Recombinant bone morphogenetic protein-7 as an intracorporal bone growth stimulator in unstable thoracolumbar burst fractures in humans: preliminary results |
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Authors: | M Laursen K Høy E S Hansen J Gelineck F B Christensen C E Bünger |
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Institution: | (1) The Spine Unit, Department of Orthopedics E, Aarhus University Hospital, Aarhus, Denmark, DK;(2) Radiological Department R, Aarhus University Hospital, Aarhus, Denmark, DK;(3) Tordenskjoldsgade 33, IV, TH, DK-8200 Aarhus, Denmark Tel.: +45-89 494 102, Fax: +45-89 494 150, DK |
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Abstract: | The study presented here is a pilot study in five patients with unstable thoracolumbar spine fractures treated with transpedicular
OP-1 transplantation, short segment instrumentation and posterolateral fusion. Recombinant bone morphogenetic protein-7 in
combination with a collagen carrier, also referred to as OP-1, has demonstrated ability to induce healing in long-bone segmental
defects in dogs, rabbits and monkeys and to induce successful posterolateral spinal fusion in dogs without need for autogenous
bone graft. Furthermore OP-1 has been demonstrated to be effective as a bone graft substitute when performing the PLIF maneuver
in a sheep model. Five patients with single-level unstable burst fracture and no neurological impairment were treated with
intracorporal OP-1 transplantation, posterior fixation (USS) and posterolateral fusion. One patient with osteomalacia and
an L2 burst fracture had an additional intracorporal transplantation performed proximal to the instrumented segment, i.e.
OP-1 into T 12 and autogenous bone into T 11. Follow-up time was 12–18 months. On serial radiographs, Cobb and kyphotic angles,
as well as anterior, middle and posterior column heights, were measured. Serial CT scans were performed to determine the bone
mineral density at fracture level.
In one case, radiographic and CT evaluation after 3 and 6 months showed severe resorption at the site of transplantation,
but after 12 months, new bone had started to fill in at the area of resorption. In all cases there was loss of correction
with regard to anterior and middle column height and sagittal balance at the latest follow-up. These preliminary results
regarding OP-1 as a bone graft substitute and stimulator of new bone formation have been disappointing, as the OP-1 device
in this study was not capable of inducing an early sufficient structural bone support. There are indications to suggest that
OP-1 application to a fracture site in humans might result in detrimental enhanced bone resorption as a primary event.
Received: 13 February 1999 Revised: 4 August 1999 Accepted: 18 August 1999 |
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Keywords: | Thoracolumbar burst fractures Recombinant human bone morphogenetic protein-7 Transpedicular transplantation Clinical results Bone graft substitute |
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