[biofreeze]

#22523

Just came across this on the internet….can you please elaborate ?

NERVE ROOT INJURIES DUE TO BONE
MORPHOGENETIC PROTEIN IN LUMBAR
FUSIONS
Several studies now document that the application
of recombinant human BMP‑2 (rhBMP‑2) in lumbar
fusion procedures can produce neural injury not only
documented clinically, but also histopathologically.[3,9,21]
Dmitriev et al., in their 2011 article, demonstrated the
significant negative impact of applying rhBMP‑2 near
neural structures.[9] In another study, Corenman et al.
retrospectively evaluated the results of TLIF performed
with BMP-2 for patients with discogenic pain syndromes;
11 (30.6%) patients exhibited unexplained postoperative
radiculitis, whereas 4 needed additional surgery
[Table 2].[3] In the review article by Tannoury and An in
2014, they noted that rhBMP‑2 resulted in adverse events
including nerve root injury/radiculitis when utilized to
perform cervical or lumbar fusions.[21] Although all of
these authors cite “real concerns” about the off‑label use
of BMP in spinal surgery, where is the momentum to
remove this product from the shelves?
Financial support and sponsorship

[Donald Corenman, MD, DC]

#22524

BMP does have the possibility of causing neuro-irritation. This is why it needs to be sequestered. Placing BMP near a nerve root has the possibility of neuro-irritation when placed in a TILF cage in the disc space. This is why the BMP needs to be placed anterior and have a synthetic graft and cage isolate it from the root. I have never see this inflammation in a case of posterolateral fusion but I have seen it in some cases of TLIF. I have not seen this inflammation since the above technique is used. BMP should never be used in the anterior cervical spine as the inflammatory properties could cause too much swelling in that enclosed space.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[biofreeze]

#22541

That makes sense in the disc space, however does the above also refer to issues using BMP with posterolateral fusion. i.e. neuroforaminal complication ?

[Donald Corenman, MD, DC]

#22542

I have completed approximately 200 posterolateral BMP fusions with BMP. This includes ones with a central decompression for central stenosis. I have never seen an inflammatory seroma causing canal inflammation. In addition, I have never seen BMP cause heterotopic ossification of the foramen. If the natural barriers are left intact (transverse ligament and transversals muscles), there is no connection between the foramen and the BMP. Also, even in the central decompression, there is a ridge left where the facet is located. The erector spine and multifidi muscle will “hold” the BMP in place and keep it sequestered. Interestingly, in the post-operative CT scans, the posterolateral fusion almost always fuses before the central disc does (in a TLIF of course).

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[biofreeze]

#22548

Thank you,

What is central decompression ? What is central stenosis ?

I thought decompression was restoring height to the disc space….

[Donald Corenman, MD, DC]

#22551

If there is central stenosis (see website), then a central decompression is needed. This procedure opens up the canal from the rear. Decompression is the removing of a compressive structure to take pressure off the neurological structure. Decompression can be “direct” (the direct removal of the compressive structure) or “indirect” (changing the alignment of the vertebra to move the pressure off of the neurological structure).

The TLIF restores the disc space height and can indirectly decompress the neurological structures.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

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