Does anyone know how long it takes BMP to finish working in a c1 c2 fusion? Does it take a year or a few months or longer to penetrate and finish growing the fused bone? It's not a cage he's using it's a thin sponge.
BMP is what motivates your own bone cells to grow. It just works at the very beginning, to kind of jump-start your own cells. I think it primarily works within the first two weeks.
The initial issues with off-label use of BMP in the cervical spine were problems with inflammation -- so much so quickly that it tended to choke the patient by closing off the airways. In the lumbar spine, the main problem is with it growing too much and encasing the surrounding nerves in what turns out to be hard bone.
[QUOTE=teteri66;5071119]BMP is what motivates your own bone cells to grow. It just works at the very beginning, to kind of jump-start your own cells. I think it primarily works within the first two weeks.
The initial issues with off-label use of BMP in the cervical spine were problems with inflammation -- so much so quickly that it tended to choke the patient by closing off the airways. In the lumbar spine, the main problem is with it growing too much and encasing the surrounding nerves in what turns out to be hard bone.[/QUOTE]
I asked him about the choking and the airway being blocked because of swelling, but he said it's when they were using it in the front not the back.
[QUOTE=teteri66;5071185]Did you see the article I sent you?[/QUOTE]
Yes I read it...but that was from a year ago...so maybe they feel more comfortable using it. I don't know why Bae didn't even mention the BMP...he just said a little protein to help fuse it. Nothing else. I wonder if I was going to be his experiment so that's why he wasn't telling too much about it. I didn't even ask about the protein...I thought it was going to be a sort of vitamin!
BMP is not to be used in the cervical spine. EVER. It can cause a serious overgrowth of bone , interfere with breathing and swallowing, and cause permanent damage.
It is also never supposed to be used in just the sponge. It is supposed to be used with the sponge material placed in a cage, then inserted into the area of the lumbar spine..
It's action is limited to the first few weeks, then it is supposed to stop working.
I would be very seriously investigating why it was used in the cervical area in your situation and making sure that there are not overgrowth abnormalities. I didn't find out about how badly bmp use damaged my lumbar canal- until last year. Some 5 years after it was used, and it has now narrowed my lumbar canal from 14 mm, to 3.23 mm- and it also caused the dura to adhere to the back of the vertebra at three levels. I need another surgery- my third, but can not have it until I am paralyzed, due the extent of the dural tear that I will wind up with......
Make sure that you follow up with another surgeon to find out if you are going to have any concerns after having this stuff used on you.
If I were you, I think that I would postpone surgery and consult with at least two more doctors. This current surgeon of yours wants to use bmp off label, and of course, you will be asked to sign a consent which basically would eliminate your rights to sue if you sign it and something bad happens. Talk to other surgeons and get their opinions. They can use bone cement if needed to make sure that bone heals, a bone growth stimulator is another option. I would opt for cadaver bone, since I think that I recall reading that your bone density scans showed osteopenia? Or try one of the drugs out there for increasing bone density and then have the surgery once the osteopenia numbers have improved.
It is a risk to use bmp that you might seriously want to not take on...back surgery is difficult enough without adding further risk to the outcome. You want success, not to cause further problems for yourself down the road.
Actually I went to about 4 spine surgeons who all said they use the off label BMP. Most are from Cedar Siani in Los Angeles and the other from UCLA. These are all top spine surgeons in the nation. They all said it's safe to use and they didn't have serious problems with it. I asked the surgeon who is doing my surgery about cancer, but he doesn't think there is a link. I don't know what to do. Maybe I should consider other things, he said I can but he said it's not as good as BMP and he doesn't want my fusion to fail. So it looks like all the top hospitals are using BMP without worry. I read somewhere that the reasons the problems came us is because the surgeons were using too much of it.
Last edited by Jazzmine1212; 10-13-2012 at 06:24 PM.
I'm not really disputing your conclusions, but keep in mind that going to several surgeons who practice at the same hospital is pretty much like getting an opinion from one surgeon. Surgeons from one program tend to follow the same procedures, particularly in an academic department.
BMP lawsuits are still on-going. Some have been settled, but new ones are commencing...so you have a tough decision to make. Your fusion is going to be so high up. I wonder if that makes any difference?
[QUOTE=teteri66;5071876]I'm not really disputing your conclusions, but keep in mind that going to several surgeons who practice at the same hospital is pretty much like getting an opinion from one surgeon. Surgeons from one program tend to follow the same procedures, particularly in an academic department.
BMP lawsuits are still on-going. Some have been settled, but new ones are commencing...so you have a tough decision to make. Your fusion is going to be so high up. I wonder if that makes any difference?[/QUOTE]
The last surgeon said he can use other things as well if I don't want BMP. He said there are artificial bones and cadaver bones. I think he said he would use both...he said he needs a lot of material to fill the area. I just hope I fuse. I wonder what determines if a person fuses or not.
I assume you don't smoke. That is probably the #1 thing that keeps people from fusing. Then some people just grow new bone cells better than others. If the doctor suspects there may be issues, some order the use of bone growth stimulator. I never had one, so can't comment....
Did you say they are fusing C1-C2? I have lumbar issues so a not as knowledgeable about the cervical issues...but I honestly didn't know they could fuse that high up into the skull. Do you know if this is a rather rare surgery?
Yes it is a rare surgery. No I don't smoke. I think the surgeon worked for Medtronic...I don't know if he still is. I just found that out by researching him online. He did say he will respect my wishes and not use BMP if I choose not to. He just better not sneak it in! I guess the other two things are cadaver mixed with my own bone and synthetic mixed with my own bone. I don't think there are any other choices left for fusions. I didn't want to take bone from my hip, but it seems like there really isn't any other choice that will help the fusion. I wish BMP didn't have a cancer risk. I was reading the link and it was pretty significant (number of ppl that got cancer). On the other hand I also don't want a failed fusion because I could end up in so much more pain and with problems later because it's so high up. I wish they knew more about BMP. That Yale study was flawed because of the bias with the study that was done prior to Yale stepping in. So they didn't have the correct data. I've heard they use this stuff in dental implants too. So do those people have the same risk for cancer? I live in Los Angeles and beleive it or not there really aren't too many other surgeons that do this other than the large hospitals. This surgeon was telling me the BMP off lable use is like 85% or something like that in all spine fusions. I think if more people were aware of the risks it would be much lower. The fact that they don't even talk about it and just say it's a protein makes people think it's nothing serious. I guess they're just hoping most people don't ask about it so they can use it for their own studies.
Last edited by Jazzmine1212; 10-14-2012 at 12:19 AM.
A huge number of surgeons are or were on the payroll at Medtronic, so it is hard to figure out whether that has any influence on your surgeon or not.
When I had my first fusion in 2008 I was new to all this and I just trusted my surgeon. I had consulted with 8 different surgeons over a two year period before I finally decided to have the surgery, and had decided on the one that worked best for me...so when he told me what he'd do (in about 20 words, as I recall) BMP was not mentioned and I'd never heard of it at that point anyway, so it wouldn't have made any difference. I wasn't keen on the idea of having bone harvested from my iliac crest as I'd heard in many cases that surgical site remained more painful post surgery than the actual spine surgery.
I often wonder if some of the people who end up with "failed back surgery syndrome" after fusion are having issues due to BMP used in their surgeries. I think it is probably still too early to know the full impact of BMP, especially in long-range issues like the development of cancer, etc.
Frankly it seems to me that, at least in my experience, surgeons seem to shrug off our concerns a bit too easily. BMP makes their job easier...and, after all, it isn't going into their bodies....
You have a big decision to make. I do not envy you.