft in multilevel adult spinal deformity surgery: minimum two-year evaluation of fusion. Spine 2008;33:2153–9.

    Article  Google Scholar 

  8. Maeda T, Buchowski JM, Kim YJ, et al. Long adult spinal deformity fusion to the sacrum using rhBMP-2 versus autogenous iliac crest bone graft. Spine 2009;34:2205–12.

    Article  Google Scholar 

  9. Deyo RA, Ching A, Matsen L, et al. Use of bone morphogenetic proteins in spinal fusion surgery for older adults with lumbar stenosis. Spine 2012;37:222–30.

    Article  Google Scholar 

  10. Pichelmann MA, Lenke LG, Bridwell KH, et al. Revision rates following primary adult spinal deformity surgery: six hundred forty-three consecutive patients followed-up to twenty-two years postoperative. Spine 2010;35:219–26.

    Article  Google Scholar 

  11. Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 1992;45:613–9.

    Article  CAS  Google Scholar 

  12. Boden SD, Zdeblick TA, Sandhu HS, et al. The use of rhBMP-2 in interbody fusion cages. Definitive evidence of osteoinduction in humans: a preliminary report. Spine 2000;25:376–81.

    Article  CAS  Google Scholar 

  13. Burkus JK, Transfeldt EE, Kitchel SH, et al. Clinical and radiographic outcomes of anterior lumbar interbody fusion using recombinant human bone morphogenetic protein-2. Spine 2002;27:2396–408.

    Article  Google Scholar 

  14. Burkus JK, Heim SE, Gornet MF, et al. Is INFUSE bone graft superior to autograft bone? An integrated analysis of clinical trials using the LT-CAGE lumbar tapered fusion device. J Spinal Disord Tech 2003;16:113–22.

    Article  Google Scholar 

  15. Burkus JK, Dorchak JD, Sanders DL. Radiographic assessment of interbody fusion using recombinant human bone morphogenetic protein type 2. Spine 2003;28:372–7.

    PubMed  Google Scholar 

  16. Burkus JK, Sandhu HS, Gornet MF, et al. Use of rhBMP-2 in combination with structural cortical allografts: clinical and radiographic outcomes in anterior lumbar spinal surgery. J Bone Joint Surg 2005;87:1205–12.

    PubMed  Google Scholar 

  17. Johnsson R, Strömqvist B, Aspenberg P. Randomized radiostereometric study comparing osteogenic protein-1 (BMP-7) and autograft bone in human noninstrumented posterolateral lumbar fusion: 2002 Volvo Award in clinical studies. Spine 2002;27:2654–61.

    Article  Google Scholar 

  18. Ong KL, Villarraga ML, Lau E, et al. Off-label use of bone morphogenetic proteins in the United States using administrative data. Spine 2010;35:1794–800.

    Article  Google Scholar 

  19. Bollini G, Docquier P-L, Viehweger E, et al. Thoracolumbar hemivertebrae resection by double approach in a single procedure: long-term follow-up. Spine 2006;31:1745–57.

    Article  Google Scholar 

  20. Sink EL, Newton PO, Mubarak SJ, et al. Maintenance of sagittal plane alignment after surgical correction of spinal deformity in patients with cerebral palsy. Spine 2003;28:1396–403.

    PubMed  Google Scholar 

  21. Jones KB, Erkula G, Sponseller PD, et al. Spine deformity correction in Marfan syndrome. Spine 2002;27:2003–12.

    Article  Google Scholar 

  22. Alman BA, Kim HK. Pelvic obliquity after fusion of the spine in Duchenne muscular dystrophy. J Bone Joint Surg 1999;81:821–4.

    Article  CAS  Google Scholar 

  23. Sengupta DK, Mehdian SH, McConnell JR, et al. Pelvic or lumbar fixation for the surgical management of scoliosis in Duchenne muscular dystrophy. Spine 2002;27:2072–9.

    Article  Google Scholar 

  24. Oluigbo CO, Solanki GA. Use of recombinant human bone morphogenetic protein-2 to enhance posterior cervical spine fusion at 2 years of age: technical note. Pediatr Neurosurg 2008;44:393–6.

    Article  Google Scholar 

  25. Abd-El-Barr MM, Cox JB, Antonucci MU, et al. Recombinant human bone morphogenetic protein-2 as an adjunct for spine fusion in a pediatric population. Pediatr Neurosurg 2011;47:266–71.

    Article  Google Scholar 

  26. Fahim DK, Whitehead WE, Curry DJ, et al. Routine use of recombinant human bone morphogenetic protein-2 in posterior fusions of the pediatric spine: safety profile and efficacy in the early postoperative period. Neurosurgery 2010;67:1195–204; discussion 1204.

    Article  Google Scholar 

  27. Lindley TE, Dahdaleh NS, Menezes AH, et al. Complications associated with recombinant human bone morphogenetic protein use in pediatric craniocervical arthrodesis. J Neurosurg Pediatr 2011;7:468–74.

    Article  Google Scholar 

  28. Gressot LV, Patel AJ, Hwang SW, et al. Rh-BMP-2 for L5-S1 arthrodesis in long fusions to the pelvis for neuromuscular spinal deformity in the pediatric age group: analysis of 11 patients. Childs Nerv Syst 2013;30:249–55.

    Article  Google Scholar 

  29. Dodwell E, Snyder B, Wright J. Off-label use of bone morphogenetic proteins in pediatric spinal arthrodesis. JAMA 2012;308:1429–32.

    Article  CAS  Google Scholar 

  30. Jain A, Kebaish KM, Sponseller PD. Factors associated with use of bone morphogenetic protein during pediatric spinal fusion surgery: an analysis of 4817 patients. J Bone Joint Surg 2013;95:1265–70.

    Article  Google Scholar 

  31. Haft GF. Is off-label use of BMP in pediatric spine surgery now a standard of care? Commentary on an article by Amit Jain, MD, et al.: “Factors associated with use of bone morphogenetic protein during pediatric spinal fusion surgery: an analysis of 4817 patients.” J Bone Joint Surg 2013;95:e103.1–2.

    Article  Google Scholar 

  32. Carreon LY, Glassman SD, Djurasovic M, et al. RhBMP-2 versus iliac crest bone graft for lumbar spine fusion in patients over 60 years of age: a cost-utility study. Spine 2009;34:238–43.

    Article  Google Scholar 

  33. Kim YJ, Bridwell KH, Lenke LG, et al. Pseudarthrosis in adult spinal deformity following multisegmental instrumentation and arthrodesis. J Bone Joint Surg 2006;88:721–8.

    Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, 301 E 17th Street, New York, NY, 10003, USA

    Justin C. Paul MD, PhD, Shaleen Vira MD, Ian David Kaye MD & Thomas J. Errico MD

  2. Department of Orthopaedic Surgery, Division of Spine Surgery, Mount Sinai Beth Israel, 820 2nd Ave. #7A, New York, NY, 10017, USA

    Baron S. Lonner MD

Authors
  1. Justin C. Paul MD, PhD
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  2. Baron S. Lonner MD
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  3. Shaleen Vira MD
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  4. Ian David Kaye MD
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  5. Thomas J. Errico MD
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Corresponding author

Correspondence to Baron S. Lonner MD.

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Author disclosures

JCP (none), BSL (personal fees from Depuy Synthes, personal fees from K2M, personal fees from Spine Search, personal fees from Paradigm Spine, grants from Setting Scoliosis Straight Foundation, grants from AO Spine, grants from John and Marcella Fox Fund, grants from OREF, outside the submitted work), SV (none), IDK (none), TJE (none).

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the authors do not have any conflicts of interest.

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Paul, J.C., Lonner, B.S., Vira, S. et al. Reoperation Rates After Long Posterior Spinal Fusion: Use of Recombinant Bone Morphogenetic Protein in Idiopathic and Non-idiopathic Scoliosis. Spine Deform 4, 304–309 (2016). https://doi.org/10.1016/j.jspd.2015.12.003

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  • DOI: https://doi.org/10.1016/j.jspd.2015.12.003

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