Understanding BMP's

Article written by Jeff Fischgrund, MD

One of the most common procedures performed in the spine is a spinal fusion. There are many ways to perform this procedure, but the final outcome is always the "growing together" of 2 adjacent spine bones. The traditional method of obtaining this fusion is to take bone from the patient's pelvis and place this bone or "autograft" (host bone) between the vertebrae. After 6-12 weeks, the graft grows from one bone to the other, essentially "fusing" a portion of the spine. It is estimated that approximately 1.5 million bone grafting operations are performed annually in the United States. These include a multitude of procedures such as spinal fusion, internal fixation of fractures, treatment of bone defects, and others.

Although commonly performed, usually with successful results, bone graft harvesting has a significant disadvantage-PAIN. Many patients complain of pain from their bone graft site months and even years after their surgery. Although the spine surgery and fusion may have a successful outcome, persistent pelvic pain often leaves patients frustrated and unhappy. Fortunately, over the past 20 years there has been extensive scientific research in the field of bone graft replacements, specifically Bone Morphogenetic Proteins-BMP's.

BMP's are a family of proteins that have been identified as essential in bone formation and are now mass produced. When applied appropriately in the spine, these proteins are capable of inducing bone formation and ultimately spinal fusion, without any bone graft harvesting. Two specific proteins, BMP-2 and BMP-7 are currently approved by the Food and Drug Administration (FDA) for use in the spine. The advantage of these products to the patient is enormous. There is less postoperative pain, a shorter hospital stay, and a faster recovery due to the elimination of a second, painful procedure.

Infuse® (BMP-2) is currently approved by the FDA for anterior lumbar interbody fusions when used with 2 metal cages. This procedure is performed by an incision through the abdomen, with the BMP-2 liquid placed on sponges which are rolled inside the cage prior to cage insertion.

OP-1® (BMP-7) is currently FDA approved for revision posterolateral lumbar fusions in patients who are identified to have risk factors which predispose them to poor healing of a fusion. OP-1 is mixed with a carrier which forms a putty. This putty is then placed in the back of the spine. With time, the OP-1 causes your bodies own cells to turn into bone forming cells. Your body then produces normal bone between the vertebrae, resulting in a spinal fusion. OP-1 has been safely implanted in over 11,000 patients around the world over the past 12 years.

If you are scheduled to undergo a posterolateral spinal fusion, ask your doctor if you are a candidate to have OP-1 implanted, rather than having your own bone harvested from your pelvis. Your surgeon will be able to more fully describe the indications and advantages of this exciting new technology.