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BMP
(Bone Graft)
Overview
Background
Description
Alternatives
Overview
So what makes a good bone graft? All bone grafts are judged on three elements:
osteoconductive scaffolding, osteoinductive growth factors, and the ability
to incorporate with osteogenetic progenitor cells found in the human
body. Though the terms may be difficult, the concept is relatively simple.
These elements have been successfully achieved by the use of a particular
graft taken from a patient's own body.
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Background
Currently there is only one bone graft available that has been proven to
meet all three elements. rhBMP2, or INFUSE® Bone Graft not only utilizes
an osteoconductive scaffold, contains an effective level of BMP to be
osteoinductive and initiates the process of bone formation, but also
does not require any second procedures. INFUSE® Bone Graft does not
need autograft or bone marrow aspirate.
The use of rhBMP-2 is still in an experimental stage. Spine surgeons have
recently integrated INFUSE into their surgical repertoire as a surgical treatment
option for patients suffering from degenerative disc disease.
The Spine Institute is currently engaged in the randomized clinical research
study of the spinal implant device which consists of three components: (1)
recombinant human bone morphogenetic protein-2 (rhBMP-2) which is soaked
into (2) compression resistant matrix (CRM) and used with (3) the CD HORIZON® Spinal
System. BMP-2 is a human protein.
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Description
Bone Morphogenetic Protein
- 2, (BMP - 2), is a specific protein that has been clinically
proven to stimulate bone growth. BMP-2 is found in trace amounts
in human bone, but the limited supply of human donor bones precludes
its extraction as an option. To solve this problem of finite supply,
a recombinant version of naturally occurring BMP - 2 is manufactured
using molecular biology techniques. The result is Recombinant Human
Bone Morphogenetic Protein - 2, or rhBMP - 2.
Instead of using bone harvested from other parts of the patient's body to
generate bone growth in the spine, doctors insert rhBMP-2 between two or
more vertebrae. This insertion induces bone growth and causes the vertebrae
to fuse together, re-establishing spinal stability and alleviating pain caused
by pressure on the nerves.
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Alternatives
Autograft
The "gold standard" of all bone grafts, has been a graft surgically removed
from the iliac crest (hip area) of the patient about to have spinal fusion
surgery. This bone graft is called an "autograft." The problem with an autograft,
is the procedure needed to access the bone and remove it, can cause complications
of its own. Studies show an increased operative time, increased patient recovery
time, and chronic pain at the location where the bone graft was taken as
common complications of this procedure. Also, not everyone has bone suitable
for use during surgery. A patient suffering from osteoporosis or who smokes
is typically not a good candidate for autograft fusions. Because of these
problems with autograft many physicians and researchers have tried to find
or manufacture options that hold up to the high standards of autograft, without
the complications.
Bone Marrow Aspirate
The problems and complications that occur when using bone marrow aspirate
are similar to those that occur with autograft taken from the iliac crest.
According to the National Institutes of Health, most patients complain of
pain during this procedure. Besides pain, bleeding is the most common complication,
and bruising at the donor site can also occur. According to the May 2002
supplement of Orthopedics, no human studies have currently been performed
to test the osteoinductive properties of bone marrow aspirate.
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