E. P. Abraham

University of British Columbia

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David Alexander

Royal Brompton & Harefield NHS Foundation Trust

Alain Jodoin

Hôpital du Sacré-Cœur de Montréal

James Mahood

University of Alberta

Robert McBroom

University of British Columbia

R. John Hurlbert

Banner - University Medical Center Tucson

Stewart I. Bailey

Western University

S. Bailey

Western University

Charles G. Fisher

University of British Columbia

Charles Fisher

University of British Columbia

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University of British Columbia

Trillium Health Centre

Dalhousie University

University of Alberta

Western University

University of Calgary

London Health Sciences Centre

Victoria Hospital

University of Toronto

Neurological Surgery

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EVALUATION OF A NEW RHBMP-2 FORMULATION IN TWO LEVEL POSTEROLATERAL LUMBAR SPINE FUSIONS

Orthopaedic Proceedings (2008)

E. P. Abraham David Alexander S. Bailey

Preliminary results suggest that a new rhBMP-2 formulation may provide an alternative for autologous bone graft in two-level posterolateral fusions The purpose of this study was to compare the success of instrumented two level fusions using a new rhBMP-2 formulation versus iliac crest bone graft (ICBG). In this formulation, rhBMP-2 was at a concentration of 2mg/cc in a Biphasic Calcium Phosphate (60% hydroxyapatite/40% tricalcium phosphate) ceramic granule carrier. Twenty-nine patients were enrolled in this multicentered, prospective, randomized study. Either 30cc of rhBMP-2/BCP or fresh ICBG were used. Clinical evaluations were done preoperatively, at discharge and 1.5, three, six, twelve and twenty-four months including Oswestry Disability Index SF36, back pain and leg pain questionnaires. CT scan and xrays were independently assessed at six, twelve, and twenty-four months. Fusion criteria included bilateral bridging trabecular bone on each level, less than 3mm translation, less than five degrees angulation . Seventeen patients received ICBG and twelve received rhBMP-2/BCP. With the use of rhBMP-2 average OR time was reduced from 3.8 to 2.9 hours. Twenty-nine patients (100%) have reached twenty-four month followup. Clinical improvements were similar in both groups, however, fusion success was much improved with the use of rhBMP-2. At twenty-four months all patients receiving rhBMP-2/BCP were fused versus 58% of ICBG patients. These results suggest that rhBMP-2/BCP may have improved fusion success in challenging two level posterolateral fusions as compared to ICBG.

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Spine (2014)

R. John Hurlbert David Alexander Stewart I. Bailey James Mahood E. P. Abraham

Hurlbert, R. John MD, PhD, FRCSC, FACS; Alexander, David MD, FRCSC; Bailey, Stewart MD, FRCSC; Mahood, James MD, FRCSC; Abraham, Ed MD, FRCSC; McBroom, Robert MD, FRCSC; Jodoin, Alain MD, FRCSC; Fisher, Charles MD, FRCSC, MSc Author Information

10.1097/brs.0000000000000155

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rhBMP-2 for Posterolateral Instrumented Lumbar Fusion

Spine (2013)

R. John Hurlbert David Alexander Stewart I. Bailey James Mahood E. P. Abraham

Multicenter randomized controlled trial.To evaluate the effect of recombinant human bone morphogenetic protein (rhBMP-2) on radiographical fusion rate and clinical outcome for surgical lumbar arthrodesis compared with iliac crest autograft.In many types of spinal surgery, radiographical fusion is a primary outcome equally important to clinical improvement, ensuring long-term stability and axial support. Biologic induction of bone growth has become a commonly used adjunct in obtaining this objective. We undertook this study to objectify the efficacy of rhBMP-2 compared with traditional iliac crest autograft in instrumented posterolateral lumbar fusion.Patients undergoing 1- or 2-level instrumented posterolateral lumbar fusion were randomized to receive either autograft or rhBMP-2 for their fusion construct. Clinical and radiographical outcome measures were followed for 2 to 4 years postoperatively.One hundred ninety seven patients were successfully randomized among the 8 participating institutions. Adverse events attributable to the study drug were not significantly different compared with controls. However, the control group experienced significantly more graft-site complications as might be expected. 36-Item Short Form Health Survey, Oswestry Disability Index, and leg/back pain scores were comparable between the 2 groups. After 4 years of follow-up, radiographical fusion rates remained significantly higher in patients treated with rhBMP-2 (94%) than those who received autograft (69%) (P = 0.007).The use of rhBMP-2 for instrumented posterolateral lumbar surgery significantly improves the chances of radiographical fusion compared with the use of autograft. However, there is no associated improvement in clinical outcome within a 4-year follow-up period. These results suggest that use of rhBMP-2 should be considered in cases where lumbar arthrodesis is of primary concern.

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10.1097/brs.0000000000000007

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RESULTS OF POSTEROLATERAL FUSION VS. COMBINED POSTEROLATERAL AND INTERBODY FUSION IN ONE LEVEL DEGENERATIVE DISORDERS OF THE LUMBAR SPINE – TWO YEAR FOLLOWUP

Orthopaedic Proceedings (2008)

E. P. Abraham

The purpose of the study is to evaluate the outcome of two methods: Posterolateral fusion and instrumentation versus posterolateral fusion, instrumentation and interbody fusion using clinical and radiological criteria in demographically similar groups. This is a prospective cohort study of sixty-four patients randomized to two therapeutic strategies (Level II study). Sixty-four patients were randomized to either instrumented posterolateral fusion (control) or combined instrumented posterolateral and interbody fusion (study) in one level degenerative disorders of the lumbar spine. Demographics of the groups were similar including age, gender and other variables. The demographics of the groups were similar for one level degenerative disorders—disc herniation, spondylolisthesis and spinal stenosis. The primary outcome was measured by the Oswestry Disability Index at two years. There was no statistically significant difference. Secondary outcomes (SF36, VAS, fusion rate, disc height maintenance, maintenance of deformity correction, adjacent segment degeneration) were statistically similar in both groups. In conclusion, no clinical advantage with interbody fusion versus posterolateral fusion alone. Analysis of the correlation between the pedicle shape and the spinal canal anatomy in scoliotic anatomic specimens. S. Parent1, H. Labelle, W. Skalli, J. de Guise, 13175 Cote Ste-Catherine, Montreal, Quebec H3T 1C5. The objective of the present study was to analyze the correlation between the pedicle shape and spinal canal anatomy in scoliotic specimens. Vertebral canal anatomy was evaluated in a series of thirty anatomic scoliotic specimens and compared to thirty normal specimens. Spinal canal enlargement inversely correlated with pedicle width modifications on the concavity of scoliotic curves. These findings suggest that changes in pedicle anatomy are secondary to local changes in spinal cord position. Recent studies have demonstrated the close relationship between the spinal cord and the pedicle on the concavity of the scoliotic curve of patients with scoliotic deformities. The hypothesis of the present study is that changes in spinal canal shape are related to spinal cord position and resulting bone remodeling. This study evaluated the characteristic changes of spinal canal shape in anatomic scoliotic specimens. Posterior elements morphology is closely related to the local spinal cord anatomy and its relationship with the bony architecture. The characteristic posterior element changes seen in scoliosis are likely the result of local bone remodeling. Spinal asymmetry was observed in scoliotic specimens when compared to normal specimens. Spinal canal was enlarged asymmetrically on the concavity of thoracic scoliotic curves (p Spinal canal characteristic shape was evaluated in thirty scoliotic anatomic specimens and thirty normal anatomic specimens using twelve parameters representing measures of right and left hemi-canal length, width or surface area. The 3-D coordinates of eight points taken at the periphery of each spinal canal were recorded. The results of this study support the hypothesis that spinal canal shape is modified by the spinal cord position and that posterior element changes seen in scoliosis are in part due to bone remodeling in response to local neural anatomy modifications. Funding: Fonds de Recherche en Sante du Quebec

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