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  • Bone morphogenetic protein BMP & Allograft or w/o Allograft

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    Old 10-01-2005, 07:18 PM   #1
    notpain
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    Bone morphogenetic protein BMP & Allograft or w/o Allograft

    There are other posts on the board about Bone morphogenetic protein (BMP) and it's use with Allografts but I have a couple of questions for those who may have had this.

    1. Has anyone had a fusion proceedure without anything placed between the discs - just something to stablize the area? I'd imagine if there was no nerve compression this would be possible - I'm alluding to speeding up natural fusion with the use of BMP - might sound far fetched but it might be something being done? I am thinking of having endoscopic proceedures to remove the herniation, but it would be interesting if there were some way to inject this stuff into the area to promote natural fusion which is already taking place, no?

    2. I read that most Allograft material is freeze dried at -70 C within 4 to 8 hours of the donors death and that once freeze dried and vacum sealed it can be stored at room temperature? Seems odd to me, can anyone verify this? Obviously if needed we would all want the freshest material.

    3. I read that there are no blood cells in the freeze dried bone, yet there is a risk of disease transmission. If there are no blood cells and it's freeze dried to -70 C and could still potentially cause disease how would one know the bone is disease free? How do they test it?

    4. In lumbar use I read they use a special cage with the Allograft and the BMP. What about in Cervical Proceedures? Still use a cage?

    Many confusing questions come to mind about BMP use, but it seems from the articles that I have read to draw closer the gap between Autograft and the potential for hip pain, and Allograft's downside.

    Comments?

     
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    Old 10-01-2005, 08:58 PM   #2
    Quietcook
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    Re: Bone morphogenetic protein BMP & Allograft or w/o Allograft

    notpain,

    I've had multiple fusions so will give you a brief fusion history. One prior to BMP, when bone was taken from the hip crest and it took more than a year to heal. The hip was worse than the back as far as the healing and the pain.

    My first 3 level fusion was a couple of days after the FDA approved it's use but as my spine specialist was already on board, he was aware of problems encountered during clinical trials, so took precautions to avoid the problems seen with BMP getting into unwanted areas. It worked beautifully! Later, I was in a MVA and the first fusion broke, so I had the 3rd three level fusion when the first one had to be redone. Then, more levels collapsed so just 9 months ago I had a 10 level fusion from T10 through S3.

    As to having fusion without anything such as the cages being placed between the disc, it isn't something I would even consider. The reasons are that our disc provide spacing between our vertebrae and if these are removed and nothing is put in to space the vertebrae, we loose even more height than we do with the current process of our disc degenerating and with fusion with cage. BTW, with my massive fusions I've lost 3 1/2 to 4 inches in height, and I was short anyway, but I wonder when it becomes so much that the doc can no longer pack the spinal cord into less space! Sure we can buy more clothes to adjust, but I'd like to have been able to keep what little height I had.

    Secondly, because early on there were a number of off-label procedures where cages were not used, and the BMP got into unwanted areas, thereby encasing some nerves and creating worse problems for some patients. The manufacturers and FDA came to terms and now the BMP is packaged so that in order to buy the BMP doctors (at least in the US) have to purchase the cages. Granted that does not force the doctor use the cages, and yes there are still off-label procedures done, but that is something that the patient and doctor must decide whether it is right for their condition and the patient is willing to take the risks, IF those risks are explained to them.

    Not sure what you mean by natural fusion just because the BMP is placed in cages. I can tell you that even with 10 levels being fused,things looked really good at 5 months and at 7 months I had been fused long enough to go back on my arthritis meds.

    All I can tell you about the graft/donor materials is that while BMP fusions are near 100%, those which fail are most often from donor or allograft materials. After all, with that we are introducing yet another foreign material into our bodies. My doc used the ground bone from my laminectomies which spine specialist typically does with a fusion, so no need to take bone from my hip. That's been sufficient bone, and I've not had a failure or rejection yet.

    There are different cages, and again I cannot tell you about the cervical area, but some other members may be able to answer you. I have three different style/types of cages, two different types in the lumbar area as the first one with BMP was done anteriorly,and the cage is way different when placed from the front, than the ones placed from the back.

    Some of your thoughts may be addressed if you go to the clinical trial and FDA web sites and look at some of the reports of what was learned in the more than 5 years of trials. Those are sites I went to, to read information so that I was able to talk with my spine specialist about using this even before FDA approved it in 2002.

    What I can tell you is that BMP made my recoveries MUCH shorter than the first fusion prior to BMP, and that BMP with ground bone is a much stronger fusion than your bone alone, like mine that was broken in the wreck. As my spine specialist compared it to the chipped board that is produced to make the super strong beams used in construction. Those with the superglue type material and chipped wood is then several times stronger than using a piece of solid wood - the same material. The BMP works like the super glue type material in that beam, and it too makes our fusion of bone stronger than the fusion I had which was just bone and bone.

    What I do recommend to many is the web site that Bionic Witch has at the top of the threads - one on new info for lots of you. That web site has great information on ADR's, fusion with BMP as well as the Dynesys flexible fusion system. I also recommend that people use a true spine specialist instead of a general ortho or general neuro surgeons, as fixed fusion is likely all that they will offer. A true spine specialist may provide the ADR or Dynesys flexible fusion as alternatives, but the general orthor or neuro surgeons aren't likely to do so for some years. I had hopes of ADR/fusion combination which is now approved and if not, perhaps the Dynesys system, so as to retain some flexibility. Unfortunately, my spine is a disaster area, but as I have already dealt with being paralyzed once, I am so happy that even though I cannot bend anymore, I am walking and I am an active retiree.

    Best wishes and hope all goes well with whatever route you take.

     
    Old 10-02-2005, 05:54 AM   #3
    flyonthewall
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    Re: Bone morphogenetic protein BMP & Allograft or w/o Allograft

    I had a laminectomy and a posterolateral fusion from L3-S1 with BMP on sponges that were laid on either side of my spine. My OSS did use one PEEK, plastic, spacer and I have two rods and 8 screws, but no cages. It has been 15 months and I've done great. It was off-label but it is being done throughout the spine community.
    fly

     
    Old 10-03-2005, 11:39 AM   #4
    BobiM
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    Re: Bone morphogenetic protein BMP & Allograft or w/o Allograft

    [QUOTE=flyonthewall]I had a laminectomy and a posterolateral fusion from L3-S1 with BMP on sponges that were laid on either side of my spine. My OSS did use one PEEK, plastic, spacer and I have two rods and 8 screws, but no cages. It has been 15 months and I've done great. It was off-label but it is being done throughout the spine community.
    fly[/QUOTE]

    Do you mind saying who did your surgery and where is he located?

     
    Old 10-03-2005, 12:27 PM   #5
    flyonthewall
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    Re: Bone morphogenetic protein BMP & Allograft or w/o Allograft

    He was in Berwick, PA. Where are you located? Check out spine.org to find someone near you who would be able to do the same thing.
    fly

     
    Old 10-03-2005, 02:35 PM   #6
    injured betty
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    Re: Bone morphogenetic protein BMP & Allograft or w/o Allograft

    We did a lot of reseach on the methods of fusion for the neck before getting it done.

    The best method that we came up with was with using the BMP mixed with bone marrow taken from your hip using a needle, not a piece the hip. Then, using cages and screws putting it all back together.

    He just had a co-worker have the same operation, different neuro and she is doing quite well, fusing.

    My husband fused within six months and is now pain free and completely fused. No problems, no pain. He did use a bone growth stimulator for two months. It is an expensive piece of equipment that he laid on for a half an hour each night.

     
    Old 10-04-2005, 02:25 AM   #7
    flyonthewall
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    Re: Bone morphogenetic protein BMP & Allograft or w/o Allograft

    Residue from the laminectomy I had at the same time as the fusion was mixed with the BMP. My hip was never touched.
    fly

     
    Old 10-05-2005, 12:50 PM   #8
    BobiM
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    Re: Bone morphogenetic protein BMP & Allograft or w/o Allograft

    [QUOTE=flyonthewall]He was in Berwick, PA. Where are you located? Check out spine.org to find someone near you who would be able to do the same thing.
    fly[/QUOTE]

    I only live 1 hour or lessfrom Berwick. what is his name?

    Bobi

     
    Old 10-05-2005, 01:02 PM   #9
    flyonthewall
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    Re: Bone morphogenetic protein BMP & Allograft or w/o Allograft

    Dr Foti. Hes only three years off a spine fellowship.

     
    Old 10-05-2005, 01:06 PM   #10
    BobiM
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    Re: Bone morphogenetic protein BMP & Allograft or w/o Allograft

    [QUOTE=flyonthewall]Dr Foti. Hes only three years off a spine fellowship.[/QUOTE]


    Thank you. Was this your first spinal surgery?

     
    Old 10-05-2005, 01:23 PM   #11
    flyonthewall
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    Re: Bone morphogenetic protein BMP & Allograft or w/o Allograft

    Yes, it was my first. I was 63 and I could hardly walk because of spinal stenosis. He did a laminectomy AND a cutting-edge 3-level fusion. I've done great! I was allowed to drive at six weeks and I drove 130 miles at 4 months. I haven't been on any pain meds since I've been home.

     
    Old 10-06-2005, 03:43 AM   #12
    flyonthewall
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    Re: Bone morphogenetic protein BMP & Allograft or w/o Allograft

    Bobi,
    I've heard that Dr Foti is one of the few surgeons around who are willing to go in behind someone else. He has no problem with revisions. He has a revision scheduled this month for someone else on this board.
    fly

     
    Old 10-06-2005, 05:36 AM   #13
    BobiM
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    Re: Bone morphogenetic protein BMP & Allograft or w/o Allograft

    [QUOTE=flyonthewall]Bobi,
    I've heard that Dr Foti is one of the few surgeons around who are willing to go in behind someone else. He has no problem with revisions. He has a revision scheduled this month for someone else on this board.
    fly[/QUOTE]

     
    Old 10-06-2005, 05:39 AM   #14
    BobiM
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    Re: Bone morphogenetic protein BMP & Allograft or w/o Allograft

    [QUOTE=flyonthewall]Bobi,
    I've heard that Dr Foti is one of the few surgeons around who are willing to go in behind someone else. He has no problem with revisions. He has a revision scheduled this month for someone else on this board.
    fly[/QUOTE]


    Thank you for telling me that. I looked him up and noticed that he also has an office in Kingston PA. That is about 20 minutes from me. I'll see what happens with my son's fusion. I'm just keeping him in the back of my mind just in case there are problems with him fusing.

    I'm thrilled with things working out so well with you.

    Bobi

     
    Old 10-06-2005, 08:39 AM   #15
    flyonthewall
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    Re: Bone morphogenetic protein BMP & Allograft or w/o Allograft

    He's only in Kingston a couple of times a month. I hope your son doesn't need him. But he is good.
    fly

     
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