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Monday, September 8, 2008

Even with BMPs, osteoinductive matrices still play a role in spine restoration cases

September 2008

While osteoinductive factors and matrices may be advantageous for spinal fusion, a leading spine surgeon warns about the consequences of using bone morphogenetic proteins in large doses and calls for a re-examination of iliac crest bone grafting.

“Lumbar spine fusion, especially posterior lumbar spine [fusion], continues to present a difficult clinical problem,” Harvinder S. Sandhu, MD, said. “Although BMPs are powerful and useful biologic tools, do not underestimate the risks when using supraphysiologic doses. There is an inflammatory and osteolytic host response in some cases and, in the spine, chronic radiculitis. Well-designed osteoconductive matrices and local bone graft and bone marrow still have an important role.

“I think that we have to revisit the whole issue of iliac crest bone grafting, particularly in light of the newer, less invasive bone harvesting methods that are now available. It ultimately may be a safer and more cost effective method, even when combined with osteoconductive matrices,” he said.

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