714375 - Use of BMP for Adult Spinal Deformity Surgery: Patterns of Usage and Changes over the past Decade

Thursday, February 27, 2020

8:35 AM – 8:40 AM

Location: Ballroom B

Participants should be aware of the following financial/non-financial relationships:

Mathieu Bannwarth, MD: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Justin S. Smith, MD: AlloSource (Individual(s) Involved: Self, Products/Services: none): consultant; Alphatec (Individual(s) Involved: Self, Products/Services: stock owner): stock owner; AOSpine (Individual(s) Involved: Self, Products/Services: fellowship support): fellowship support; Cerapedics (Individual(s) Involved: Self, Products/Services: none): consultant; Depuy Synthes (Individual(s) Involved: Self, Products/Services: Research study group support): Research study group support; NREF (Individual(s) Involved: Self, Products/Services: fellowship support): fellowship support; NuVasive (Individual(s) Involved: Self, Products/Services: implants): consultant, royalties; Stryker/K2M (Individual(s) Involved: Self, Products/Services: BACS): consultant; Zimmer Biomet (Individual(s) Involved: Self, Products/Services: Instrumentation): consultant, royalties

Shay Bess, MD: Depuy Synthes (Individual(s) Involved: Self, Products/Services: Research): Research; Globus (Individual(s) Involved: Self, Products/Services: Research): Research; Medtronic (Individual(s) Involved: Self, Products/Services: Research): Research; NuVasive (Individual(s) Involved: Self, Products/Services: Research): Research; SI Bone (Individual(s) Involved: Self, Products/Services: Research): Research; Stryker/K2M (Individual(s) Involved: Self, Products/Services: Research): Research

Eric Klineberg, MD: AOSpine (Individual(s) Involved: Self, Products/Services: Honoraria and Fellowship Grant): ; Depuy Synthes (Individual(s) Involved: Self, Products/Services: Consulting): ; Medicrea (Individual(s) Involved: Self, Products/Services: Consulting): ; Stryker (Individual(s) Involved: Self, Products/Services: Consulting):

Christopher P. Ames, MD: BIOMET (Now ZIMMER BIOMET) (Individual(s) Involved: Self, Products/Services: Consulting): Consulting; BIOMET (Now ZIMMER BIOMET) (Individual(s) Involved: Self, Products/Services: Royalties): Royalties; Depuy Synthes (Individual(s) Involved: Self, Products/Services: Consulting): Consulting; Depuy Synthes (Individual(s) Involved: Self, Products/Services: Research): Research; Depuy Synthes (Individual(s) Involved: Self, Products/Services: Royalties): Royalties; Global Spine Analytics (Individual(s) Involved: Self, Products/Services: Director): Director; International Spine Study Group (Individual(s) Involved: Self, Products/Services: Executive Committee): Executive Committee; International Spine Study Group (Individual(s) Involved: Self, Products/Services: Research): Research; K2M (Individual(s) Involved: Self, Products/Services: Consulting): Consulting; K2M (Individual(s) Involved: Self, Products/Services: Royalties): Royalties; Medicrea (Individual(s) Involved: Self, Products/Services: Royalties): Royalties; Medtronic (Individual(s) Involved: Self, Products/Services: Consulting): Consulting; Next Orthosurgical (Individual(s) Involved: Self, Products/Services: Royalties): Royalties; NuVasive (Individual(s) Involved: Self, Products/Services: Royalties): Royalties; Operative Neurosurgery (Individual(s) Involved: Self, Products/Services: Editorial Board): Editorial Board; Scoliosis Research Society (SRS) (Individual(s) Involved: Self, Products/Services: Grant Funding): Grant Funding; Stryker (Individual(s) Involved: Self, Products/Services: Consulting): Consulting; Stryker (Individual(s) Involved: Self, Products/Services: Royalties): Royalties; Titan Spine (Individual(s) Involved: Self, Products/Services: Research): Research

Robert A. Hart, MD, MA, MHCDS, FAOA: Depuy Synthes (Individual(s) Involved: Self, Products/Services: Consulting): ; Globus Medical (Individual(s) Involved: Self, Products/Services: Consulting): ; Medtronic (Individual(s) Involved: Self, Products/Services: Consulting): ; SeaSpine (Individual(s) Involved: Self, Products/Services: Consulting):

Gregory M. Mundis, Jr., MD: K2M Stryker Spine (Individual(s) Involved: Self, Products/Services: Royalties, consulting): ; NuVasive, Inc (Individual(s) Involved: Self, Products/Services: royalties, consulting, research support, stock): ; SeaSpine (Individual(s) Involved: Self, Products/Services: consulting): ; VISEON (Individual(s) Involved: Self, Products/Services: royalties, consulting):

Renaud Lafage, MS: Nemaris (Individual(s) Involved: Self, Products/Services: Ownership interest):

Munish C. Gupta, MD: Alphatec (Individual(s) Involved: Self, Products/Services: consultant): consultant, travel; AO Spine (Individual(s) Involved: Self, Products/Services: speaker): honorarium; Depuy Spine (Individual(s) Involved: Self, Products/Services: consultant): Royalty, consultant, advisory, travel; Globus (Individual(s) Involved: Self, Products/Services: travel): travel; Innomed (Individual(s) Involved: Self, Products/Services: instruments): royalty; Johnson & Johnson (Individual(s) Involved: Self, Products/Services: stock): stock; Medtronic (Individual(s) Involved: Self, Products/Services: consultant): consultant, advisory, travel; Proctor & Gamble (Individual(s) Involved: Self, Products/Services: stock): stock; Scoliosis Research Society (Individual(s) Involved: Self, Products/Services: faculty): travel as faculty

Douglas Burton, MD: Bioventus (Individual(s) Involved: Self, Products/Services: Consultant): Consultant; Depuy Spine (Individual(s) Involved: Self, Products/Services: Research support, consultant, royalties): ; Pfizer (Individual(s) Involved: Self, Products/Services: Research support): Research support; Progenerative Medical (Individual(s) Involved: Self, Products/Services: Stock): Consultant.

Christopher I. Shaffrey, MD: Disclosure information not submitted.

Frank Schwab, MD: Globus Medical (Individual(s) Involved: Self, Products/Services: product design): consulting; International Spine Study Group (Individual(s) Involved: Self, Products/Services: n/a): advisory board; K2 Medical, LLC (Individual(s) Involved: Self, Products/Services: Royalties): Royalties; Medicrea (Individual(s) Involved: Self, Products/Services: n/a): Royalties; Medtronic (Individual(s) Involved: Self, Products/Services: Royalties): Royalties

Virginie Lafage, PhD: Depuy Spine (Individual(s) Involved: Self, Products/Services: n/a): Speaking/teaching arrangements; Globus Medical (Individual(s) Involved: Self, Products/Services: n/a): consulting; International Spine Study Group (Individual(s) Involved: Self, Products/Services: n/a): advisory board; NuVasive (Individual(s) Involved: Self, Products/Services: n/a): consulting

International Spine Study Group: AlloSource (Individual(s) Involved: Self, Products/Services: na): Research; Depuy Synthes (Individual(s) Involved: Self, Products/Services: na): Research; Globus Medical, Inc. (Individual(s) Involved: Self, Products/Services: na): Research; Medtronic Inc. (Individual(s) Involved: Self, Products/Services: na): Research; NuVasive, Inc (Individual(s) Involved: Self, Products/Services: na): Research; Orthofix (Individual(s) Involved: Self, Products/Services: na): Research; SI Bone (Individual(s) Involved: Self, Products/Services: na): Research; Stryker/K2M (Individual(s) Involved: Self, Products/Services: na): Research

Background: 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: The study aims at assessing applications and dosing of BMP for ASD surgery and how these have changed over the past 10 years.
Study Design/Setting: Retrospective review of prospective multicenter database
Eligible population: ASD patients from a prospective multicenter database
Length of follow-up: N/A
Patient accountability: N/A
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: 1,180 pts met inclusion (60 years old, 30% revisions). BMP was used in 74% of cases overall and in 73% of posterior-only and 72% of combined approach surgeries. Mean BMP doses for interbody fusion (IBF) and posterior fusion were 9.1 mg and 23.5 mg, respectively. Patients receiving BMP had greater age (61 vs 58 years old, p 0: 56% vs 71% vs 68%, p = 0.003) and incidence of previous surgery (22% vs 33% vs 34%, p = 0.006). Similar increases were not noted for patients who did not receive BMP. For patients with posterior fusion without IBF, BMP use increased over time (50.8% vs 75.2% vs 90.6%, p < 0.001) but not the BMP dose. For patients with posterior fusion with IBF, BMP use increased then decreased (70% vs 82% vs 71%, p = 0.002) while BMP dose decreased overtime for posterior fusion (28.9 vs 24.0 vs 18.7 mg, p < 0.001), for TLIF and PLIF (7.8 vs 9.0 vs 4.5 mg p < 0.001) and for ALIF and LLIF (14.2 vs 12.3 vs 8.9 mg, p < 0.001). Sub-analysis by sites and by surgeons who enrolled during the entire timeframe demonstrated similar findings.

Conclusion: 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.

Presenting Author(s)

Mathieu Bannwarth, MD

Research fellow
Hospital for Special Surgery

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

Justin S. Smith, MD

Harrison Distinguished Professor of Neurosurgery
University of Virginia Health System : Spine Center

Disclosure: AlloSource : consultant (Status: Ongoing); Alphatec : stock owner (Status: Ongoing); AOSpine : fellowship support (Status: Ongoing); Cerapedics : consultant (Status: Ongoing); Depuy Synthes : Research study group support (Status: Ongoing); NREF : fellowship support (Status: Ongoing); NuVasive : consultant, royalties (Status: Ongoing); Stryker/K2M : consultant (Status: Ongoing); Zimmer Biomet : consultant, royalties (Status: Ongoing)
Shay Bess, MD

Spine surgeon
Presbyterian St. Luke’s Medical Center - Rocky Mountain Hospital for Children

Disclosure: Depuy Synthes : Research (Status: Ongoing); Globus : Research (Status: Ongoing); Medtronic : Research (Status: Ongoing); NuVasive : Research (Status: Ongoing); SI Bone : Research (Status: Ongoing); Stryker/K2M : Research (Status: Ongoing)
Eric Klineberg, MD

Professor, Vice Chair Department of Orthopaedic Surgery
University of California, Davis

Disclosure: AOSpine (Individual(s) Involved: Self, Products/Services: Honoraria and Fellowship Grant): ; Depuy Synthes (Individual(s) Involved: Self, Products/Services: Consulting): ; Medicrea (Individual(s) Involved: Self, Products/Services: Consulting): ; Stryker (Individual(s) Involved: Self, Products/Services: Consulting):
Christopher P. Ames, MD

Professor of Clinical Neurological Surgery and Orthopaedic Surgery
UCSF

Disclosure: BIOMET (Now ZIMMER BIOMET) : Consulting (Status: Ongoing), Royalties (Status: Ongoing); Depuy Synthes : Consulting (Status: Ongoing), Research (Status: Ongoing), Royalties (Status: Ongoing); Global Spine Analytics : Director (Status: Ongoing); International Spine Study Group : Executive Committee (Status: Ongoing), Research (Status: Ongoing); K2M : Consulting (Status: Ongoing), Royalties (Status: Ongoing); Medicrea : Royalties (Status: Ongoing); Medtronic : Consulting (Status: Ongoing); Next Orthosurgical : Royalties (Status: Ongoing); NuVasive : Royalties (Status: Ongoing); Operative Neurosurgery : Editorial Board (Status: Ongoing); Scoliosis Research Society (SRS) : Grant Funding (Status: Ongoing); Stryker : Consulting (Status: Ongoing), Royalties (Status: Ongoing); Titan Spine : Research (Status: Ongoing)
Robert A. Hart, MD, MA, MHCDS, FAOA

Surgeon
Swedish Neuroscience Institute

Disclosure: Depuy Synthes (Individual(s) Involved: Self, Products/Services: Consulting): ; Globus Medical (Individual(s) Involved: Self, Products/Services: Consulting): ; Medtronic (Individual(s) Involved: Self, Products/Services: Consulting): ; SeaSpine (Individual(s) Involved: Self, Products/Services: Consulting):
Gregory M. Mundis, Jr., MD

Co-Director San Diego Spine Fellowship
San Diego Center for Spinal Disorders

Disclosure: K2M Stryker Spine (Individual(s) Involved: Self, Products/Services: Royalties, consulting): ; NuVasive, Inc (Individual(s) Involved: Self, Products/Services: royalties, consulting, research support, stock): ; SeaSpine (Individual(s) Involved: Self, Products/Services: consulting): ; VISEON (Individual(s) Involved: Self, Products/Services: royalties, consulting):
Renaud Lafage, MS

Scientist
Hospital For Special Surgery

Disclosure: Nemaris (Individual(s) Involved: Self, Products/Services: Ownership interest):
Munish C. Gupta, MD

Mildred B. Simon Distinguished Professor of Orthopaedic Surgery, Professor of Neurological Surgery
Department of Orthopaedic Surgery, Washington University

Disclosure: Alphatec : consultant, travel (Status: Terminated --- 2019); AO Spine : honorarium (Status: Ongoing); Depuy Spine : Royalty, consultant, advisory, travel (Status: Ongoing); Globus : travel (Status: Terminated --- ); Innomed : royalty (Status: Ongoing); Johnson & Johnson : stock (Status: Ongoing); Medtronic : consultant, advisory, travel (Status: Ongoing); Proctor & Gamble : stock (Status: Ongoing); Scoliosis Research Society : travel as faculty (Status: Ongoing)
Douglas Burton, MD

Professor of Orthopedic Surgery
Kansas University Medical Center

Disclosure: Bioventus : Consultant (Status: Terminated --- 2019); Pfizer : Research support (Status: Terminated --- 2019); Progenerative Medical : Consultant. (Status: Ongoing)
Christopher I. Shaffrey, MD

Duke University

Disclosure: Disclosure information not submitted.
Frank Schwab, MD

attending surgeon
Hospital for Special Surgery

Disclosure: Globus Medical : consulting (Status: Ongoing); International Spine Study Group : advisory board (Status: Ongoing); K2 Medical, LLC : Royalties (Status: Ongoing); Medicrea : Royalties (Status: Ongoing); Medtronic : Royalties (Status: Ongoing)
Virginie Lafage, PhD

Senior Director Spine Research
Hospital for Special Surgery
Hospital for Special Surgery

Disclosure: Depuy Spine : Speaking/teaching arrangements (Status: Ongoing); Globus Medical : consulting (Status: Ongoing); International Spine Study Group : advisory board (Status: Ongoing); NuVasive : consulting (Status: Ongoing)
International Spine Study Group

na
ISSGF

Disclosure: AlloSource : Research (Status: Ongoing); Depuy Synthes : Research (Status: Ongoing); Globus Medical, Inc. : Research (Status: Ongoing); Medtronic Inc. : Research (Status: Ongoing); NuVasive, Inc : Research (Status: Ongoing); Orthofix : Research (Status: Ongoing); SI Bone : Research (Status: Ongoing); Stryker/K2M : Research (Status: Ongoing)