Evidence map›Paper›PMID 39528828›Full record

ArticleActa neurochirurgica2024

Treatment of adult spine deformity: A retrospective comparison of bone morphogenic protein and bone marrow aspirate with bone allograft.

Oluwatobi O Onafowokan, Akachimere C Uzosike, Abhinav Sharma, Matthew Galetta, Nathan Lorentz, Samuel Montgomery, Max R Fisher, Anthony Yung, Paritash Tahmasebpour, Lauren Seo and 9 more

Abstract readComparative Study
PubMed Publisher
In one paragraph

Article in Acta neurochirurgica, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Review
  2. Review
  3. Article
  4. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors.

Oluwatobi O OnafowokanDuke Spine Division, Departments of Neurological and Orthopaedic Surgery, Duke School of Medicine, Durham, NC, USA.
Akachimere C UzosikeDivision of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, USA.
Abhinav SharmaDepartment of Orthopedic Surgery, University of California Irvine School of Medicine, Irvine, CA, USA.
Matthew GalettaDivision of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, USA.
Nathan LorentzDivision of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, USA.
Samuel MontgomeryDivision of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, USA.
Max R FisherDuke Spine Division, Departments of Neurological and Orthopaedic Surgery, Duke School of Medicine, Durham, NC, USA.
Anthony YungDuke Spine Division, Departments of Neurological and Orthopaedic Surgery, Duke School of Medicine, Durham, NC, USA.
Paritash TahmasebpourHoag Neurosciences Institute, Newport Beach, CA, USA.
Lauren SeoDuke Spine Division, Departments of Neurological and Orthopaedic Surgery, Duke School of Medicine, Durham, NC, USA.
Timothy RobertsDivision of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, USA.
Renaud LafageDepartment of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA.
Justin SmithDepartment of Neurosurgery, University of Virginia, Charlottesville, VA, USA.
Pawel P JankowskiHoag Neurosciences Institute, Newport Beach, CA, USA.
Zeeshan M SardarDepartment of Orthopedic Surgery, Columbia University, New York, NY, USA.
Christopher I ShaffreyDuke Spine Division, Departments of Neurological and Orthopaedic Surgery, Duke School of Medicine, Durham, NC, USA.
Virginie LafageDepartment of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA.
Andrew J SchoenfeldDepartment of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Peter G PassiasDuke Spine Division, Departments of Neurological and Orthopaedic Surgery, Duke School of Medicine, Durham, NC, USA. pgpassias@yahoo.com.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe use of bone morphogenic protein (BMP-2) in adult spine deformity (ASD) surgery remains controversial more than two decades following its approval for clinical application in spine surgery. This study was performed to assess outcomes in patients undergoing ASD surgery with BMP application compared with a combination of bone marrow aspirate, cancellous bone chips and i-Factor.

methodsThis was a retrospective cohort study. ASD patients were stratified by use of intra-operative BMP (BMP +) or not (BMA + I) and surveyed for the development of complications and mechanical failure. Quality of life gained following the procedure was evaluated using quality-adjusted life years (QALYs). Cost was calculated using the PearlDiver database and CMS definitions. Multivariable analyses (ANCOVA) and logistic regression were used to adjust for confounding.

results512 patients were included (60% BMP +). At baseline, BMP + patients were older (62.5 vs 60.8 years, p < 0.010). Radiographic and quality-of-life metrics did not differ at follow up timepoints (all p > 0.05). BMP use was associated with higher supplemental rod use (OR: 7.0, 1.9 - 26.2, p = 0.004), greater number of levels fused (OR: 1.1, 1.03 - 1.17, p = 0.003) and greater neurological complications (OR: 5.0, 1.3 - 18.7, p = 0.017). Controlling for rod use and levels fused, BMP use was not associated with a lower risk of mechanical complications (OR 0.3, 95% CI: 0.2 - 3.0, p = 0.353), rod breakage (OR: 3.3, 0.6 - 18.7, p = 0.182) or implant failure (OR: 0.3, 0.04 - 1.51). At 2 years, the BMP + cohort exhibited higher overall costs ($108,062 vs $95,144, p = 0.002), comparable QALYs (0.163 vs 0.171, p = 0.65) and higher cost per QALY (p = 0.001) at two years.

conclusionsIn this analysis, BMP-2 application was not associated with superior outcomes when compared to a less costly biologic alternative (bone marrow aspirate + cancellous bone chips + i-Factor) following ASD surgery. The use of BMP-2 in ASD surgery appears to have reduced cost-efficacy at two years postoperatively.

Indexed as

Bone TransplantationAdultAgedAllograftsBone Marrow TransplantationBone Morphogenetic Protein 2FemaleHumansMaleMiddle AgedQuality of LifeRetrospective StudiesSpinal FusionTreatment OutcomeBone Morphogenetic Protein 2BiologicsBone marrow aspirate concentrateRealignmentRecombinant human bone morphogenic protein-2Spine deformitySpine fusion

Identifiers

PMID39528828

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.