(2007) Arthrodesis using BMP-2 in adult scoliosis: Clinical and radiographic results

2007

INTRODUCTION

The use of rhBMP-2 in adult scoliosis patients is expected to decrease pseudarthrosis and improve clinical outcomes.

METHODS

Sixty-eight consecutive patients were surgically corrected by a single surgeon with posterior instrumented fusion. All had interbody fusion (58 ALIF, 10 TLIF). rhBMP-2 (dose 4-12 mg/disc) on collagen sponges were used with structural support (cage or allograft) in interbody spaces in 53 patients (avg 3 levels/pt, 172 levels) and structural allograft alone in 15 patients (avg 6 levels/pt, 90 levels). Fusion was assessed by CT or flex-ext radiographs with >3° motion or screw halos defining nonunion.

RESULTS

No BMP related complications occurred. Follow-up avg >4 years (24-154 months). 5/15 allograft patients had nonunions (33%). 3/53 BMP patients (6%) had nonunions and 2 delayed unions which fused by 1 year. Dose of BMP (4 vs. 12 mg) was unrelated to nonunion occurrence. Oswestry and VAS pain scores were better in the patients that fused.

CONCLUSION

rhBMP-2 significantly improves the fusion rate and clinical outcomes in patients surgically treated for adult scoliosis.

SUMMARY

This single surgeon consecutive series assesses the clinical and radiologic outcomes of 68 adult scoliosis patients treated with posterior fusion and anterior column support, fused with either BMP-2 or structural allograft alone. At 4 years follow-up, the rhBMP-2 group (53 patients) had 6% nonunions and allograft group (15 patients) produced 33% nonunions. Oswestry and VAS scores favored patients with solid fusions.