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Andrew Jea - One of the best experts on this subject based on the ideXlab platform.
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routine use of recombinant human bone morphogenetic protein 2 in posterior fusions of the pediatric Spine and incidence of cancer
Journal of Neurosurgery, 2015Co-Authors: Christina M Sayama, Thomas G Luerssen, Matthew Willsey, Murali Chintagumpala, Alison Brayton, Valentina Briceno, Sheila L Ryan, Steven W Hwang, Andrew JeaAbstract:OBJECT The aim of this study was to determine the safety of recombinant human bone morphogenetic protein-2 (rhBMP-2) use in posterior instrumented fusions in the pediatric population, focusing on cancer risk. In a previous study, the authors reported the short-term (mean follow-up of 11 months) safety and efficacy of rhBMP-2 in the pediatric age group. The present study reports their results with a minimum of 24 months' follow-up. METHODS The authors retrospectively reviewed 57 consecutive cases involving pediatric patients who underwent posterior occiptocervical, cervical, thoracic, lumbar, or Lumbosacral Spine fusion from October 1, 2007, to June 30, 2011, at Texas Children's Hospital. Seven cases were excluded from further analysis because of loss to follow-up. Three patients died during the follow-up period and were placed in a separate cohort. RESULTS The patients' average age at the time of surgery was 11 years, 4 months (range 9 months to 20 years). The mean duration of follow-up was 48.4 months (range 24-70 months). Cancer status was determined at the most recent encounter with the patient and/or caretaker(s) in person, or in telephone follow-up. Twenty-four or more months after administration of rhBMP-2, there were no cases of new malignancy, degeneration, or metastasis of existing tumors. The cause of death of the patients who died during the study period was not related to BMP or to the development, degeneration, or metastasis of cancer. CONCLUSIONS Despite the large number of adult studies reporting increased cancer risk associated with BMP use, the authors' outcomes with rhBMP-2 in the pediatric population suggest that it is a safe adjunct to posterior Spine fusions of the occipitocervical, cervical, thoracic, lumbar, and Lumbosacral Spine. There were no new cases of cancer, or degeneration or metastasis of existing malignancies in this series.
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routine use of recombinant human bone morphogenetic protein 2 in posterior fusions of the pediatric Spine safety profile and efficacy in the early postoperative period
Neurosurgery, 2010Co-Authors: Daniel K Fahim, William E Whitehead, Daniel J Curry, Robert C Dauser, Thomas G Luerssen, Andrew JeaAbstract:BACKGROUND: Previous studies using recombinant human bone morphogenetic protein-2 (rhBMP-2) in the adult lumbar Spine have shown consistently good results, There have been no pediatric case series. OBJECTIVE: To determine the safety and efficacy of rhBMP-2 use in posterior instrumented fusions of the pediatric population. METHODS: A retrospective review of 19 consecutive pediatric patients who underwent posterior occiptocervical, cervical, thoracic, lumbar, or Lumbosacral Spine fusion from October 1, 2007, to June 30, 2008, at Texas Children's Hospital was performed. The average age was approximately 12 years old (range, 9 months to 20 years). The minimum follow-up was 17 months (average of 19 months, range: 17-25 months), with computed tomography (CT) evaluation and grading of fusion by an independent radiologist at 3 months after surgery. RESULTS: The average CT grade was 3, indicating bilateral bridging bone. No pseudoarthroses or loss of correction was identified clinically or radiographically at 3 months and latest follow-up. There was one complication of bony overgrowth and restenosis of the spinal canal necessitating reoperation, and two superficial wound infections. There were no deep wound infections. CONCLUSION: Early outcomes using rhBMP-2 in the pediatric population show that it is a safe and efficacious adjunct to posterior Spine fusions of the occipitocervical, cervical, thoracic, lumbar, and Lumbosacral Spine. It dependably results in the development of stable bridging bone at 3 months after surgery with good maintenance of correction and stability in long-term follow-up. Lessons learned from the case of unexpected bony overgrowth are discussed.
Pattama Amarttayakong - One of the best experts on this subject based on the ideXlab platform.
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awareness of the median sacral artery during Lumbosacral spinal surgery an anatomic cadaveric study of its relationship to the Lumbosacral Spine
European Spine Journal, 2015Co-Authors: Surachai Saejung, Kimaporn Khamanarong, Worawut Woraputtaporn, Pattama AmarttayakongAbstract:Purpose The purpose was to investigate the median sacral artery (MSA) anatomical pathway in terms of its relationship to the Lumbosacral Spine.
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awareness of the median sacral artery during Lumbosacral spinal surgery an anatomic cadaveric study of its relationship to the Lumbosacral Spine
European Spine Journal, 2015Co-Authors: Surachai Saejung, Kimaporn Khamanarong, Worawut Woraputtaporn, Pattama AmarttayakongAbstract:The purpose was to investigate the median sacral artery (MSA) anatomical pathway in terms of its relationship to the Lumbosacral Spine. The posterior wall and Lumbosacral Spine of 54 adult embalmed cadavers were dissected. The MSA emerging point was identified. The distance from its emerging point to the lateral border of the vertebral body was measured bilaterally. The pathway of the MSA from the emerging point to the sacral promontory was described together with the MSA length. All outcomes were independently measured by two observers. Statistics on obtained data were calculated. Most of the MSA emerging points were at the L5 vertebral body (94.4 %). The emerging point from the right and left lateral border of the L5 vertebral body was 3.31 ± 0.54 cm and 2.39 ± 0.51 cm, respectively. The MSA then lay along the middle one-third of the anterior surface of the Lumbosacral junction. The mean length between the emerging point and the sacral promontory was 2.73 ± 0.97 cm. The MSA anatomy is important for prevention of intra-operative bleeding. For anterior Lumbosacral surgery, the MSA should be identified and controlled before proceeding with the spinal surgery. For posterior bicortical sacral screw placement, the screw tip should be fluoroscopically checked to avoid inserting the screw tip into the mid sacral promontory. By first approaching the anterior sacral promontory, the surgeon will find the MSA within the middle one-third zone, and 2.47–2.99 cm cephalad to this, the iliac vessels. Knowledge of the MSA helps the surgeon to operate more safely.
Thomas G Luerssen - One of the best experts on this subject based on the ideXlab platform.
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routine use of recombinant human bone morphogenetic protein 2 in posterior fusions of the pediatric Spine and incidence of cancer
Journal of Neurosurgery, 2015Co-Authors: Christina M Sayama, Thomas G Luerssen, Matthew Willsey, Murali Chintagumpala, Alison Brayton, Valentina Briceno, Sheila L Ryan, Steven W Hwang, Andrew JeaAbstract:OBJECT The aim of this study was to determine the safety of recombinant human bone morphogenetic protein-2 (rhBMP-2) use in posterior instrumented fusions in the pediatric population, focusing on cancer risk. In a previous study, the authors reported the short-term (mean follow-up of 11 months) safety and efficacy of rhBMP-2 in the pediatric age group. The present study reports their results with a minimum of 24 months' follow-up. METHODS The authors retrospectively reviewed 57 consecutive cases involving pediatric patients who underwent posterior occiptocervical, cervical, thoracic, lumbar, or Lumbosacral Spine fusion from October 1, 2007, to June 30, 2011, at Texas Children's Hospital. Seven cases were excluded from further analysis because of loss to follow-up. Three patients died during the follow-up period and were placed in a separate cohort. RESULTS The patients' average age at the time of surgery was 11 years, 4 months (range 9 months to 20 years). The mean duration of follow-up was 48.4 months (range 24-70 months). Cancer status was determined at the most recent encounter with the patient and/or caretaker(s) in person, or in telephone follow-up. Twenty-four or more months after administration of rhBMP-2, there were no cases of new malignancy, degeneration, or metastasis of existing tumors. The cause of death of the patients who died during the study period was not related to BMP or to the development, degeneration, or metastasis of cancer. CONCLUSIONS Despite the large number of adult studies reporting increased cancer risk associated with BMP use, the authors' outcomes with rhBMP-2 in the pediatric population suggest that it is a safe adjunct to posterior Spine fusions of the occipitocervical, cervical, thoracic, lumbar, and Lumbosacral Spine. There were no new cases of cancer, or degeneration or metastasis of existing malignancies in this series.
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routine use of recombinant human bone morphogenetic protein 2 in posterior fusions of the pediatric Spine safety profile and efficacy in the early postoperative period
Neurosurgery, 2010Co-Authors: Daniel K Fahim, William E Whitehead, Daniel J Curry, Robert C Dauser, Thomas G Luerssen, Andrew JeaAbstract:BACKGROUND: Previous studies using recombinant human bone morphogenetic protein-2 (rhBMP-2) in the adult lumbar Spine have shown consistently good results, There have been no pediatric case series. OBJECTIVE: To determine the safety and efficacy of rhBMP-2 use in posterior instrumented fusions of the pediatric population. METHODS: A retrospective review of 19 consecutive pediatric patients who underwent posterior occiptocervical, cervical, thoracic, lumbar, or Lumbosacral Spine fusion from October 1, 2007, to June 30, 2008, at Texas Children's Hospital was performed. The average age was approximately 12 years old (range, 9 months to 20 years). The minimum follow-up was 17 months (average of 19 months, range: 17-25 months), with computed tomography (CT) evaluation and grading of fusion by an independent radiologist at 3 months after surgery. RESULTS: The average CT grade was 3, indicating bilateral bridging bone. No pseudoarthroses or loss of correction was identified clinically or radiographically at 3 months and latest follow-up. There was one complication of bony overgrowth and restenosis of the spinal canal necessitating reoperation, and two superficial wound infections. There were no deep wound infections. CONCLUSION: Early outcomes using rhBMP-2 in the pediatric population show that it is a safe and efficacious adjunct to posterior Spine fusions of the occipitocervical, cervical, thoracic, lumbar, and Lumbosacral Spine. It dependably results in the development of stable bridging bone at 3 months after surgery with good maintenance of correction and stability in long-term follow-up. Lessons learned from the case of unexpected bony overgrowth are discussed.
Neil Mehta - One of the best experts on this subject based on the ideXlab platform.
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dosimetric predictors of acute hematologic toxicity in cervical cancer patients treated with concurrent cisplatin and intensity modulated pelvic radiotherapy
International Journal of Radiation Oncology Biology Physics, 2005Co-Authors: Loren K Mell, J D Kochanski, John C Roeske, Josh J Haslam, Neil MehtaAbstract:Purpose: To identify dosimetric parameters associated with acute hematologic toxicity (HT) and chemotherapy delivery in cervical cancer patients undergoing concurrent chemotherapy and intensity-modulated pelvic radiotherapy. Methods and Materials: We analyzed 37 cervical cancer patients receiving concurrent cisplatin (40 mg/m 2 /wk) and intensity-modulated pelvic radiotherapy. Pelvic bone marrow (BM) was contoured for each patient and divided into three subsites: Lumbosacral Spine, ilium, and lower pelvis. The volume of each region receiving 10, 20, 30, and >40 Gy (V10 ,V 20 ,V 30, and V40, respectively) was calculated. HT was graded according to the Radiation Therapy Oncology Group system. Multivariate regression models were used to test associations between dosimetric parameters and HT and chemotherapy delivery. Results: Increased pelvic BM V10 (BM-V10) was associated with an increased Grade 2 or worse leukopenia and neutropenia (odds ratio [OR], 2.09; 95% confidence interval [CI], 1.24‐3.53; p 0.006; and OR, 1.41; 95% CI, 1.02‐1.94; p 0.037, respectively). Patients with BM-V10 >90% had higher rates of Grade 2 or worse leukopenia and neutropenia than did patients with BM-V10 <90% (11.1% vs. 73.7%, p < 0.01; and 5.6% vs. 31.6%, p 0.09) and were more likely to have chemotherapy held on univariate (16.7% vs. 47.4%, p 0.08) and multivariate (OR, 32.2; 95% CI, 1.67‐622; p 0.02) analysis. No associations between HT and V30 and V40 were observed. Dosimetric parameters involving the Lumbosacral Spine and lower pelvis had stronger associations with HT than did those involving the ilium. Conclusion: The volume of pelvic BM receiving low-dose radiation is associated with HT and chemotherapy delivery in cervical cancer patients undergoing concurrent chemoradiotherapy. © 2006 Elsevier Inc. Intensity-modulated radiotherapy, Bone marrow, Cervical cancer, Hematologic toxicity.
Steven W Hwang - One of the best experts on this subject based on the ideXlab platform.
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routine use of recombinant human bone morphogenetic protein 2 in posterior fusions of the pediatric Spine and incidence of cancer
Journal of Neurosurgery, 2015Co-Authors: Christina M Sayama, Thomas G Luerssen, Matthew Willsey, Murali Chintagumpala, Alison Brayton, Valentina Briceno, Sheila L Ryan, Steven W Hwang, Andrew JeaAbstract:OBJECT The aim of this study was to determine the safety of recombinant human bone morphogenetic protein-2 (rhBMP-2) use in posterior instrumented fusions in the pediatric population, focusing on cancer risk. In a previous study, the authors reported the short-term (mean follow-up of 11 months) safety and efficacy of rhBMP-2 in the pediatric age group. The present study reports their results with a minimum of 24 months' follow-up. METHODS The authors retrospectively reviewed 57 consecutive cases involving pediatric patients who underwent posterior occiptocervical, cervical, thoracic, lumbar, or Lumbosacral Spine fusion from October 1, 2007, to June 30, 2011, at Texas Children's Hospital. Seven cases were excluded from further analysis because of loss to follow-up. Three patients died during the follow-up period and were placed in a separate cohort. RESULTS The patients' average age at the time of surgery was 11 years, 4 months (range 9 months to 20 years). The mean duration of follow-up was 48.4 months (range 24-70 months). Cancer status was determined at the most recent encounter with the patient and/or caretaker(s) in person, or in telephone follow-up. Twenty-four or more months after administration of rhBMP-2, there were no cases of new malignancy, degeneration, or metastasis of existing tumors. The cause of death of the patients who died during the study period was not related to BMP or to the development, degeneration, or metastasis of cancer. CONCLUSIONS Despite the large number of adult studies reporting increased cancer risk associated with BMP use, the authors' outcomes with rhBMP-2 in the pediatric population suggest that it is a safe adjunct to posterior Spine fusions of the occipitocervical, cervical, thoracic, lumbar, and Lumbosacral Spine. There were no new cases of cancer, or degeneration or metastasis of existing malignancies in this series.
