title: Adverse swelling associated with use of rh-BMP-2 in anterior cervical discectomy and fusion: a case study.
abstract: BACKGROUND
  The use of recombinant bone morphogenetic protein-2 (rh-BMP-2) is effective in augmenting lumbar spinal fusions. A safe, effective dosage of rh-BMP-2 in the cervical spine has yet to be determined. Use of rh-BMP-2 is currently being evaluated and is only indicated for use in the cervical spine on Investigational Device Exempt cases.
  
  
  OBJECTIVE
  To present a potentially serious adverse event that may occur when using rh-BMP-2 in cervical spine surgery.
  
  
  METHODS
  An emergent sequence of events including physical examination, radiographic studies, intubation, and surgical exploration were performed upon arrival to the emergency department.
  
  
  METHODS
  We report a case of a 54-year-old male patient presenting with neck swelling and difficulty swallowing 5 days after anterior cervical discectomy and fusion (ACDF) using rh-BMP-2.
  
  
  RESULTS
  The patient was found to have massive neck swelling including the pharyngeal tissue. The patient was admitted to the intensive care unit where parenteral steroids were administered for 24 hours during monitored intubation. The patient was extubated on the second hospital day and discharged home on the fourth hospital day after swelling subsided.
  
  
  CONCLUSIONS
  Caution should be exercised with rh-BMP-2 use in ACDF surgery as the correct dose and technique for application is not yet determined. Respiratory distress and dysphagia may result secondary to rh-BMP-2 induced anterior neck swelling.
authors.affiliation: Institute for Spinal Disorders, Cedars-Sinai Medical Center, 444 S. San Vicente Blvd, Ste 800, Los Angeles, CA 90048, USA. perrib@cshs.org
authors.forename: Brian
authors.initials: B
authors.lastname: Perri
authors.forename: Martin
authors.initials: M
authors.lastname: Cooper
authors.forename: Carl
authors.initials: C
authors.lastname: Lauryssen
authors.forename: Neel
authors.initials: N
authors.lastname: Anand
mesh_terms: D055396:Bone Morphogenetic Protein 2; D019485:Bone Morphogenetic Proteins / Q000009:adverse effects*; D002574:Cervical Vertebrae / Q000601:surgery; D003680:Deglutition Disorders / Q000209:etiology; D003907:Dexamethasone / Q000031:analogs & derivatives / Q000627:therapeutic use; D017586:Diskectomy / Q000379:methods; D004487:Edema / Q000188:drug therapy / Q000209:etiology*; D015658:HIV Infections / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000473:pathology; D011183:Postoperative Complications / Q000188:drug therapy; D011994:Recombinant Proteins / Q000009:adverse effects; D013123:Spinal Fusion / Q000379:methods; D014057:Tomography, X-Ray Computed; D016212:Transforming Growth Factor beta / Q000009:adverse effects*
chemical_list: C525718:BMP2 protein, human; D055396:Bone Morphogenetic Protein 2; D019485:Bone Morphogenetic Proteins; D011994:Recombinant Proteins; D016212:Transforming Growth Factor beta; C004180:dexamethasone 21-phosphate; D003907:Dexamethasone