STUDY DESIGN: Retrospective case series. OBJECTIVE: The purpose of this study was to determine the fusion rate and evaluate the complications associated with the application of recombinant human bone morphogenetic protein-2 (rhBMP-2) in posterior cervical fusion. SUMMARY OF BACKGROUND DATA: The rates of fusion and complications associated with the use of rhBMP-2 in posterior cervical fusion is unclear, though recent work has shown up to a 100% fusion rate. METHODS: We independently reviewed consecutive series of patients who underwent posterior cervical, occipitocervical, or cervicothoracic instrumented fusion augmented with rhBMP-2. Two surgeons at a tertiary-referral, academic medical center performed all operations, and each patient had a minimum of 2-year follow-up. Fusion status was determined by bony bridging on computed tomography scans, absence of radiolucency around instrumentation, and absence of motion on lateral flexion/extension radiographs. RESULTS: Fifty-seven patients with a mean age of 56.7±13.2 years and mean follow-up of 37.7±20.6 months were analyzed. Forty-eight patients (84.2%) had undergone previous cervical surgery, and 42.1% had a preexisting nonunion. Constructs spanned 5.6±2.6 levels; 19.3% involved the occiput, whereas 61.4% crossed the cervicothoracic junction. The mean rhBMP-2 dose was 21.1±8.7 mg per operation. Iliac crest autograft was used for 29.8% of patients. Six patients (10.5%) experienced nonunion; only 2 required revision. In each case of nonunion, instrumentation crossed the occipitocervical or cervicothoracic junction. However, none of the analyzed variables was statistically associated with nonunion. Fourteen patients (24.6%) suffered complications, with 7 requiring additional surgery. CONCLUSIONS: The observed fusion rate of rhBMP-2-augmented posterior cervical, occipitocervical, and cervicothoracic fusions was 89.5%. This reflects the complicated nature of the patients included in the current study and demonstrates that rhBMP-2 cannot always overcome the biomechanical challenges entailed in spanning the occipitocervical or cervicothoracic junction.
STUDY DESIGN: Retrospective case series. OBJECTIVE: The purpose of this study was to determine the fusion rate and evaluate the complications associated with the application of recombinant humanbone morphogenetic protein-2 (rhBMP-2) in posterior cervical fusion. SUMMARY OF BACKGROUND DATA: The rates of fusion and complications associated with the use of rhBMP-2 in posterior cervical fusion is unclear, though recent work has shown up to a 100% fusion rate. METHODS: We independently reviewed consecutive series of patients who underwent posterior cervical, occipitocervical, or cervicothoracic instrumented fusion augmented with rhBMP-2. Two surgeons at a tertiary-referral, academic medical center performed all operations, and each patient had a minimum of 2-year follow-up. Fusion status was determined by bony bridging on computed tomography scans, absence of radiolucency around instrumentation, and absence of motion on lateral flexion/extension radiographs. RESULTS: Fifty-seven patients with a mean age of 56.7±13.2 years and mean follow-up of 37.7±20.6 months were analyzed. Forty-eight patients (84.2%) had undergone previous cervical surgery, and 42.1% had a preexisting nonunion. Constructs spanned 5.6±2.6 levels; 19.3% involved the occiput, whereas 61.4% crossed the cervicothoracic junction. The mean rhBMP-2 dose was 21.1±8.7 mg per operation. Iliac crest autograft was used for 29.8% of patients. Six patients (10.5%) experienced nonunion; only 2 required revision. In each case of nonunion, instrumentation crossed the occipitocervical or cervicothoracic junction. However, none of the analyzed variables was statistically associated with nonunion. Fourteen patients (24.6%) suffered complications, with 7 requiring additional surgery. CONCLUSIONS: The observed fusion rate of rhBMP-2-augmented posterior cervical, occipitocervical, and cervicothoracic fusions was 89.5%. This reflects the complicated nature of the patients included in the current study and demonstrates that rhBMP-2 cannot always overcome the biomechanical challenges entailed in spanning the occipitocervical or cervicothoracic junction.
Authors: Hsin Chuan Pan; Soonchul Lee; Kang Ting; Jia Shen; Chenchao Wang; Alan Nguyen; Emily A Berthiaume; Janette N Zara; A Simon Turner; Howard B Seim; Jin Hee Kwak; Xinli Zhang; Chia Soo Journal: Am J Pathol Date: 2017-05-11 Impact factor: 4.307
Authors: Sravisht Iyer; Han Jo Kim; Hongda Bao; Justin S Smith; Munish Gupta; Todd J Albert; Themistocles S Protopsaltis; Gregory M Mundis; Peter Passias; Brian J Neuman; Eric O Klineberg; Virginie Lafage; Christopher P Ames Journal: Global Spine J Date: 2018-03-26