Quietcook, I've heard you refer to it a bunch and I've done a search but don't have a clear understanding of it. Can anyone give me the basics of what BMP is?
Dh's neuro says he'll replace the disks at 3 levels during his PLIF at L4/5, L5/S1, and is considering L3/4 but doesn't like doing a three level interbody fusion. His report is a bit different from what was said in the appt. We heard 3 levels fused with disc replacement (not ADR, but what?), using bone from dh's vertebrae at those levels and the next two levels will have screws. Are the levels that are 'screwed' still considered a type of fusion? He mentioned using cages at the lower levels. Oh, and what does interbody mean? I understand the posterior part...
Of course all these questions come AFTER the appt. Searching the web is confusing cause everyone uses different vocabulary for the same issue. HELP!
Quietcook, I've heard you refer to it a bunch and I've done a search but don't have a clear understanding of it. Can anyone give me the basics of what BMP is?
Dh's neuro says he'll replace the disks at 3 levels during his PLIF at L4/5, L5/S1, and is considering L3/4 but doesn't like doing a three level interbody fusion. His report is a bit different from what was said in the appt. We heard 3 levels fused with disc replacement (not ADR, but what?), using bone from dh's vertebrae at those levels and the next two levels will have screws. Are the levels that are 'screwed' still considered a type of fusion? He mentioned using cages at the lower levels. Oh, and what does interbody mean? I understand the posterior part...
Of course all these questions come AFTER the appt. Searching the web is confusing cause everyone uses different vocabulary for the same issue. HELP!
BMP is Bone Morphogenic Protein, and the newest is called BMP2. The simple version as my doc explains it is that it is like using the best super glue and mixing it with ground/crushed bone (he prefers from your own body and so do I). The BMP mix is much stronger than just your bone, especially if you have osteoporsis. Think of it like you have seen in home construction. The strongest beams that they use when building a big room, or maybe a carport are really long ones, but they are not a solid big plank. They are something like wood bits set in a sealant which makes it about 12 times stronger than a single plank of the same thickness. You will need to do your search using the full words with either a period or plus sign separating the words.
Now, as for the bone. My first fusion without BMP, they took bone from the hip paddle and it hurts worse than the back for several weeks. Luckily my doc had warned me and said I would really hate him the first couple of weeks. Thank goodness, with the BMP there is no need to do that if doing a laminectomy within the whole procedure. That is usually enough for the process, as a type of sponge is soaked in the mix and carefully placed with cages. That has been refined a lot too, as early on, BMP seeped out and caused problems when it got on nerves and the like. For that reason, my first BMP fusion, they went in anterior removing my intestines and doing the cages to the front of the spine so that if any seepage took place, it would be out into the body cavity where it was far less likely to cause problems. Now with further refinement, they use tubes or scopes in order to place the sponges and can do posteriorly without disturbing the intestines. However, I will have to say that my recovery on the anterior surgery was a lot easier than posterior, but I did worry that the handling of intestines they might get twisted or have a tear. Nothing happened and all was fine.
During all these when facing this last surgery in Dec, I was waiting for the testing to be completed using ADR with fusions, because until then they would not do ADR on anyone who had prior fusions. Finally they were doing it but I still didn't qualify even though my doc was doing the ADR. Don't recall from all my research whether there was a limit to the levels fused in order to have ADR. Still, I think it is wonderful if a person can have the ADR versus a 10 level fusion like I have. Not complaining, but it would be nice to be more flexible.
Now, there were no screws and rods to remove when I had the BMP fusions for three levels. There are different types of cages they use, and that might play a part in that as well as a doctor's own preference in how they do the surgery. But, with this big fusion, yes I have two rods, 18 screws and about 14 cages I could count when I saw the xray. Sounds and looks scary, but I am walking, I am going to keep doing and I have control of my lower organs and that is a blessing.
Sure hope this helps you and hubby understand a little more, and don't hesitate to ask any question. Someone here is bound to have some experience in most any area.
I had an off-label posterior fusion from L3-S1 with BMP. It's a substance that is already in the body but there isn't enough of it so they use a synthetic. My OSS mixed the scrapings from a laminectomy with BMP on sponges that were laid on either side of my spine. I also have 2 rods and 8 screws. I'm at 9 months and doing great.
fly
Last edited by flyonthewall; 03-24-2005 at 06:25 AM.
Just a quick observation. You wrote that the dr said he would do a posterior only? It is my understanding that when there is more than 1 level involved the successs rates are dramatically higher when the fusion is done 360'.
Basically when you start screwing the spine together in that many places it is much stronger to have it done from both sides.
I would ask the dr why he does not do the 360' for so many levels
Yes, I've read that posterior approach does not remove as much of the disc space and thereby the placement of the cage doesn't cover as much area. However, if the surgeon is well trained and is a spine specialist who is doing the posterior approach, they will be able to achieve success. I too have read that anterior approach or what is called the 360 approach had a slightly higher success rate early on, as the cages were larger and therefore the cages and the BMP covered a larger area. Certainly the cages used in my anterior approach are much different from the posterior cages, but the surgeon will take all precautions, use different type cages based on the positions needed to cover, etc.
I personally healed easier than with previous spine surgeries with the anterior approach when I had BMP the first time after it was approved. The reason my surgeon did the anterior approach was in the years of testing, the BMP had caused additional problems when surgeons got it into areas it wasn't needed, or when some seeped out of cages, thereby causing fusion on or around nerves and additional damage. He chose to go anterior to avoid any problems, but he did not need to go posteriorly for the three level. Then by the time I had the next fusion they had developed the tubes used for placing the BMP so as to protect areas they didn't want the BMP in, so again I had posterior approach. For the biggie fusion in December, again posterior approach, but then the fused areas had to be reworked. That's normal when you have isthmic spondylolisthesis, although an anterior approach is used more often. The way I was opened up from upper shoulders all the way down, all was peeled back so a 360 was achieved with the single huge incision. Gosh, if I had to be approached from both front and back I would not recovery - too many other medical problems. With all the new advancements though, I most assuredly cannot complain with the way I've healed these past four months.
As far as screws on the additional levels, I would say that is considered fused, especially if the hardware is to remain in. My hardware did come out after 17 months as when you are fusing 3 levels and you become physically active, the hardware eventually becomes a problem as your mucles rub over the screw heads. My doc said his patients with 3 levels fused usually began wanting the hardware out at about 1 year. Not sure I understand why screw additional two levels unless the surgeon means the one above and one below the fused areas. Then I see the screws as just stablalizers until teh fusion is completed.
Forgot when DH's surgery is planned. Do you have a date yet? Know he is anxious for relief.
Re: Bmp? 
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