Introduction: Theoretical advantages of BMP use include high fusion rates and improved outcomes, however little data exists evaluating fusion grade, complications and health related quality of life (HRQOL) for ASD patients treated with BMP. Purpose: evaluate fusion grade, complications and HRQOL associated with BMP vs. no BMP use in a prospective, multicenter, consecutive ASD cohort, minimum 2 year follow-up.
Methods: Multicenter, prospective analysis of consecutive ASD patients receiving BMP (BMP) or no BMP (NOBMP). Inclusion criteria: ASD, age = 18 years, spinal fusion= 4 levels, complete demographic and radiographic data, and minimum two-year follow up. ASD=scoliosis =20 degrees, sagittal vertical axis =5cm, pelvic tilt =25 degrees, or thoracic kyphosis> 60 degrees. Spine fusion evaluated using Lenke grade, complications noted, baseline and 2 year postoperative HRQOL (SRS-22r, SF-36, ODI) analyzed.
Results: 141 of 189 patients had complete two year data (75% follow-up); mean follow up 35.8 months (range 24.1-47.9). BMP (n=110; mean BMP doses: posterolateral= 2.6mg/level, interbody= 5.3 mg/level) and NOBMP (n= 31) had similar preop deformity, baseline HRQOL, and total posterior fusion levels (BMP=11.6, NOBMP=12.9). BMP was older (56 vs. 49 years), had more anteroposterior surgery (25 vs. 6.5%), and fewer pedicle subtraction osteotomy/patient (0.12 vs. 0.3), than NOBMP, respectively (p<0.05). BMP had more minor complications (61% vs. 29%) and fewer implant failures (1.8 vs. 13%) than NOBMP, respectively (p<0.05). Mean BMP fusion grade was greater than NOBMP (1.9 vs. 1.5; p<0.05). BMP had greater 2 year improvement in SRS-22r total (0.9 vs. 0.5), mental (0.4 vs. -.02), and pain (1.0 vs. 0.4) scores than NOBMP, respectively (p<0.05).
Conclusions: BMP use in ASD, at reported BMP dose/level, demonstrated higher fusion grade, fewer implant failures, similar major complications, and greater HRQOL improvement at 2 year follow-up than NOBMP. Research is needed evaluating long term complications and outcomes.
Patient Care: Improve our understanding of surgical treatment strategies for adults with spinal deformity.
Learning Objectives: By the conclusion of this session, participants should be able to: (1) Appreciate that, compared with adult spinal deformity patients whose surgery did not include BMP, those with BMP demonstrated higher fusion grade, fewer implant failures, similar major complications, and greater health-related quality of life improvement at 2 year follow-up; (2) Appreciate that further research is needed to evaluate the potential long-term effects of BMP.