title: Complications associated with recombinant human bone morphogenetic protein use in pediatric craniocervical arthrodesis.
abstract: OBJECTIVE
  Management of pediatric occipitocervical instability remains especially challenging. The off-label use of recombinant human bone morphogenetic protein (rhBMP)-2 for spinal fusion has increased with a well-documented increase in fusion rate in many case series. Unfortunately, recent reports have documented complications associated with rhBMP use in adult spinal fusions. Complications associated with the use of rhBMP in pediatric spinal surgery is less well understood. In this study the authors report on the fusion rate and complications associated with rhBMP in pediatric occipitocervical arthrodesis.
  
  
  METHODS
  The authors reviewed the medical records of those patients 18 years old and younger who underwent dorsal occipitocervical fusion from January 2004 to December 2007 at the University of Iowa Hospitals and Clinics. Forty-eight patients were identified who received rhBMP-augmented fusion. The clinical outcome and complications of these fusions were analyzed.
  
  
  RESULTS
  All 48 patients had fusion confirmed on lateral radiographs within 4-14 months with an average fusion time of 6.7 months. There were 6 complications, 5 of which included seroma formation. Two of 5 patients who developed postoperative seroma presented with symptoms suggesting brainstem compression and obstructive hydrocephalus requiring emergency reoperation. One patient developed heterotopic bone formation causing cervicomedullary compression requiring reoperation.
  
  
  CONCLUSIONS
  The use of rhBMP to augment autograft in occipitocervical fusion allows for a high rate of successful arthrodesis, but is associated with potentially life-threatening complications in pediatric patients.
authors.affiliation: Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA.
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Lindley
authors.forename: Nader S
authors.initials: NS
authors.lastname: Dahdaleh
authors.forename: Arnold H
authors.initials: AH
authors.lastname: Menezes
authors.forename: Kingsley O
authors.initials: KO
authors.lastname: Abode-Iyamah
mesh_terms: D000293:Adolescent; D055396:Bone Morphogenetic Protein 2; D019485:Bone Morphogenetic Proteins / Q000009:adverse effects* / Q000627:therapeutic use; D016025:Bone Transplantation; D002574:Cervical Vertebrae / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003399:Craniotomy; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis / Q000601:surgery; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007593:Joint Instability / Q000601:surgery*; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D008297:Male; D009777:Occipital Bone / Q000601:surgery*; D056687:Off-Label Use; D009999:Ossification, Heterotopic / Q000175:diagnosis / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D011994:Recombinant Proteins / Q000009:adverse effects* / Q000627:therapeutic use; D012086:Reoperation; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016212:Transforming Growth Factor beta / Q000009:adverse effects* / Q000627:therapeutic use; D014696:Ventriculostomy
chemical_list: D055396:Bone Morphogenetic Protein 2; D019485:Bone Morphogenetic Proteins; D011994:Recombinant Proteins; D016212:Transforming Growth Factor beta; C499469:recombinant human bone morphogenetic protein-2