192. Use of BMP for adult spinal deformity surgery: patterns of usage and changes over the past decade

Abstract

BACKGROUND CONTEXT Bone morphogenetic protein (BMP) has been shown to increase fusion rates but cost, limited FDA approval, and possible complications impact its use. Decisions regarding BMP use and changes over time have not been well defined. PURPOSE To assess applications and dosing of BMP for adult spinal deformity (ASD) surgery and how these have changed over the past 10 years. STUDY DESIGN/SETTING Retrospective review of prospective multicenter database. PATIENT SAMPLE ASD patients from a prospective multicenter database. OUTCOME MEASURES BMP applications and dosing and changes over the past decade. METHODS ASD patients treated surgically from 2008-2018 with data available on BMP use were identified from a prospective multicenter database. Demographics, comorbidities, radiographic parameters, and surgical data were collected, including use of BMP, location of BMP use (anterior, posterior, or combined) and BMP dose. For assessment of BMP use over time, 3 intervals were created: 2008-2011 (n=312), 2012-2015 (n=433), and 2016-2018 (n=435). RESULTS A total of 1,180 patients met inclusion (mean age 60 yrs, 30% revision surgery). At baseline, patients had high disability (mean SRS-22 2.8, ODI 44, PCS 31.5), high frailty (mean ASD FI 1.8), and high comorbidities (mean Charlson 3.4). Sagittal malalignment was severe in more than 65% of patients based on SRS-Schwab modifiers. BMP was used in 73.9% of cases overall and in 72.7% of posterior-only and 72.1% of combined approach surgeries. For IBF, mean dose was 9.1 mg and use and dose increased from T10-11 to L5-S1 (1% vs 29.4% and 2 vs 4.7mg, respectively). Mean dose of BMP was 23.5 mg for posterior fusion. Patients receiving BMP had greater age (61.1 vs 57.9 yrs, p 0: 55.9% vs 70.8% vs 67.9%, respectively, p=0.003) and a higher incidence of previous surgery (21.5% vs 32.7% vs 34.0%, respectively, p=0.006). Similar increases were not noted for patients who did not receive BMP. For patients with posterior fusion without IBF, BMP use has increased over time (50.8% vs 75.2% vs 90.6%, respectively, p CONCLUSIONS In this large multicenter ASD series, BMP was used in the majority of cases, more commonly in older patients with greater frailty, greater comorbidities, and worse sagittal alignment. Over the last 10 years, BMP has been increasingly used for patients with greater severity of deformity and history of previous surgery. Although BMP use has continued to increase significantly for posterior-only surgery, the dose used has decreased. FDA DEVICE/DRUG STATUS Unavailable from authors at time of publication.