rhBMP2

Spine fusion is an operation in which two or more vertebrae are encouraged to grow together. This in principle will stop the painful movement between them. Once a damaged disc is removed, and the space cleaned, the body must be encouraged to produce bone and build a strong union between the two vertebrae. This union does not just happen automatically. Traditionally, bone grafts were shaved off of the back of the pelvis or iliac crest and placed into the disc space (autologous iliac bone graft).

The osteoinductive properties of autologous graft (ability to attract cells from the blood stream, induce them to turn into bone forming cells and lay down new bone) it was discovered in the late 1960s, resides within a class of bone proteins called bone morphogenic proteins (BMPs). Bone from cadavers or bone substitutes made of calcium salts or coral have been shown to have a considerably lower rates of fusion than a patient's own (autologous) bone.  Using autologous iliac crest bone induced fusion rates near 90%, but often it also created chronic, permanent pain at the bone graft donor site in up to 20% of patients. The next advance then was the commercial availability of BMP, which required recombinant synthesis and purification of the BMP that induces the best bone formation (rhBMP2).  By binding rhBMP2 to an absorbable sponge and placing this within a disc spacer, the fusion rate was further enhanced without having to take bone grafts.

There are many BMP forms that are still undergoing research. Some enhance ligamentous healing, some bone growth, many their full effects and purpose remain obscure. In addition, the best concentrations and means of application to enhance the fusion process under a variety of circumstances still remains to be worked out.

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                                                    Last modified: 04/04/06