Fusion is a surgery to be avoided for 95% of the patients for which it’s recommended. Having said that, if you really need the surgery, you also need a spinal fusion recovery plan, which like most things involves education. While BMPs are commonly used in spinal fusion surgery, most patients have no earthly idea what BMP is or why they should care about this bone growth drug. However, if you are planning on a spinal fusion, your recovery could depend on knowing all about BMPs. Turns out that while surgeons love to splash this costly drug in the low back fusion to promote the area growing together, a new study shows that it’s inferior to using your own bone and stem cells.
BMP stands for Bone Morphogenic Protein. It’s a naturally occurring hormone your body uses to help bone heal. It has been isolated, patented, and mass produced by the company Medtronic (branded as the drug InFuse or Amplify) for use in helping surgeons get the spine to fuse together. While the product seems to help bone grow, sometimes it helps too much bone grow, leading to more pinched nerves, something a fusion surgery is often trying to help. In addition, there’s some controversy as to whether InFuse causes cancer or sterility in men. Finally, InFuse can really cause quite a bit of spinal nerve root irritation. Through the years, we’ve treated countless patients with severely irritated spinal nerves after fusion surgery where BMP was used. Despite all of this, the product is very commonly used in spinal fusions due to aggressive marketing.
A more natural option to help spine bones to fuse is using your own bone and stem cells. This bone graft with bone marrow concentrate (a less advanced form of the Regenexx-SD procedure) can be easily obtained by the surgeon and also added to the fusion. This technique has none of the downside side effects of InFuse and is becoming more common as the evidence mounts of problems with BMPs. However, is one technique better? Can the artificial drug beat the patient’s own natural stem cells for promoting fusion?
The new paper looked at this issue in some detail. The study authors took more than 50 patients and used one technique or the other and then reviewed CT Scans at one year to see who had fused and how much of the disc space had grown together. Overall 89% of the levels treated fused (leaving about 1 in 10 that didn’t). Disturbingly, almost all of the InFuse cases had a large hole in the middle of the fusion (98% of the cases). Only 4 in 10 of the bone and marrow stem cell treated fusions had holes which were about 3 times smaller than the areas treated with BMP. The InFuse treated cases had twice the failure rate and three times the rate of levels that were considered doubtful to have successfully fused!
The upshot? InFuse has had it’s problems through the years, mostly related to excessive bone growth, pissed off spinal nerves, and suspicions that the product may be associated with high cancer rates or sterility. Now the biggest problem of all may be that it just doesn’t work as well as using the patient’s own bone and marrow stem cells. What can you do if you or a loved one is planning a fusion? Based on treating many patients with complications from InFuse and armed with this new data, my advice is you find out if your surgeon uses InFuse and if so, request that your own stem cells be used instead.