Complications of anterior cervical discectomy and fusion using recombinant human bone morphogenetic protein-2.
The use of bone morphogenetic protein-2 (rhBMP-2) in spinal fusion has increased dramatically since an FDA approval for its use in anterior lumbar fusion with the LT cage. There are several reports of its use in transforaminal lumbar interbody fusion, posterolateral fusion, and anterior cervical fusion. Reports on adverse effects of rhBMP-2 when used in spinal fusion are scarce in literature. An Institutional Review Board approved retrospective study was conducted in patients undergoing anterior spinal fusion and instrumentation following diskectomy at a single center. Forty-six consecutive patients were included. Twenty-two patients treated with rhBMP-2 and PEEK cages were compared to 24 in whom allograft spacers and demineralized bone matrix was used. Patients filled out Cervical Oswestry Scores, VAS for arm pain, neck pain, and had radiographs preoperatively as well at every follow up visit. Radiographic examination following surgery revealed end plate resorption in all patients in whom rhBMP-2 was used. This was followed by a period of new bone formation commencing at 6 weeks. In contrast, allograft patients showed a progressive blurring of end plate-allograft junction. Dysphagia was a common complication and it was significantly more frequent and more severe in patients in whom rhBMP-2 was used. Post operative swelling anterior to the vertebral body on lateral cervical spine X-ray was significantly larger in the rhBMP-2 group when measured from 1 to 6 weeks after which it was similar. These effects are possibly due to an early inflammatory response to rhBMP-2 and were observed to be dose related. With the parameters we used, there was no significant difference in the clinical outcome of patients in the two groups at 2 years. The cost of implants in patients treated with rhBMP-2 and PEEK spacers was more than three times the cost of allograft spacers and demineralized bone matrix in 1, 2, and 3-level cases. Despite providing consistently good fusion rates, we have abandoned using rhBMP-2 and PEEK cages for anterior cervical fusion, due to the side effects, high cost, and the availability of a suitable alternative.
Vaidya
Rahul
R
Department of Orthopedics, Detroit Receiving Hospital, University Health Center, 4201 St. Antoine Boulevard 6A, Detroit, MI 48201, USA. rahvaidya@hotmail.com
Carp
Julia
J
Sethi
Anil
A
Bartol
Stephen
S
Craig
Joseph
J
Les
Clifford M
CM
D000328:Adult; D000368:Aged; D001174:Arthrodesis / Q000009:adverse effects / Q000379:methods; D001857:Bone Matrix; D055396:Bone Morphogenetic Protein 2; D019485:Bone Morphogenetic Proteins / Q000009:adverse effects / Q000627:therapeutic use*; D001860:Bone Plates / Q000009:adverse effects; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D003680:Deglutition Disorders / Q000209:etiology; D017586:Diskectomy / Q000009:adverse effects* / Q000191:economics / Q000379:methods; D005260:Female; D006685:Hoarseness / Q000209:etiology; D006801:Humans; D016268:Internal Fixators / Q000009:adverse effects / Q000191:economics; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D019736:Prostheses and Implants / Q000009:adverse effects; D011859:Radiography; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects* / Q000191:economics / Q000379:methods; D016212:Transforming Growth Factor beta / Q000009:adverse effects / Q000627:therapeutic use*; D014184:Transplantation, Homologous
C525718:BMP2 protein, human; D055396:Bone Morphogenetic Protein 2; D019485:Bone Morphogenetic Proteins; D011994:Recombinant Proteins; D016212:Transforming Growth Factor beta