Spinal-fusion substance may do more harm than good

A substance that is increasingly being used in spinal-fusion surgery may do more harm than good for some patients, a study of more than 300,000 patient records suggests.

Many problems - including spinal fracture, misaligned vertebrae, a herniated disk, cancer - can cause severe back pain. The best option in some cases is to fuse two or more vertebrae together.

Bone-creation substances known as BMP, for bone morphogenetic proteins, speed the process, reducing the risk of incomplete healing and making a second operation less likely. The U.S. Food and Drug Administration first approved them for use in the lower back in 2002.

But when these proteins are used in neck-vertebrae surgery, patients are about 40 percent more likely to suffer serious swelling, hoarseness, and difficulty swallowing, compared with surgeries without the protein, researchers report in the current Journal of the American Medical Association. Their hospital stay and cost of the surgery also increased.

The paper concludes that it may be time to reassess BMP's suitability for neck fusions. Lead author Kevin Cahill, a spine surgeon at Brigham and Women's Hospital in Boston, said in an interview that he would encourage patients to discuss the costs, risks, and benefits with their surgeon in advance. - Karen Knee

Likely benefits to prescribing statins to curb heart disease

Cholesterol-lowering statin drugs, the standard of care for people with heart disease, may also benefit many patients who are merely at risk of developing the disease, researchers report in a review of 10 previous studies involving 70,000 people worldwide.

Prescribing statins as a preventive measure to patients with risk factors such as diabetes and high blood pressure was associated with a 30 percent drop in major heart disease and a 12 percent drop in deaths over an average of four years, researchers said on bmj.com, an online British medical journal.

Statins are powerful drugs, and the researchers - several of whom reported support in the past from manufacturers - stopped short of recommending their use for all people at risk of developing heart disease.

While men over 65 who have other risk factors and older women with diabetes and other risk factors appear to be most in danger of developing heart disease, they write, "the correct identification of such people remains a challenge," as does prediction of an individual's risk. - Heather J. Chin

Study of falls suggests need to teach safer use of walkers

More than 47,000 older Americans a year - 129 a day - seek treatment at hospitals after falls involving walkers or canes, according to a six-year review of ER records that suggests more time should be spent teaching people how to use walking aids.

Falls are the leading cause of injuries in people over 65. Less than 3 percent involve walking aids, but the researchers, from the U.S. Centers for Disease Control and Prevention, said they were the frailest and most vulnerable population. And while twice as many older people use canes than use walkers, the researchers found seven times as many injuries associated with walkers.

Fractures were the most common type of injury. Men injured their head and neck most frequently, while women hit their hip or pelvis. Women, who are more likely to use walkers, made up 77 percent of all falls examined.

The goal now, the authors write in the Journal of the American Geriatrics Society, is to identify potential risk factors that lead to falls, to design better walking aids, and to provide education on safe usage. Information about falls and how to prevent them: http://go.philly.com/health. - Heather J. Chin

Agency: Children should get Hib booster at next doctor visit

Children who skipped the booster dose of Hib vaccine because of a supply shortage should get the shot at their next regular medical visit.

The Haemophilus influenzae type b booster, which normally is given to children ages 12 through 15 months, was suspended in December 2007 to ensure adequate supplies of the primary series of three doses at ages 2, 4, and 6 months.

The U.S. Centers for Disease Control and Prevention and other organizations jointly reinstated the booster recommendation in response to increased production by Sanofi Pasteur. Merck & Co. Inc., which triggered the shortage when it voluntarily withdrew 1.2 million doses and suspended manufacturing because of possible contamination at its plant in West Point, Montgomery County, has not yet resumed production.

Hib caused serious illness in about one of every 200 children under 5 before vaccines virtually eliminated it over the last two decades. A Q&A about the new recommendation, the vaccine and the disease: http://go.philly.com/health. - Don Sapatkin