Anterior cervical discectomy and fusion involving a polyetheretherketone spacer and bone morphogenetic protein.
OBJECTIVE
The authors reviewed clinical and radiographic outcomes in patients who had undergone anterior cervical discectomy and fusion (ACDF) involving the placement of polyetheretherketone (PEEK) spacers filled with recombinant human bone morphogenetic protein (rhBMP)-2.


METHODS
Data obtained in 24 cases were retrospectively evaluated. The follow-up period ranged from 12 to 16 months (mean 13 months). Fifteen patients presented with radiculopathy, eight with myeloradiculopathy, and one with quadriparesis. Single-level ACDF was performed in 12 patients, two-level ACDF in nine, and three-level ACDF in three. Clinical outcomes were assessed using Odom criteria, and fusion was assessed by examining flexion-extension radiographs and computerized tomography scans in cases in which arthrodesis was questionable. Follow-up data were available for 23 patients. One patient died of medical complications unrelated to surgery 4 weeks after ACDF. Clinical outcomes were rated as good/excellent in 22 patients (95%) and fair in one (5%). Solid radiographically documented fusion, with evidence of solid bridging bone and no instability on flexion-extension x-ray films, was present in all cases. Complications included transient recurrent laryngeal nerve injury in one case, transient C-5 paresis in one, cerebrospinal fluid leakage in one, and transient dysphagia in two.


CONCLUSIONS
Analysis of the results indicated that ACDF involving an rhBMP-2-filled PEEK spacer leads to good clinical outcomes (by Odum criteria) and solid fusion (even in multilevel cases) while avoiding the complications associated with harvesting iliac crest bone grafts.
Boakye
Maxwell
M
Department of Neurosurgery, Stanford University, Palo Alto, California, USA.
Mummaneni
Praveen V
PV
Garrett
Mark
M
Rodts
Gerald
G
Haid
Regis
R
D000328:Adult; D000368:Aged; D001577:Benzophenones; D001672:Biocompatible Materials / Q000627:therapeutic use*; D055396:Bone Morphogenetic Protein 2; D019485:Bone Morphogenetic Proteins / Q000627:therapeutic use*; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery; D017586:Diskectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007659:Ketones / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000209:etiology; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D011108:Polymers; D011183:Postoperative Complications; D019736:Prostheses and Implants; D011994:Recombinant Proteins; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D016212:Transforming Growth Factor beta / Q000627:therapeutic use*; D016896:Treatment Outcome
C525718:BMP2 protein, human; D001577:Benzophenones; D001672:Biocompatible Materials; D055396:Bone Morphogenetic Protein 2; D019485:Bone Morphogenetic Proteins; D007659:Ketones; D011108:Polymers; D011994:Recombinant Proteins; D016212:Transforming Growth Factor beta; C499469:recombinant human bone morphogenetic protein-2; C063834:polyetheretherketone; D011092:Polyethylene Glycols