Case Reports   |    
Formation of Abdominal Heterotopic Bone Following the Utilization of Bone Morphogenetic Protein in Anterior Lumbar Spinal FusionA Case Report
Shaun F. Steeby, MD1; Joel T. Jeffries, MD1; Theodore J. Choma, MD1; Craig A. Kuhns, MD1
1 Department of Orthopaedic Surgery, University of Missouri, Missouri Orthopaedic Institute, 1100 Virginia Avenue, DC953.00, Columbia, MO 65212. E-mail address for C.A. Kuhns: craigkuhns@yahoo.com
View Disclosures and Other Information
  • Disclosure statement for author(s): PDF

Investigation performed at the Department of Orthopaedic Surgery, University of Missouri, Missouri Orthopaedic Institute, Columbia, Missouri

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2014 by The Journal of Bone and Joint Surgery, Inc.
JBJS Case Connector, 2014 Jan 08;4(1):e5 1-4. doi: 10.2106/JBJS.CC.M.00113
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case


INFUSE (Medtronic), or recombinant human bone morphogenetic protein-2 (rhBMP-2), was introduced in 2002 as an osteoinductive material to increase spinal fusion rates with the potential to eliminate the morbidity associated with bone-grafting of the iliac crest. This U.S. Food and Drug Administration (FDA)-approved indication is to use INFUSE as an adjuvant in achieving fusion with the LT-Cage Lumbar Tapered Fusion Device (Medtronic) in anterior lumbar interbody fusion (ALIF). Off-label use is widespread and includes implementation in anterior cervical fusion, anterior lumbar fusion with implants other than the LT-Cage, and posterior lumbar fusion1. Epstein and Schwall reported that 96% of their institution’s use of rhBMP-2 was off-label, with an estimated cost of $4,547,822 for one year2. A number of reports have recently cited complications, including hematoma and seroma formation; soft-tissue swelling; heterotopic bone formation; vertebral osteolysis; bowel, bladder, and sexual dysfunction; and neurologic deficit3. Another major concern is the potential association of malignancy arising in patients in whom rhBMP-2 has been used4-6. More studies are needed to further our understanding of this association.
Figures in this Article

    First Page Preview

    View Large
    First page PDF preview
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS Case Connector?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org


    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe

    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Treatment & Procedures
    Topic Collections
    Related Audio and Videos
    PubMed Articles
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    S. Carolina - Department of Orthopaedic Surgery Medical Univerity of South Carlonina
    Pennsylvania - Penn State Milton S. Hershey Medical Center
    Oklahoma - The University of Oklahoma
    Louisiana - Ochsner Health System