Assessment of outcome following the use of recombinant human bone morphogenetic protein-2 for spinal fusion in the elderly population
Allografts; anterior cervical-spine; Bone morphogenetic protein-2; clinical article; ectopic bone; Elderly; graft; lumbar interbody fusion; Neurosciences & Neurology; off-label use; older-adults; Outcome Assessment (Health Care); perioperative complications; rhBMP-2; rhBMP-2; Spinal fusion; Spine surgery; Surgery; Surgery
INTRODUCTION: Although the use of recombinant human bone morphogenetic protein-2 (rhBMP-2) for spinal fusion has been fairly studied in the general population, relatively little research has been conducted on its use in the elderly patient demographic despite this population's growth. The authors sought to examine the clinical efficacy, complication rate, and cost-effectiveness of rhBMP-2 use in elderly patients undergoing spinal fusion surgery. EVIDENCE ACQUISITION: We conducted a systematic review of the published literature for elderly patients that underwent spinal fusion surgery with the use of rhBMP-2. A systematic search was performed utilizing the PUBMED and MEDLINE databases in order to identify all papers dealing with recombinant human Bone Morphogenic Protein-2 use in patients over the age of 60 years. EVIDENCE SYNTHESIS: Twenty-five papers were identified that met our inclusion criteria. While successful fusion, improvement in pain, and improved quality of life were encountered in elderly patients who were treated with fusions surgery along with rhBMP-2, there were several complications that were encountered including seroma formation, pleural effusions, and bone non-union. CONCLUSIONS: The literature demonstrated that BMP serves as a potent osteoinductive agent in the elderly with similar efficacy to bone auto graft. Although use of BMP showed mixed results and had higher initial costs, when taken into account with complication correction and costs, BMP usage appears to be more economically beneficial overall. Future studies are needed to clarify the clinical significance of the complications encountered in elderly patients treated with rhBMP-2. Future research can assist in developing recommendations which can minimize these risks in the elderly patient demographic.
Shweikeh F; Hanna G; Bloom L; Sayegh E T; Liu J; Acosta F L; Drazin D
Journal of Neurosurgical Sciences
2016
2016-06
Journal Article
n/a
Does Patient Sex Affect the Rate of Mortality and Complications After Spine Surgery? A Systematic Review
anterior cervical fusion; clinical article; lumbar interbody fusion; medicare beneficiaries; Orthopedics; perioperative complications; reoperation rates; risk-factors; Surgery; surgical characteristics; thromboembolic events; united-states
Available studies disagree regarding the influence of patient sex on mortality and complications after spine surgery. We sought to conduct a systematic review and pool the results of existing research to better understand this issue. We performed a systematic review to address two questions: (1) Does sex (male versus female) influence mortality after spine surgery? (2) Does sex impact the development of postoperative complications after spine surgery? This systematic review was performed through a query of PubMed using a structured search algorithm. Additional queries of Embase, SCOPUS, Web of Science, and the tables of contents of orthopaedic and neurosurgical journals were also conducted using search terms such as "sex factors", "male or female", "risk factors", and "spine surgery". Selected papers were independently abstracted by three of the authors (AJS, ENR, EIW) and pooling was performed. Our literature search returned 720 studies, of which 99 underwent full review. Of these, 50 were selected for final abstraction. The Cochrane Q test was used to assess study heterogeneity; significant study heterogeneity was present and so a random-effects model was used. A Harbord test was used to evaluate for the presence of publication bias; this analysis found no statistically significant evidence of publication bias. Males were at increased odds of mortality after spine surgery (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.35-1.97; p < 0.001). No differences between the sexes were identified for the odds of complications (OR, 1.04; 95% CI, 0.95-1.13; p = 0.42). Our results determined that males were at elevated odds of mortality but not of complications after spine surgery. These results should be used to inform preoperative discussion and decision-making at the time of surgical consent. Future work should be directed at determining the underlying factors responsible for increased mortality among males and prospective studies specifically designed to evaluate sex-based differences in outcomes after spine surgery. Level III, therapeutic study.
Schoenfeld A J; Reamer E N; Wynkoop E I; Choi H; Bono C M
Clinical Orthopaedics and Related Research
2015
2015-08
Journal Article
<a href="http://doi.org/10.1007/s11999-014-4102-z" target="_blank" rel="noreferrer noopener">10.1007/s11999-014-4102-z</a>