# Relationship between BMP2/9 Levels and Spinal Function and Quality of Life in Patients with Severe Scoliosis after PVCR

Authors: Quan Li; Zhi Zhao; Jingming Xie; Ying Zhang; Tao Li; Yingsong Wang
Journal: Evidence-Based Complementary and Alternative Medicine
 (2021)

---

## Abstract

Objective. To explore the relationship between (bone fusion associated protein) bone morphogenetic protein (BMP)2 and BMP9 and spinal function and quality of life in patients with severe scoliosis after posterior vertebral column resection (PVCR). Methods. 78 cases of severe scoliosis treated with PVCR surgery in our hospital from January 2015 to April 2018 were selected and set as the observation group, and 80 health examiners in the same period were selected and set as the control group. The ELISA method was used to detect the levels of BMP2 and BMP9 in the two groups. Also, the relationship between the recovery of spinal function, quality of life, and serum BMP2 and BMP9 in the observation group was analyzed. The receiver operating characteristic curve was used to evaluate the predictive value of BMP2 and BMP9 for complications after PVCR. Results. One month after PVCR, the serum BMP2 and BMP9 levels of patients with severe scoliosis were higher than those of healthy people P<0.05. One year after PVCR, Pearson correlation analysis showed that serum levels of BMP2 and BMP9 in patients with scoliosis were positively correlated with ODI scores (r = 0.778, P<0.001; r = 0.746, P<0.001), SRS-22 scores (r = 0.758, P<0.001; r = 0.722, P<0.001), and Cobb angle correction rate (r = 0.838, P<0.001; r = 0.802, P<0.001). Conclusion. The levels of BMP2 and BMP9 of patients with scoliosis after PVCR are higher than those of healthy people. After 1-year follow-up, the patients’ serum BMP2 and BMP9 levels were positively correlated with spinal function recovery, quality of life, and surgical efficacy. Among them, BMP2 and BMP9 had the highest correlation with PVCR surgical efficacy. Paying attention to the serum BMP2 and BMP9 levels of patients with scoliosis has certain clinical significance.


---

## Body

## 1. Introduction

Severe scoliosis means that the Cobb angle of the coronal plane is greater than 90 degrees, which can lead to stiffness and stability of the spine of the patient, resulting in thoracic deformation, abnormal heart and lung development, and impaired respiratory function; this causes serious damage to the patient’s appearance, spine physiological function, and quality of life [1, 2]. At present, surgery is the main method of treatment for patients with severe scoliosis. Among all surgical methods, PVCR is one of the most effective surgical methods for the treatment of severe scoliosis and has been universally recognized by many scholars around the world [3, 4]. However, the treatment effect of PVCR on patients’ spinal deformity, function, and quality of life still needs to be improved. Moreover, there are large individual differences in its effect. Bone morphogenetic protein (BMP) has osteogenic activity and can induce the formation of chondrocytes and bone cells. It has important value in the research of fractures, nonunion, and other bone diseases. In terms of treatment, BMP can not only independently mediate and promote bone formation but also mix with other bone growth factors to enhance their efficacy in disease recovery, with BMP2 being the most effective, followed by BMP9 [5, 6]. However, there are few reports on the relationship between the recovery of scoliosis patients after orthopedic surgery and the level of BMP. This study explores the relationship between BMP2 and BMP9 levels and spinal function and quality of life in patients with severe scoliosis after PVCR.


## 2. Materials and Methods

### 2.1. Research Object

78 cases of severe scoliosis treated with PVCR surgery in our hospital from January 2015 to April 2018 were selected and set as the observation group. Inclusion criteria were as follows: follow-up time over 2 years, PVCR operations are performed by the same doctors, and no other related treatment was given. Exclusion criteria were as follows: clinical information is missing or incomplete, combined with other serious diseases, and estimated time to live is less than 2 years. The observation group consists of 46 males and 32 females, aged 20–60 years, with an average age of 30.21 ± 9.88 years. Course of disease ranged from 5 to 20 years, with an average of 6.97 years. 80 health examiners in the same period were selected and set as the control group (age: 20–60 years and average age: 33.56 ± 9.74 years).


### 2.2. Research Methods

Fasting venous blood was drawn in the morning of one month after PVCR operation in patients of the observation group, and the levels of serum BMP2 and BMP9 were detected by ELISA. In the control group, the levels were detected at the same time during physical examination.After 1-year follow-up, the Oswestry Disability Index (ODI) questionnaire was used to judge the patient’s spinal function recovery. The lower the ODI score, the better the spinal function. The Scoliosis Research Society health-related quality of life questionnaire 22 (SRS-22) was used to determine the quality of life of patients. SRS-22 included five dimensions of pain, functional activity, self-image, psychological state, and treatment satisfaction. The higher the SRS-22 score was, the better the quality of life of patients would be. Cobb angle correction rate is used to judge the patient’s surgical efficacy. Cobb angle correction rate = (preoperative Cobb angle − Cobb angle at follow-up)/preoperative Cobb angle × 100%. The higher the Cobb angle correction rate and better trunk and shoulder balance, the better the surgical effect. The ELISA method was used to detect serum BMP2 and BMP9 levels in patients. The correlation between BMP2 and BMP9 and ODI, SRS-22, and Cobb angle correction rate in patients was analyzed.


### 2.3. Statistical Methods

The SPSS19.0 software was used for processing, measurement data are expressed as mean ± standard deviation (mean ± SD), and pairwise comparison is analyzed by thet-test. Correlation analysis adopts Pearson correlation analysis. P<0.05 indicates that the difference is statistically significant.


## 2.1. Research Object

78 cases of severe scoliosis treated with PVCR surgery in our hospital from January 2015 to April 2018 were selected and set as the observation group. Inclusion criteria were as follows: follow-up time over 2 years, PVCR operations are performed by the same doctors, and no other related treatment was given. Exclusion criteria were as follows: clinical information is missing or incomplete, combined with other serious diseases, and estimated time to live is less than 2 years. The observation group consists of 46 males and 32 females, aged 20–60 years, with an average age of 30.21 ± 9.88 years. Course of disease ranged from 5 to 20 years, with an average of 6.97 years. 80 health examiners in the same period were selected and set as the control group (age: 20–60 years and average age: 33.56 ± 9.74 years).


## 2.2. Research Methods

Fasting venous blood was drawn in the morning of one month after PVCR operation in patients of the observation group, and the levels of serum BMP2 and BMP9 were detected by ELISA. In the control group, the levels were detected at the same time during physical examination.After 1-year follow-up, the Oswestry Disability Index (ODI) questionnaire was used to judge the patient’s spinal function recovery. The lower the ODI score, the better the spinal function. The Scoliosis Research Society health-related quality of life questionnaire 22 (SRS-22) was used to determine the quality of life of patients. SRS-22 included five dimensions of pain, functional activity, self-image, psychological state, and treatment satisfaction. The higher the SRS-22 score was, the better the quality of life of patients would be. Cobb angle correction rate is used to judge the patient’s surgical efficacy. Cobb angle correction rate = (preoperative Cobb angle − Cobb angle at follow-up)/preoperative Cobb angle × 100%. The higher the Cobb angle correction rate and better trunk and shoulder balance, the better the surgical effect. The ELISA method was used to detect serum BMP2 and BMP9 levels in patients. The correlation between BMP2 and BMP9 and ODI, SRS-22, and Cobb angle correction rate in patients was analyzed.


## 2.3. Statistical Methods

The SPSS19.0 software was used for processing, measurement data are expressed as mean ± standard deviation (mean ± SD), and pairwise comparison is analyzed by thet-test. Correlation analysis adopts Pearson correlation analysis. P<0.05 indicates that the difference is statistically significant.


## 3. Results

### 3.1. Serum BMP2 and BMP9 Levels in Patients with Severe Scoliosis after PVCR

One month after PVCR, the serum BMP2 and BMP9 levels of patients with severe scoliosis were higher than those of healthy peopleP<0.05, as shown in Table 1.Table 1
Comparison of clinical efficacy of the two groups (n, %).
GroupnBMP2 (ng/L)BMP9 (ng/L)Control group80145.69 ± 29.750.87 ± 0.26Observation group78181.67 ± 27.461.13 ± 0.31t value7.9025.705P value<0.001<0.001


### 3.2. Correlation between Serum BMP2 and BMP9 and Spinal Function in Patients with Scoliosis after PVCR

One year after PVCR, Pearson correlation analysis showed that serum levels of BMP2 and BMP9 in patients with scoliosis were positively correlated with ODI scores (r = 0.778, P<0.001; r = 0.746, P<0.001), as shown in Figures 1 and 2.Figure 1
Correlation between BMP2 and ODI in patients with scoliosis after PVCR.Figure 2
Correlation between BMP9 and ODI in patients with scoliosis after PVCR.


### 3.3. Correlation between Serum BMP2 and BMP9 and Quality of Life in Patients with Scoliosis after PVCR

One year after PVCR, Pearson correlation analysis showed that serum levels of BMP2 and BMP9 in patients with scoliosis were positively correlated with SRS-22 scores (r = 0.758, P<0.001; r = 0.722, P<0.001), as shown in Figures 3 and 4.Figure 3
Correlation between BMP2 and SRS-22 in patients with scoliosis after PVCR.Figure 4
Correlation between BMP9 and SRS-22 in patients with scoliosis after PVCR.


### 3.4. Correlation between Serum BMP2 and BMP9 and Surgical Effect in Patients with Scoliosis

One year after PVCR, Pearson correlation analysis showed that serum levels of BMP2 and BMP9 in patients with scoliosis were positively correlated with Cobb angle correction rate (r = 0.838, P<0.001; r = 0.802, P<0.001), as shown in Figures 5 and 6.Figure 5
Correlation between BMP2 and Cobb angle correction rate in patients with scoliosis after PVCR.Figure 6
Correlation between BMP9 and Cobb angle correction rate in patients with scoliosis after PVCR.


## 3.1. Serum BMP2 and BMP9 Levels in Patients with Severe Scoliosis after PVCR

One month after PVCR, the serum BMP2 and BMP9 levels of patients with severe scoliosis were higher than those of healthy peopleP<0.05, as shown in Table 1.Table 1
Comparison of clinical efficacy of the two groups (n, %).
GroupnBMP2 (ng/L)BMP9 (ng/L)Control group80145.69 ± 29.750.87 ± 0.26Observation group78181.67 ± 27.461.13 ± 0.31t value7.9025.705P value<0.001<0.001


## 3.2. Correlation between Serum BMP2 and BMP9 and Spinal Function in Patients with Scoliosis after PVCR

One year after PVCR, Pearson correlation analysis showed that serum levels of BMP2 and BMP9 in patients with scoliosis were positively correlated with ODI scores (r = 0.778, P<0.001; r = 0.746, P<0.001), as shown in Figures 1 and 2.Figure 1
Correlation between BMP2 and ODI in patients with scoliosis after PVCR.Figure 2
Correlation between BMP9 and ODI in patients with scoliosis after PVCR.


## 3.3. Correlation between Serum BMP2 and BMP9 and Quality of Life in Patients with Scoliosis after PVCR

One year after PVCR, Pearson correlation analysis showed that serum levels of BMP2 and BMP9 in patients with scoliosis were positively correlated with SRS-22 scores (r = 0.758, P<0.001; r = 0.722, P<0.001), as shown in Figures 3 and 4.Figure 3
Correlation between BMP2 and SRS-22 in patients with scoliosis after PVCR.Figure 4
Correlation between BMP9 and SRS-22 in patients with scoliosis after PVCR.


## 3.4. Correlation between Serum BMP2 and BMP9 and Surgical Effect in Patients with Scoliosis

One year after PVCR, Pearson correlation analysis showed that serum levels of BMP2 and BMP9 in patients with scoliosis were positively correlated with Cobb angle correction rate (r = 0.838, P<0.001; r = 0.802, P<0.001), as shown in Figures 5 and 6.Figure 5
Correlation between BMP2 and Cobb angle correction rate in patients with scoliosis after PVCR.Figure 6
Correlation between BMP9 and Cobb angle correction rate in patients with scoliosis after PVCR.


## 4. Discussion

Severe scoliosis (Cobb angle > 90°) has an impact on the patient’s appearance, physical function, psychological and emotional health, social communication, and other aspects, which is extremely harmful, and its treatment is also more difficult [7]. PVCR is the main surgical method for the treatment of severe scoliosis, but the efficacy of PVCR in different patients varies greatly, and the postoperative recovery time is longer, up to 6 months to 1 year [8, 9]. Bone morphogenetic proteins (BMPs) are a group of highly conservative functional proteins with similar structures and belong to the TGF-β family. BMP can stimulate DNA synthesis and cell replication, thus promoting the directional differentiation of mesenchymal cells into osteoblasts. It is also the main factor that induces the formation of bone and cartilage in vivo and is expressed in limb growth, endochondral ossification, early fracture, and cartilage repair. It plays an important role in bone embryonic development, regeneration, and repair, with BMP2 and BMP9 being the most prominent.This study found that there were significant differences in serum levels of BMP2 and BMP9 between patients with scoliosis after PVCR and healthy people, and the levels of patients were higher than those of healthy people. This situation may be caused by the following reasons: (1) the etiology of some patients with scoliosis is closely related to the abnormal secretion of BMP and other bone growth-promoting factors. The long-term abnormal increase of BMP and other factors can induce the aggravation of bone deformities in the case of abnormal bone structure, which can cause severe scoliosis for a long time. (2) After PVCR surgery, the patient receives traumatic stimulation and the body has a stress response to promote the secretion of BMP2, BMP9, and other bone-promoting factors, in order to accelerate wound healing and recovery [10, 11]. (3) The secretion of BMP2 and BMP9 proteins needs a certain material basis, and their metabolism in the body is rapid after secretion. The nutritional support of PVCR in a period of time is also a part of the treatment of scoliosis, which may indirectly promote the secretion of BMP2 and BMP9.In addition, the results of this study also show that the serum BMP2 and BMP9 levels of patients are positively correlated with recovery-related indicators (ODI, SRS-22, and Cobb angle correction rate), when the patient goes through a 1-year recovery period. The higher the BMP2 level, the better the postoperative recovery of the patient. Besides, the levels of BMP2 and BMP9 have the closest correlation with Cobb angle correction rate (r = 0.838 and r = 0.802, respectively). This result suggests that BMP2 and BMP9 may be of higher value in predicting spinal function, quality of life, and surgical efficacy in patients with severe scoliosis after PVCR surgery, and positive intervention for patients with low levels of BMP2 and BMP9 after surgery may produce certain therapeutic benefits.Bone graft fusion is an important factor affecting the efficacy of PVCR surgery. BMP can induce bone formation and irreversibly promote the differentiation of mesenchymal cells into chondrocytes and bone cells [12]. Among all BMP protein families, BMP2 and BMP9 have the strongest osteogenic ability; they can also induce the formation and deposition of calcium phosphate in bone, which is conducive to repairing bone and joint damage [13, 14]. The higher the level of BMP2 and BMP9, the better the degree of bone graft fusion and damage repair [15]. Therefore, patients with better recovery after PVCR have higher levels of both. In addition, patients with severe scoliosis generally have abnormal development of cardiopulmonary function. Even after the deformity is corrected by PVCR, the cardiopulmonary injury still exists. This kind of injury will have a serious impact on the patient’s postoperative recovery and quality of life. In addition to promoting bone fusion, BMP2 and BMP9 induce embryonic stem cells to differentiate into cardiomyocytes and promote vascular remodeling, thereby strengthening cardiopulmonary function and promoting the recovery of respiratory function [16]. This effect is mainly achieved through multiple signal pathways transduced by the transforming growth factor-β superfamily. However, there are still some shortcomings in this study. The patients with severe scoliosis have a long course of disease and large differences in individual patients. Some individual factors are difficult to control during the study, which may affect the experimental results, so the sample size needs to be further expanded for in-depth study.


## 5. Conclusion

After 1-year follow-up, the patients’ serum BMP2 and BMP9 levels were positively correlated with spinal function recovery, quality of life, and surgical efficacy. Among them, BMP2 and BMP9 had the highest correlation with PVCR surgical efficacy. Therefore, for severe scoliosis patients with BMP2 and BMP9 levels after PVCR surgery, relevant intervention measures can be used as a new entry point for clinical treatment of such patients.



---

*Source: 7008898-2021-10-29.xml*