Prospective nonrandomized comparison of an allograft with bone morphogenic protein versus an iliac-crest autograft in anterior cervical discectomy and fusion.
BACKGROUND
Anterior cervical discectomy and fusion (ACDF) using autogenous iliac bone graft may lead to donor-site morbidity. This has led some surgeons to use alternatives to iliac bone graft, but often the alternatives have greater rates of nonunion and delayed union. Bone morphogenic protein (BMP) studies have found high arthrodesis rates in lumbar fusions.


OBJECTIVE
The objective of this pilot study was to compare the success of BMP combined with bone allograft with iliac bone autograft in ACDF patients.


METHODS
The institutional review board approved a prospective but nonrandomized study of 66 consecutive patients who had primary one- to three-level ACDF with either iliac-crest bone autograft or BMP allograft (0.9 mg BMP per level) followed prospectively over a 2- to 3-year period.


METHODS
Consecutive patients who had primary one- to three-level ACDF with either iliac-crest bone autograft (n=36) or BMP-allograft (n=30). Patients in both iliac bone graft and BMP-allograft groups had comparable preoperative pain and disability.


METHODS
Visual analog scale pain, pain drawing, Oswestry index, pain medication use, opinion of treatment success, and neurological recovery.


RESULTS
Given the nonrandomized nature of the study, the study groups were not matched. Within this limitation, both groups of patients had similar improvement in all outcome scales (visual analog scale pain, pain drawing, Oswestry index, pain medication use, and opinion of treatment success) and neurological recovery over the 2- to 3-year follow-up period. Patients in the iliac bone graft group had two pseudarthroses and two complications of the iliac-crest donor site. In the BMP-allograft group, one patient had a pseudarthrosis, but 50% had neck swelling presenting as dysphagia, which was substantially more common than the 14% present in the iliac bone graft group. Patients in the BMP-allograft group had slightly shorter surgery time, but implant and hospitalization costs were higher.


CONCLUSIONS
ACDF performed with BMP (0.9 mg BMP per level) allograft is as effective as iliac bone graft in terms of patient outcomes and fusion rates. Safety concerns related to neck swelling and higher initial costs were associated with patients in the bone morphogenic protein group.
Buttermann
Glenn Robin
GR
Midwest Spine Institute Stillwater, Spine Surgery Division, 1950 Curve Crest Blvd, Stillwater, MN 55115, USA. butte011@umn.edu
D019485:Bone Morphogenetic Proteins / Q000191:economics / Q000627:therapeutic use*; D002574:Cervical Vertebrae; D017586:Diskectomy; D005260:Female; D006801:Humans; D007085:Ilium / Q000637:transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D020127:Recovery of Function; D013122:Spinal Diseases / Q000601:surgery*; D013123:Spinal Fusion / Q000191:economics / Q000379:methods*; D014182:Transplantation, Autologous / Q000191:economics / Q000379:methods; D014184:Transplantation, Homologous / Q000191:economics / Q000379:methods; D016896:Treatment Outcome
D019485:Bone Morphogenetic Proteins