The safety and efficacy of anterior cervical discectomy and fusion with polyetheretherketone spacer and recombinant human bone morphogenetic protein-2: a review of 200 patients.
OBJECTIVE
The goal in this study was to demonstrate the safety and efficacy of anterior cervical discectomy and fusion ([ACDF]; single- or multilevel procedure) performed using titanium plates and polyetheretherketone (PEEK) spacers filled with recombinant human bone morphogenetic protein-2 (rhBMP-2) impregnated in a type I collagen sponge to achieve fusion.


METHODS
The authors retrospectively reviewed 200 patients who underwent a single- or multilevel ACDF with titanium plate fixation and PEEK spacer filled with a collagen sponge impregnated with low-dose rhBMP-2. Clinical outcomes were assessed using pre- and postoperative Nurick grades and the Odom criteria. Radiographic outcomes were assessed using dynamic radiographs and computed tomography (CT) scans.


RESULTS
The follow-up period ranged from 8 to 36 months (mean 16.7 months). A single-level ACDF was performed in 96 patients, 2-level ACDF in 62 patients, 3-level ACDF in 36 patients, and 4-level ACDF in 6 patients. Long-term follow-up was available for 193 patients. The Odom outcomes were rated as good to excellent in 165 patients (85%), fair in 24 (12.4%), and poor in 4 (2%). Among patients with myelopathy, Nurick grades improved from a preoperative mean of 1.42 to a postoperative mean of 0.26. All patients (100%) achieved solid radiographic fusion on dynamic radiographs and CT scans. Fourteen patients (7%) in this series experienced clinically significant dysphagia, and 4 (2%) required repeated operation for hematoma or seroma.


CONCLUSIONS
An ACDF performed using a PEEK spacer filled with rhBMP-2 leads to good to excellent clinical outcomes and solid fusion, even in multilevel cases and in patients who are smokers. The incidence of symptomatic dysphagia may be decreased with a lower dose of rhBMP-2 that is placed only within the PEEK spacer.
Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA.
Luis M
LM
Tumialán
Jeff
J
Pan
Gerald E
GE
Rodts
Praveen V
PV
Mummaneni
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001577:Benzophenones; D001672:Biocompatible Materials / Q000737:chemistry*; D055396:Bone Morphogenetic Protein 2; D019485:Bone Morphogenetic Proteins / Q000627:therapeutic use*; D001860:Bone Plates; D002574:Cervical Vertebrae / Q000601:surgery*; D024042:Collagen Type I / Q000737:chemistry; D003680:Deglutition Disorders / Q000209:etiology; D017586:Diskectomy / Q000295:instrumentation / Q000379:methods*; D004337:Drug Carriers; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000209:etiology; D006801:Humans; D007659:Ketones / Q000737:chemistry*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009984:Orthopedic Fixation Devices; D011092:Polyethylene Glycols / Q000737:chemistry*; D011108:Polymers; D011183:Postoperative Complications; D016059:Range of Motion, Articular / Q000502:physiology; D011994:Recombinant Proteins; D012189:Retrospective Studies; D012449:Safety; D049291:Seroma / Q000209:etiology; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D014025:Titanium; D014057:Tomography, X-Ray Computed; 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; D024042:Collagen Type I; D004337:Drug Carriers; D007659:Ketones; D011108:Polymers; D011994:Recombinant Proteins; D016212:Transforming Growth Factor beta; C063834:polyetheretherketone; D011092:Polyethylene Glycols; D014025:Titanium