Biomimetic calcium phosphate coatings as bone morphogenetic protein delivery systems in spinal fusion.

BACKGROUND CONTEXT: Use of recombinant human bone morphogenetic protein-2 (rhBMP-2) has been shown to enhance spinal fusion rates. Case reports of soft-tissue swelling, ectopic bone formation, and osteolysis have recently surfaced. It is hypothesized that incorporation of rhBMP-2 within a calcium phosphate (CaP) coating may help to localize delivery and mitigate these complications. PURPOSE: To compare the characteristics of posterolateral fusion between rabbits receiving rhBMP-2 delivered via physical adsorption to a collagen sponge or rhBMP-2 incorporated within the physical structure of a CaP coating on a collagen sponge. STUDY DESIGN/SETTING: New Zealand white rabbit model of posterolateral lumbar fusion at L5-L6. METHODS: Eighteen (18) New Zealand white rabbits underwent posterolateral spinal fusion at L5-L6. Rabbits received bilateral collagen sponges that were either coated with CaP (n=3), coated with CaP and dipped in rhBMP-2 (n=3), coated with a hybrid CaP-rhBMP-2 film (n=6), or coated with a hybrid CaP-rhBMP-2 film and dipped in rhBMP-2 (n=6). Animals were followed weekly with radiographs and were sacrificed at 6 weeks. Fusion masses were further characterized by manual palpation, computed tomography, and histology. RESULTS: Radiographic evaluation showed that animals in Group 3 (incorporated BMP) fused at 4 weeks, whereas animals in Group 2 (adsorbed BMP) and Group 4 (incorporated and adsorbed BMP) fused by 6 weeks. Animals that received rhBMP-2 physically adsorbed to the collagen sponge showed extension of the fusion mass beyond the L5-L6 level in 56% of cases and bone resorption in 78%. Histology of fusion masses showed mature bone formation in animals belonging to Groups 2, 3, and 4 and extensive osteoclast recruitment in animals belonging to Groups 2 and 4. CONCLUSIONS: Delivery of rhBMP-2 via incorporation within CaP coatings results in increased rates of radiographic fusion. The burst release profile of rhBMP-2 adsorbed to surfaces, although effective in achieving fusion, may result in increased osteoclast recruitment.

Hodgkin lymphoma presenting as multiple cavitary pulmonary nodules with associated mediastinal adenopathy and neck mass.

Hodgkin lymphoma involving the lung may present in a variety of radiographic and clinical patterns including solid or necrotizing lesions, with or without associated mediastinal adenopathy. Cavitary pulmonary lesions are exceedingly rare, occurring in less than 1% of cases, and are typically solitary. We report a case of an 18-year-old male presenting with multiple cavitating pulmonary nodules and a palpable mass in the neck. Imaging revealed associated mediastinal and cervical adenopathy. Biopsy of the neck mass and lung nodule initially revealed necrosis and granulomata, suggesting infection. Treatment for a presumed infectious etiology was without resolution. Subsequent open lung biopsy revealed marked granulomatous inflammation with diagnostic Reed-Sternberg cells. Hodgkin lymphoma should always be considered in the differential diagnosis of cavitary pulmonary lesions, especially those refractory to treatment.