Bone morphogenetic proteins (BMP), commonly used off-label to enhance paediatric spinal fusion (spinal arthrodesis), did not improve revision rates for paediatric spinal fusion, according to a study presented at the annual meeting of the American Academy of Orthopaedic Surgeons (AAOS; 14-18 March, San Diego, USA).
“BMP is frequently used off-label for paediatric spinal fusions, yet children rarely have difficulty forming robust bone at the site of spinal fusion. There is no proof that BMP improves the quality of spinal fusion in children and adolescents,” says lead study author Emily Dodwell, a paediatric orthopaedic surgeon at Hospital for Special Surgery (HSS), in New York City, USA. “Although the rationale for using BMP is that it might improve bone healing and minimise the likelihood of further surgery, we found that BMP did not change the revision rate in children.”
To shed light on the issue, researchers at HSS turned to the Statewide Planning and Research Cooperative System (SPARCS) database for New York state. SPARCs is a comprehensive all-payer data reporting system of all hospital admissions and ambulatory surgery cases performed in New York state, with the exclusion of those performed in Veterans Affairs facilities or other federal hospitals. They identified 7,312 children and adolescents who underwent spinal fusion between 2004 and 2014. Of this group, 6.7% received BMP. Use spiked between 2008 and 2010, when 8.7% received the product. BMP was more likely to be used in children that were older, white, and of a higher socioeconomic status.
“We did not find any improvement in mid to long-term outcomes,” says Dodwell. “While we did not find any serious mid- to long-term complications with the use of BMP, longer-term larger prospective studies would be needed to determine the safety and efficacy of BMP in children.” She thinks the study’s findings support caution in using BMP for spinal fusion in children.