Abstract
Bone morphogenetic proteins (BMPs) are an integral part of new bone formation and are capable of inducing the entire bone formation cascade [1, 2]. It is this unique property that allows these proteins, when they are combined with a suitable carrier, to be used as a bone graft replacement. The new bone formation occurs in four distinct phases: recruitment and proliferation, differentiation, calcification, and maturation [3]. During the recruitment and proliferation phase, undifferentiated mesenchymal cells are attracted to the site by chemotaxis. These stem cells divide and increase in number. During the differentiation phase, the mesenchymal stem cells are transformed into osteoblasts. During the calcification phase, the osteoblasts produce matrix, generate callous and form new bone. During the maturation phase, the newly formed bone remodels into trabecular bone and increases in vascularity.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Urist MR (1965) Bone formation by autoinduction. Science 150: 893–899
Wozney JM (2002) Overview of bone morphogenetic proteins. Spine 27(16 Suppl 1): S2–8
Boden SD (2002) Overview of the biology of lumbar spine fusion and principles for selecting a bone graft substitute. Spine 27(Suppl 1): S26–31
Vaccaro AR, Chiba K, Heller JG, Patel TC, Thalgott JS, Truumees E, Fischgrund JS, Craig MR, Berta SC, Wang JC, North American Spine Society for Contemporary Concepts in Spine Care (2002) Bone grafting alternatives in spinal surgery. Spine J 2: 206–215
Cheng H, Jiang W, Phillips FM, Haydon RC, Peng Y, Zhou L, Luu HH, An N, Breyer B, Vanichakarn P et al (2003) Osteogenic activity of the fourteen types of human bone morphogenetic proteins (BMPs). J Bone Joint Surg Am 85: 1544–1552
Boden SD, Schimandle JH, Hutton WC (1995) The 1995 Volvo award in basic sciences. The use of an osteoconductive growth factor for lumbar spinal fusion. Part II: Study of dose, carrier, and species. Spine 20: 2633–2644
McKay B, Sandhu HS (2002) Use of recombinant human bone morphogenetic protein-2 in spinal fusion applications. Spine 27(16 Suppl 1): S66–S85
Sandhu HS, Kanim LE, Kabo JM, Toth JM, Zeegen EN, Liu D, Delamarter RB, Dawson EG (1996) Effective doses of recombinant human bone morphogenetic protein-2 in experimental spinal fusion. Spine 21: 2115–2122
Winn SR, Uludag H, Hollinger JO (1999) Carrier systems for bone morphogenetic proteins. Clin Orthop 46: 193–202
Sandhu HS, Toth JM, Diwan AD, Seim HB, Kanim LE, Kabo JM, Turner AS (2002) Histologic evaluation of the efficacy of rhBMP-2 compared with autograft bone in sheep spinal anterior interbody fusion. Spine 27: 567–575
Schimandle JH, Boden SD, Hutton WC (1995) Experimental spine fusion with recombinant human bone morphogenetic protein-2. Spine 20: 1326–1337
Baskin DS, Ryan P, Sonntag V, Westmark R, Widmayer MA (2003) A prospective, randomized, controlled cervical fusion study using recombinant human bone morphogenetic protein-2 with the CORNERSTONE-SR Allograft Ring and the ATLANTIS anterior cervical plate. Spine 28: 1219–1224
Boden SD, Kang J, Sandhu H, Heller JG (2002) 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 27: 2662–2673
Boden SD, Zdeblick TA, Sandhu HS, Heim SE (2000) The use of rhBMP-2 in interbody fusion cages. Spine 25: 376–381
Burkus JK, Gornet MF, Dickman C, Zdeblick TA (2002) Anterior lumbar interbody fusion using rhBMP-2 with tapered interbody cages. J Spinal Disord Tech 15: 337–349
Burkus JK, Transfeldt EE, Kitchel SH, Watkins RG, Balderston RA (2002) Clinical and radiographic outcomes of anterior lumbar interbody fusion using recombinant human bone morphogenetic protein-2. Spine 27: 2396–2408
Burkus JK, Heim SE, Gornet MF, Zdeblick TA (2003) 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 16: 113–122
Burkus JK, Gornet MF, Schuler TC (1999) An analysis of clinical trials using rhBMP-2 as a bone graft replacement in stand-alone lumbar interbody fusions. Orthopedics 22: 669–671
Burkus JK, Sandhu HS, Gornet MF, Longley MC (2005) Use of rhBMP-2 in combination with structural cortical allografts: Clinical and radiographic outcomes in anterior lumbar spinal surgery J Bone Joint Surg Am 87: 1205–1212
Dimar JR, Glassman SD, Burkus JK, Carreon LY (2006) 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 31: 2534–2539
Kleeman TJ, Ahn UM, Talbot-Kleeman A (2001) Laparoscopic anterior lumbar interbody fusion with rhBMP-2. A prospective study of clinical and radiographic outcomes. Spine 26: 2751–2756
Burkus JK (2003) Stand-alone anterior lumbar interbody fusion constructs: Effect of interbody design, bone graft and bone morphogenetic protein on clinical and radiographic outcomes. In: K Lewandrowski, MJ Yaszemski, AA White, DJ Trantolo, DL Wise (eds): Advances in spinal fusion: Clinical applications of basic science, molecular biology, biomechanics, and engineering. Marcel Dekker, New York, 69–84
Akamaru T, Suh D, Boden S, Kim HS, Minamide A, Louis-Ugbo J (2003) Simple carrier matrix modifications can enhance delivery of recombinant human bone morphogenetic protein-2 for posterolateral spine fusion. Spine 28: 429–434
Martin GJ Jr, Boden SD, Titus L, Scarborough NL (1999) New formulations of demineralized bone matrix as a more effective graft alternative in experimental posterolateral lumbar spine arthrodesis. Spine 24: 637–645
Singh K, Smucker JD, Boden SD (2006) Use of recombinant human bone morphogenetic protein-2 as an adjunct in posterolateral lumbar spine fusion. A prospective CT-scan analysis at one and two years. J Spinal Disord Tech 19: 416–423
Burkus JK (2004) Bone morphogenetic proteins in anterior lumbar interbody fusion: Old techniques — New technologies. J Neurosurg (Spine 1) 3: 254–260
Burkus JK, Sandhu HS, Gornet MF (2006) Influence of rhBMP-2 on the healing patterns associated with allograft interbody constructs in comparison with autograft. Spine 31: 775–781
Barnes B, Boden SB, Louis-Ugbo J, Tomak PR, Park J, Park M, Minamide A (2005) Lower dose of rhBMP-2 achieves spine fusion when combined with an osteoconductive bulking agent in non-human primates. Spine 30: 1127–1133
Glassman SD, Carreon LY, Djurasovic M, Campbell MJ, Puno RM, Johnson JR, Dimar JR (2007) Posterolateral lumbar spine fusion with INFUSE bone graft. Spine J 7: 44–49
Epstein NE (2006) A preliminary study of the efficacy of beta tricalcium phosphate as a bone expander for instrumented posterolateral lumbar fusions. J Spinal Disord Tech 19: 424–429
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2008 Birkhäuser Verlag Basel/Switzerland
About this chapter
Cite this chapter
Kenneth Burkus, J. (2008). Clinical outcomes using rhBMP-2 in spinal fusion applications. In: Vukicevic, S., Sampath, K.T. (eds) Bone Morphogenetic Proteins: From Local to Systemic Therapeutics. Progress in Inflammation Research. Birkhäuser Basel. https://doi.org/10.1007/978-3-7643-8552-1_5
Download citation
DOI: https://doi.org/10.1007/978-3-7643-8552-1_5
Publisher Name: Birkhäuser Basel
Print ISBN: 978-3-7643-8551-4
Online ISBN: 978-3-7643-8552-1
eBook Packages: MedicineMedicine (R0)