Bone Morphogenetic Protein (BMP)

For years, scientists have been searching for ways to stimulate the human body to generate and repair bone more reliably and more quickly. No one appreciates the importance of such research more than the spinal surgeon. More than half of the thousands of bone fusion operations performed annually in the United States involve fusion of the spinal column. Traditionally, spinal fusion requires the transplant of bone chips from a patient's pelvis to the spinal vertebrae to help "fuse" them together. Although this procedure can be very effective for the treatment of certain spinal disorders, the bone transplantation procedure (bone grafting) can prolong surgery, increase blood loss, increase hospital stay, increase recovery time, and increase recovery pain. Moreover, the bone grafting technique does not always reliably result in successful fusion of the vertebrae because of occasional inadequate bone growth.

Recently, scientists and spinal surgeons have demonstrated that a genetically produced protein, recombinant human bone morphogenetic protein-2, or rhBMP-2, has the ability to stimulate a patient's own cells to make more bone. This finding has obvious beneficial implications for the treatment of many bone fractures and bone defects. More importantly, though, rhBMP-2 can be tremendously beneficial to patients undergoing spinal fusion. It will eliminate the need for bone transplantation from the pelvis. It may more reliably and more quickly produce fusion of spinal vertebrae. It may even reduce the need for the implantation of spinal rods and screws.

The process of stimulating bone growth within the body is known as osteoinduction. One of the pioneers in the science of osteoinduction was Dr. Marshall Urist, Professor Emeritus of the Department of Orthopaedic Surgery at the UCLA School of Medicine. More than 35 years ago, Dr. Urist discovered that the proteins that directed bone to heal itself were contained within its own matrix, or substance. It was not until 1988 that these proteins were individually identified and genetically reproduced. Thereafter, it was quickly discovered that rhBMP-2 could, by itself, direct the repair and regeneration of bone in various parts of the skeleton. In several laboratory experiments performed from 1993 to 1997, rhBMP-2 was shown to effectively stimulate bone growth along spinal vertebrae.

In 1997, rhBMP-2 was used for the first time in patients undergoing spinal fusion. In this initial clinical trial, all eleven patients who had been implanted with rhBMP-2 achieved successful fusion within 6 months from the time of surgery. In fact, 10 of these 11 patients had achieved their fusions within 3 months of surgery. Because these patients did not require bone grafting from the pelvis, their hospital stays were shorter and their post-surgical pain was less than typically seen with traditional bone grafting techniques. These promising initial findings are now being studied in several larger clinical trials throughout the United States.

There is little doubt that powerful biologic proteins such as rhBMP-2 will eventually help all surgical specialists treat a variety of common as well as complex spinal disorders. These osteoinductive factors will enable surgeons to modify their techniques to minimize the invasiveness of their operations. Ultimately, the goal will be to reduce the pain associated with surgery and recovery, improve the effectiveness of the surgical treatments, and hasten the return of patients to productive and healthy lifestyles.

rhBMP-2 has recently received clearance from the Food and Drug Administration (FDA) for specific uses. Consult your surgeon to learn if you are a candidate.