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Old 03-20-2006, 11:13 AM   #1
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Bone Morphogenic Proteins

Has anyone else had BMP (bone morphogenic proteins) used in your surgery?

"Studies have proven that BMP not only successfully creates fusion, but it seems to do so more quickly and reliably than autograft." Spine Universe

I haven't seen much discussion of BMPs on the board.

Any opinions?

P-

Last edited by funny4mony; 03-20-2006 at 11:21 AM.

 
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Old 03-20-2006, 02:52 PM   #2
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Re: Bone Morphogenic Proteins

I had BMP applied to my fusion sites on ACDF C5-6 and C6-7. At the time June 2004 my surgeon was doing a study on BMP and I was included.

The only problem I had was increased swelling, which brought me back to the hospital the night of my release. I could breathe okay, but could not take my meds orally. Initially I was able to do that, so they released me. They got that under control, and my recovery was normal after that one problem.

Found out later that additional swelling is a side effect of BMP.

I have had a full recovery, with full fusion. No problems, no pain.

Dennis

 
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Old 03-20-2006, 05:07 PM   #3
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Re: Bone Morphogenic Proteins

wow, looks really interesting. wish i could get in on a bmp-2 study!

i was interested in the artificial discs, too, but was told they weren't appropriate for me because of curvature issues.

i read exhaustively about autograft vs. allograft and was ready to let them cut my hip open, but this surgeon is adamantly against it, claims the additional surgery, post-op pain and risk of complications aren't worth the "negligible" (his words, not mine) percentage increase of a successful fusion.

but the few articles i skimmed about bmp, supposedly in particular bmp-2 and bmp-7 (?), make it sound really promising. i guess, though, (*sigh*) that there will always be something new on the horizon.

dennis, do you know why swelling is a side effect? just the body's reaction to an artificial substance?

 
Old 03-20-2006, 06:29 PM   #4
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Re: Bone Morphogenic Proteins

BTW, BMP is FDA approved and was also approved by my insurance.

I know that BMP was used in BackintheSaddle's surgery as well. She reported a very, very sore throat post op, which may have to do with the specific issue of BMP/swelling.

I was placed on a short steroid regimen post op (not exactly sure why). My NS advised that I would likely experience pain and/or swelling in my throat as the anti-inflammatory properties of the steroids waned in the week after surgery, because the proteins (BMP) would begin "going to work." Of course, that's the watered down translation of a layman.

I wasn't able to find any side effects listed in the clinical trials, though.

I read an article, indicating BMP-2 is simply a synthetic replication of a protein found in the human body that is a key protein for bone formation and healing. The BMP itself is generally gone within 2 weeks of surgery.

My ACDF - two level - utilized allograft, which was filled with BMP "sponges."

Last edited by funny4mony; 03-20-2006 at 06:46 PM.

 
Old 03-20-2006, 08:04 PM   #5
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Re: Bone Morphogenic Proteins

that is just so fascinating to me! i believe i read that the synthetic bmp contains some natural proteins extracted from donor marrow? and that, as you said, it's found naturally in the body, but is destroyed/removed (?) during the freeze process used for donor disc material.

as for the throat swelling (which sounds awful - i'd probably be in a panic), i take it this is supposedly beyond the 'normal' esophogeal problems that seem to be so typically reported?

i did see that it had been fda approved and i'll definitely have to look for more information. the few studies/articles i went through said it showed better fusion rates that even autograft material.

i will check out backinthesaddle's posts, too.

thanks.

 
Old 03-20-2006, 10:21 PM   #6
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Re: Bone Morphogenic Proteins

Quote:
i believe i read that the synthetic bmp contains some natural proteins extracted from donor marrow? and that, as you said, it's found naturally in the body, but is destroyed/removed (?) during the freeze process used for donor disc material.
I think you're referring to how the protein might exist in donor bone prior to its commercial preparation.

"Allograft" (donor bone) actually refers to a number of commercially available donor bone products. The freeze-drying kills any bad stuff (at least 1,499,999 of 1,500,00), essentially eliminating the risk of any donor disease transfer. Various companies precision machine the bone, and it's available in myriad sizes and contortions, such as hollow with holes to hold BMP sponges.

This is a quote from UCLA, where a researcher originally isolated the protein:

"BMP is a protein that is present in the body naturally in very small amounts. The genetically produced version of the protein-recombinant human bone morphogenetic protein-2, or rhBMP-2-has the ability to stimulate the patient's own cells to make more bone," explains Jeffrey Wang, M.D., co-director of the UCLA Spine Center.

"Spinal fusion surgery using rhBMP-2 avoids the need for bone grafts, thereby making the surgery less invasive. Studies also show that BMP forms fusions just as well as the patientsB'own bone can and with a higher overall success rate," notes Nick Shamie, M.D., orthopaedic surgeon at the UCLA Spine Center. "The protein is implanted onto the spine on a sponge contained in a special carrier. The rhBMP-2 directs nearby stem cells to lay down bone and fuses the spine together. The sponge degrades over time. Since patients do not require bone grafting from their pelvises, their hospital stays are shorter and their post-surgical pain is less."

I'll address the other issue in a separate post to keep this search friendly...

 
Old 03-20-2006, 11:05 PM   #7
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Re: Bone Morphogenic Proteins

Quote:
as for the throat swelling (which sounds awful - i'd probably be in a panic), i take it this is supposedly beyond the 'normal' esophogeal problems that seem to be so typically reported?
I'm not sure. The throat pain/swelling is common, regardless, I think.

I viewed an old University of Washington video (2003) and, at the time, the issue cited with growth factors such as BMP was the inflammatory/auto-immune response. Maybe that can mean throat swelling. But it was old, too.

As I wrote, I was put on IV steroids in post op, which reduce swelling & inflammation, so I'm probably not a good example. I'm not sure if I was given steroids to reduce swelling in my throat/airway because of breathing difficulties or if it was just a standard procedure.

I was repeatedly warned about the sore throat but didn't find it that uncomfortable in my case, although I definitely felt my throat narrow.

 
Old 03-21-2006, 08:25 AM   #8
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Re: Bone Morphogenic Proteins

In my case, the BMP was used with donor bone, as my docs recommended against two grafts from my own body.

The swelling problems I had were worse than the ones normally experienced. My throat was constricted and I could not swallow at all. I was still able to breathe, but this was restricted. The hospital gave me steriods to reduce the swelling and then sent me home after about 8 hours. I was fine after that.

When I was interviewed for the study, I was asked if there was more swelling and told my story. The docs said that they had just determined that this was a side effect of the BMP. They said that the swelling I experienced was more than would be experienced in a normal ACDF surgery, because I asked them.

Having not experienced "normal" ACDF I can't tell you the difference, but I was told that the BMP causes more swelling, and my experience validates this.

It was a little scary at the time, but was brought under control very quickly. I would assume that today they would keep you in the hospital a little longer to monitor this.

The major benefit is full fusion with donor bone. The long term goal I was told was to improve fusion and get away from using your own bone, because this can cause other complications.

I just had a scan done of my neck, and the fusion sites look good. I have been living a normal life since my surgery, with no pain, and able to do a lot of things I couldn't before surgery. My quality of life has improved by about 75%, and frankly, I feel about 20 years younger...for the most part.

I would do it again, given the pain that I was in, and the result.

Dennis

 
Old 03-29-2006, 08:06 PM   #9
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Re: Bone Morphogenic Proteins

i did find a surgeon in my area who had used bmp, but even with help from my doc's office, couldn't get in to see the guy for weeks. and i didn't want to start all over and go through the waiting again when i'm so close now. so i'll stick with who and what i've got now and keep hoping for the best outcome possible!

ok, more curiousity. funny4mony - you said "sponges". were they the bovine sponges? does anyone know if that's what's typically used and if it's what causes the swelling, which, i assume is some sort of an (for lack of a better term) allergic response?

 
Old 03-29-2006, 09:28 PM   #10
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Re: Bone Morphogenic Proteins

In my case, the sponges are what held the proteins (BMP or other genetically engineered bone growth factor). The sponges themselves bio-degrade and eventually disappear.

The first use of BMP in spinal fusions included a "cage," which served as the scaffolding (machined allograft served as my scaffolding) for the proteins.

At least in one case, the growth factor is genetically engineered from bovine tissue. I don't know what may be responsible for any increased inflammation in the use of current bone growth factors.

 
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