Use of Bone Morphogenetic Protein-2 in Vertebral Column Tumor Surgery: A National Investigation

Rafael De la Garza Ramos, Jonathan Nakhla, Murray Echt, Yaroslav Gelfand, David J. Altschul, Woojin Cho, Merritt D. Kinon, Reza Yassari

Research output: Contribution to journalArticle

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Abstract

Objective: To report the rate of bone morphogenetic protein-2 (BMP-2) use in vertebral column tumor surgery. Methods: The Nationwide Inpatient Sample database (2012–2014) was queried to identify patients who underwent spinal fusion for vertebral column tumors (primary benign, primary malignant, or metastatic). The rate of BMP-2 use was calculated, and patient and operative factors associated with its use were also investigated. Results: We identified 9375 patients who underwent fusion surgery for spinal tumors between 2012 and 2014, with 540 cases using BMP-2 (5.8%). Preoperative diagnosis revealed that the rate of BMP-2 use in primary benign tumor surgery was 4.9%, 7.6% for primary malignant tumors, and 5.7% for metastatic lesions (P = 0.607). The overall complication rate was 13.2% (13.4% in the NO-BMP-2 group vs. 11.1% in the BMP-2 group; P = 0.504). Patients who received this growth factor were less likely to have epidural spinal cord compression at presentation (37.0% vs. 49.2%; P = 0.014), and more likely to have elective surgery (53.7% vs. 37.7%; P < 0.001). Analysis of hospital location indicated that the highest use of BMP-2 was in the South (7.4% rate; P = 0.002). There was no statistical difference between age, sex, insurance status, comorbidities, the presence of a pathologic fracture, or the use of inpatient radiotherapy or chemotherapy between patients who received BMP-2 and controls. Conclusions: BMP-2 has been used off-label to promote arthrodesis; however, its use in patients with spinal tumors is controversial. In this national study, BMP-2 use was highest in the South, in patients without epidural cord compression at presentation, and in elective cases.

Original languageEnglish (US)
JournalWorld Neurosurgery
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Bone Morphogenetic Protein 2
Spine
Neoplasms
Spinal Fusion
Inpatients
Spontaneous Fractures
Spinal Cord Compression
Insurance Coverage
Arthrodesis
Comorbidity
Intercellular Signaling Peptides and Proteins
Radiotherapy
Databases
Drug Therapy

Keywords

  • BMP
  • Bone morphogenetic protein
  • Cancer
  • Metastasis
  • Oncology
  • Spinal tumor

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Use of Bone Morphogenetic Protein-2 in Vertebral Column Tumor Surgery : A National Investigation. / De la Garza Ramos, Rafael; Nakhla, Jonathan; Echt, Murray; Gelfand, Yaroslav; Altschul, David J.; Cho, Woojin; Kinon, Merritt D.; Yassari, Reza.

In: World Neurosurgery, 01.01.2018.

Research output: Contribution to journalArticle

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title = "Use of Bone Morphogenetic Protein-2 in Vertebral Column Tumor Surgery: A National Investigation",
abstract = "Objective: To report the rate of bone morphogenetic protein-2 (BMP-2) use in vertebral column tumor surgery. Methods: The Nationwide Inpatient Sample database (2012–2014) was queried to identify patients who underwent spinal fusion for vertebral column tumors (primary benign, primary malignant, or metastatic). The rate of BMP-2 use was calculated, and patient and operative factors associated with its use were also investigated. Results: We identified 9375 patients who underwent fusion surgery for spinal tumors between 2012 and 2014, with 540 cases using BMP-2 (5.8{\%}). Preoperative diagnosis revealed that the rate of BMP-2 use in primary benign tumor surgery was 4.9{\%}, 7.6{\%} for primary malignant tumors, and 5.7{\%} for metastatic lesions (P = 0.607). The overall complication rate was 13.2{\%} (13.4{\%} in the NO-BMP-2 group vs. 11.1{\%} in the BMP-2 group; P = 0.504). Patients who received this growth factor were less likely to have epidural spinal cord compression at presentation (37.0{\%} vs. 49.2{\%}; P = 0.014), and more likely to have elective surgery (53.7{\%} vs. 37.7{\%}; P < 0.001). Analysis of hospital location indicated that the highest use of BMP-2 was in the South (7.4{\%} rate; P = 0.002). There was no statistical difference between age, sex, insurance status, comorbidities, the presence of a pathologic fracture, or the use of inpatient radiotherapy or chemotherapy between patients who received BMP-2 and controls. Conclusions: BMP-2 has been used off-label to promote arthrodesis; however, its use in patients with spinal tumors is controversial. In this national study, BMP-2 use was highest in the South, in patients without epidural cord compression at presentation, and in elective cases.",
keywords = "BMP, Bone morphogenetic protein, Cancer, Metastasis, Oncology, Spinal tumor",
author = "{De la Garza Ramos}, Rafael and Jonathan Nakhla and Murray Echt and Yaroslav Gelfand and Altschul, {David J.} and Woojin Cho and Kinon, {Merritt D.} and Reza Yassari",
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T1 - Use of Bone Morphogenetic Protein-2 in Vertebral Column Tumor Surgery

T2 - A National Investigation

AU - De la Garza Ramos, Rafael

AU - Nakhla, Jonathan

AU - Echt, Murray

AU - Gelfand, Yaroslav

AU - Altschul, David J.

AU - Cho, Woojin

AU - Kinon, Merritt D.

AU - Yassari, Reza

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objective: To report the rate of bone morphogenetic protein-2 (BMP-2) use in vertebral column tumor surgery. Methods: The Nationwide Inpatient Sample database (2012–2014) was queried to identify patients who underwent spinal fusion for vertebral column tumors (primary benign, primary malignant, or metastatic). The rate of BMP-2 use was calculated, and patient and operative factors associated with its use were also investigated. Results: We identified 9375 patients who underwent fusion surgery for spinal tumors between 2012 and 2014, with 540 cases using BMP-2 (5.8%). Preoperative diagnosis revealed that the rate of BMP-2 use in primary benign tumor surgery was 4.9%, 7.6% for primary malignant tumors, and 5.7% for metastatic lesions (P = 0.607). The overall complication rate was 13.2% (13.4% in the NO-BMP-2 group vs. 11.1% in the BMP-2 group; P = 0.504). Patients who received this growth factor were less likely to have epidural spinal cord compression at presentation (37.0% vs. 49.2%; P = 0.014), and more likely to have elective surgery (53.7% vs. 37.7%; P < 0.001). Analysis of hospital location indicated that the highest use of BMP-2 was in the South (7.4% rate; P = 0.002). There was no statistical difference between age, sex, insurance status, comorbidities, the presence of a pathologic fracture, or the use of inpatient radiotherapy or chemotherapy between patients who received BMP-2 and controls. Conclusions: BMP-2 has been used off-label to promote arthrodesis; however, its use in patients with spinal tumors is controversial. In this national study, BMP-2 use was highest in the South, in patients without epidural cord compression at presentation, and in elective cases.

AB - Objective: To report the rate of bone morphogenetic protein-2 (BMP-2) use in vertebral column tumor surgery. Methods: The Nationwide Inpatient Sample database (2012–2014) was queried to identify patients who underwent spinal fusion for vertebral column tumors (primary benign, primary malignant, or metastatic). The rate of BMP-2 use was calculated, and patient and operative factors associated with its use were also investigated. Results: We identified 9375 patients who underwent fusion surgery for spinal tumors between 2012 and 2014, with 540 cases using BMP-2 (5.8%). Preoperative diagnosis revealed that the rate of BMP-2 use in primary benign tumor surgery was 4.9%, 7.6% for primary malignant tumors, and 5.7% for metastatic lesions (P = 0.607). The overall complication rate was 13.2% (13.4% in the NO-BMP-2 group vs. 11.1% in the BMP-2 group; P = 0.504). Patients who received this growth factor were less likely to have epidural spinal cord compression at presentation (37.0% vs. 49.2%; P = 0.014), and more likely to have elective surgery (53.7% vs. 37.7%; P < 0.001). Analysis of hospital location indicated that the highest use of BMP-2 was in the South (7.4% rate; P = 0.002). There was no statistical difference between age, sex, insurance status, comorbidities, the presence of a pathologic fracture, or the use of inpatient radiotherapy or chemotherapy between patients who received BMP-2 and controls. Conclusions: BMP-2 has been used off-label to promote arthrodesis; however, its use in patients with spinal tumors is controversial. In this national study, BMP-2 use was highest in the South, in patients without epidural cord compression at presentation, and in elective cases.

KW - BMP

KW - Bone morphogenetic protein

KW - Cancer

KW - Metastasis

KW - Oncology

KW - Spinal tumor

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