[Johnhugo]

#27228

Hi Dr C,

I have read through the Forum topics re BMP-2 irritation and would like to know how one would determine if BMP-2 migration is the cause of ongoing pain in the pelvic area muscles/ligaments? I had an L4-S1 alif/plf, 360° fusion 2.5 years ago with bmp, Formagraft, autograft, acs ,used in Nuvasive Brigade peek cages, both inside the cages and packed around the outside of the cages. I had several seromas drained after the second day laminectomies/ w rods and screws, and significant leg swelling for 1-2 months thereafter. You mentioned in several answers that the BMP must be sequestered, and if it was packed around the outside of the cages and was infiltrated by serous fluid, could it have migrated and caused nerve damage?

I have adjacent level disease at L3 (stenosis) and bilateral SI pain (arthritis?). I am very stiff and my pain is upon walking and standing for more than 15-20 mins and chronic; I have to sit or lie down to get relief, which comes quickly when off my feet.

I can ride a bicycle for 5+ miles with no pain and suspect that my nerves become inflamed, irritated, or deprived of blood upon loading of my spine. It feels like a pelvic “girdle” of pain that affects the TF, glutes,psoas, iliacus, multifidis, rectus abdominis, erector spinae,and anterior thigh muscles. It seems like a muscle “syndrome” of no name that i can find. I have had all the typical post op pain treatments, including a scs Nevro hf10 senza, but have not gotten sufficient relief. I am relegated to inactivity, other than bike riding.

I am most suspicious of L3 stenosis and SI dysfunction, but would like to know if the off-label BMP-2 use (double-dose) could also be a factor, if it migrated where it should not have?

I don’t want another laminectomy or fusion, or SI fusion, if my problem is myelopathy. My mri and ct films show mild to moderate facet arthrosis/stenosis and bilateral vacuum phenomena in the SIJs. The scs gave some relief but break-through pain came back with extensive walking and it did not seem like a permanent fix, in light of the possibility of mechanical pain causation. So, that leaves me thinking of BMP and permanent nerve damage as a possibility.

An EMG was fine, no pathology noted, although I have classic neurogenic claudication symptoms, plus pretty severe buttocks pain, that may be related to the SIJs?

I am loath to have more surgery of any type, without an accurate differential diagnosis, having done that once already and resulting in fbss. I know that the lumbar and sacral plexi are complicated systems, but it would seem that accurate identification of the muscles that hurt so much would possibly lead to common nerve culprits and identification of possible impingement? Mysterious.

I take Vicodin for pain as needed, 2-4 per day, but need to get off them, if possible. I had a total L hip replacement one year after the back surgery that has worked out very well and R hip is fine, neither contributing to my pain. Not sure what else to look at, and would like some advice as to a plan to try to diagnose and identify potential solutions. Thanks!

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