Skip to main content

Advertisement

SpringerLink
Log in

Comparison of the use of rhBMP-7 versus iliac crest autograft in single-level lumbar fusion: a meta-analysis of randomized controlled trials

  • Original Article
  • Published:
Journal of Bone and Mineral Metabolism Aims and scope Submit manuscript

Abstract

The aim of this study was to evaluate the safety and clinical effectiveness of rhBMP-7 (or osteogenic protein-1) versus that of autogenous iliac crest bone graft (ICBG) in single-level posterolateral fusion (PLF) of the lumbar spine. A systematic search of all articles published through July 1, 2016 was conducted in databases such as PubMed, EMBASE, Scopus, and the Cochrane Collaboration Library. Randomized controlled trials (RCTs) that compared rhBMP-7 with ICBG for the treatment of single-level degenerative spondylolisthesis, provided the fusion rate, clinical success rate, safety and adverse events report, operation time, and hospital stay durations as the outcome were assessed. As a result, a total of five RCTs involving 539 patients met the inclusion criteria. The outcomes of subgroup analysis demonstrated that when compared with autogenous ICBG, rhBMP-7 appear to yield lower fusion rates in instrumented posterolateral fusion patients (RR = 0.76, 95% CI [0.60, 0.98], P = 0.03), despite the test for overall fusion rates suggested that there was no significant difference between the two groups (RR = 0.89, 95% CI [0.78, 1.02], P = 0.09). Patients treated with OP-1 had shorter operation times versus those treated with ICBG (WMD = −16.70,95% CI [−25.83, −7.57], P = 0.0003). Additionally, the outcomes demonstrated a lack of significant differences between rhBMP-7 and ICBG in terms of clinical success of ODI, overall adverse events, revision rates and duration of hospitalization. In conclusion, with the exception of reducing the operation time, our review suggests that the use of the rhBMP-7 instead of ICBG produce no any additional beneficial effect on the fusion rates, clinical success of ODI, overall adverse events, revision rates and duration of hospitalization in single level PLF. On the contrary, it appeared to yield lower fusion rate in the instrumented posterolateral fusion patients and cannot be recommended as an effective tool for this set of patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Deyo RA, Nachemson A, Mirza SK (2004) Spinal-fusion surgery: the case for restraint. N Engl J Med 350:722–726

    Article  CAS  PubMed  Google Scholar 

  2. Ito Z, Imagama S, Kanemura T et al (2013) Bone union rate with autologous iliac bone versus local bone graft in posterior lumbar interbody fusion (PLIF): a multicenter study. Eur Spine J 22:1158–1163

    Article  PubMed  PubMed Central  Google Scholar 

  3. Kim DH, Rhim R, Li L et al (2009) Prospective study of iliac crest bone graft harvest site pain and morbidity. Spine J 9:886–892

    Article  PubMed  Google Scholar 

  4. Schwartz CE, Martha JF, Kowalski P et al (2009) Prospective evaluation of chronic pain associated with posterior autologous iliac crest bone graft harvest and its effect on postoperative outcome. Health Qual Life Outcomes 7:49

    Article  PubMed  PubMed Central  Google Scholar 

  5. Silber JS, Anderson DG, Daffner SD, et al (2003) Donor site morbidity after anterior iliac crest bone harvest for single-level anterior cervical discectomy and fusion. Spine (Phila Pa 1976) 28:134–139

  6. Cook SD, Wolfe MW, Salkeld SL et al (1995) Effect of recombinant human osteogenic protein-1 on healing of segmental defects in non-human primates. J Bone Joint Surg Am 77:734–750

    Article  CAS  PubMed  Google Scholar 

  7. Ong K L, Villarraga ML, Lau E et al (2010) Off-label use of bone morphogenetic proteins in the United States using administrative data. Spine (Phila Pa 1976) 35:1794–1800

  8. Meyerding HW (1956) Spondylolisthesis; surgical fusion of lumbosacral portion of spinal column and interarticular facets; use of autogenous bone grafts for relief of disabling backache. J Int Coll Surg 26:566–591

    CAS  PubMed  Google Scholar 

  9. Walsh TL, Hanscom B, Lurie JD, et al (2003) Is a condition-specific instrument for patients with low back pain/leg symptoms really necessary? The responsiveness of the Oswestry Disability Index, MODEMS, and the SF-36. Spine (Phila Pa 1976) 28:607–615

  10. Verhagen AP, de Vet HC, de Bie RA et al (1998) The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. J Clin Epidemiol 51:1235–1241

    Article  CAS  PubMed  Google Scholar 

  11. Delawi D, Dhert WJ, Rillardon L et al (2010) A prospective, randomized, controlled, multicenter study of osteogenic protein-1 in instrumented posterolateral fusions: report on safety and feasibility. Spine (Phila Pa 1976) 35:1185–1191

  12. Vaccaro AR, Lawrence JP, Patel T, et al (2008) The safety and efficacy of OP-1 (rhBMP-7) as a replacement for iliac crest autograft in posterolateral lumbar arthrodesis: a long-term (>4 years) pivotal study. Spine (Phila Pa 1976) 33:2850–2862

  13. Vaccaro AR, Whang PG, Patel T et al (2008) The safety and efficacy of OP-1 (rhBMP-7) as a replacement for iliac crest autograft for posterolateral lumbar arthrodesis: minimum 4-year follow-up of a pilot study. Spine J 8:457–465

    Article  PubMed  Google Scholar 

  14. Kanayama M, Hashimoto T, Shigenobu K et al (2006) A prospective randomized study of posterolateral lumbar fusion using osteogenic protein-1 (OP-1) versus local autograft with ceramic bone substitute: emphasis of surgical exploration and histologic assessment. Spine (Phila Pa 1976) 31:1067–1074

  15. Vaccaro AR, Anderson DG, Patel T et al (2005) Comparison of OP-1 Putty (rhBMP-7) to iliac crest autograft for posterolateral lumbar arthrodesis: a minimum 2-year follow-up pilot study. Spine (Phila Pa 1976) 30:2709–2716

  16. Vaccaro AR, Patel T, Fischgrund J et al (2005) A 2-year follow-up pilot study evaluating the safety and efficacy of op-1 putty (rhbmp-7) as an adjunct to iliac crest autograft in posterolateral lumbar fusions. Eur Spine J 14:623–629

    Article  PubMed  PubMed Central  Google Scholar 

  17. Vaccaro AR, Patel T, Fischgrund J et al (2004) A pilot study evaluating the safety and efficacy of OP-1 Putty (rhBMP-7) as a replacement for iliac crest autograft in posterolateral lumbar arthrodesis for degenerative spondylolisthesis. Spine (Phila Pa 1976) 29:1885–1892

  18. Johnsson R, Stromqvist B, Aspenberg P (2002) Randomized radiostereometric study comparing osteogenic protein-1 (BMP-7) and autograft bone in human noninstrumented posterolateral lumbar fusion: 2002 Volvo Award in clinical studies. Spine (Phila Pa 1976) 27:2654–2661

  19. Hwang CJ, Vaccaro AR, Hong J et al (2010) Immunogenicity of osteogenic protein 1: results from a prospective, randomized, controlled, multicenter pivotal study of uninstrumented lumbar posterolateral fusion. J Neurosurg Spine 13:484–493

    Article  PubMed  Google Scholar 

  20. Delawi D, Jacobs W, van Susante JL et al (2016) OP-1 compared with iliac crest autograft in instrumented posterolateral fusion: a randomized, multicenter non-inferiority trial. J Bone Joint Surg Am 98:441–448

    Article  PubMed  Google Scholar 

  21. Guerado E, Cervan AM (2012) Surgical treatment of spondylodiscitis. An update. Int Orthop 36:413–420

    Article  PubMed  Google Scholar 

  22. Hempelmann RG, Mater E, Schon R (2010) Septic hematogenous lumbar spondylodiscitis in elderly patients with multiple risk factors: efficacy of posterior stabilization and interbody fusion with iliac crest bone graft. Eur Spine J 19:1720–1727

    Article  PubMed  PubMed Central  Google Scholar 

  23. Jenis LG, Wheeler D, Parazin SJ et al (2002) The effect of osteogenic protein-1 in instrumented and noninstrumented posterolateral fusion in rabbits. Spine J 2:173–178

    Article  PubMed  Google Scholar 

  24. Owens K, Glassman SD, Howard JM et al (2011) Perioperative complications with rhBMP-2 in transforaminal lumbar interbody fusion. Eur Spine J 20:612–617

    Article  PubMed  Google Scholar 

  25. Carragee EJ, Hurwitz EL, Weiner BK (2011) A critical review of recombinant human bone morphogenetic protein-2 trials in spinal surgery: emerging safety concerns and lessons learned. Spine J 11:471–491

    Article  PubMed  Google Scholar 

  26. Kokorina NA, Lewis JJ, Zakharkin SO et al (2012) rhBMP-2 has adverse effects on human oral carcinoma cell lines in vivo. Laryngoscope 122:95–102

    Article  CAS  PubMed  Google Scholar 

  27. Gao Q, Tong W, Luria JS et al (2010) Effects of bone morphogenetic protein-2 on proliferation and angiogenesis in oral squamous cell carcinoma. Int J Oral Maxillofac Surg 39:266–271

    Article  CAS  PubMed  Google Scholar 

  28. Rothhammer T, Poser I, Soncin F et al (2005) Bone morphogenic proteins are overexpressed in malignant melanoma and promote cell invasion and migration. Cancer Res 65:448–456

    CAS  PubMed  Google Scholar 

  29. Chirasani SR, Sternjak A, Wend P et al (2010) Bone morphogenetic protein-7 release from endogenous neural precursor cells suppresses the tumourigenicity of stem-like glioblastoma cells. Brain 133:1961–1972

    Article  PubMed  Google Scholar 

  30. Piccirillo SG, Vescovi AL (2006) Bone morphogenetic proteins regulate tumorigenicity in human glioblastoma stem cells. Ernst Schering Found Symp Proc 5:59–81

    Google Scholar 

  31. Piccirillo SG, Reynolds BA, Zanetti N et al (2006) Bone morphogenetic proteins inhibit the tumorigenic potential of human brain tumour-initiating cells. Nature 444:761–765

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Author notes

    Authors and Affiliations

    1. Department of Orthopaedic, Fujian Provincial Hospital, Provincial Clinical Medical College Affiliated to Fujian Medical University, 134 East Street, Fuzhou, 350001, Fujian, People’s Republic of China

      Fubiao Ye

    2. Department of Orthopedics, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, 362000, China

      Zhiyuan Zeng

    3. Department of Orthopaedic, First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Second Road, Guangzhou, 510080, People’s Republic of China

      Jianru Wang, Hui Liu, Hua Wang & Zhaomin Zheng

    Authors
    1. Fubiao Ye
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Zhiyuan Zeng
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Jianru Wang
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Hui Liu
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Hua Wang
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Zhaomin Zheng
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding authors

    Correspondence to Hua Wang or Zhaomin Zheng.

    Ethics declarations

    Conflict of interest

    There are no identified conflicts of interest with any of the authors.

    Additional information

    F. Ye and Z. Zeng contributed equally to this work and shared first authroship.

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Ye, F., Zeng, Z., Wang, J. et al. Comparison of the use of rhBMP-7 versus iliac crest autograft in single-level lumbar fusion: a meta-analysis of randomized controlled trials. J Bone Miner Metab 36, 119–127 (2018). https://doi.org/10.1007/s00774-017-0821-z

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00774-017-0821-z

    Keywords

    Search

    Navigation