Brendan P Lovasik1, Christopher M Holland2, Brian M Howard3, Griffin R Baum3, Gerald E Rodts4, Daniel Refai5. 1. Emory University School of Medicine, Atlanta, Georgia, USA. 2. Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina, USA. 3. Emory University School of Medicine, Atlanta, Georgia, USA; Department of Neurosurgery, Emory University, Atlanta, Georgia, USA. 4. Emory University School of Medicine, Atlanta, Georgia, USA; Department of Neurosurgery, Emory University, Atlanta, Georgia, USA; Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia, USA. 5. Emory University School of Medicine, Atlanta, Georgia, USA; Department of Neurosurgery, Emory University, Atlanta, Georgia, USA; Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia, USA. Electronic address: daniel.refai@emory.edu.
Abstract
INTRODUCTION: Anterior cervical discectomy and fusion (ACDF) is one of the most common spinal procedures performed. A direct comparison of the fusion and complication rates between recombinant human bone morphogenetic protein-2 (rhBMP2) and beta-tricalcium phosphate (bTCP) has not been reported. METHODS: A retrospective study of 191 consecutive patients who underwent ACDF with polyetheretherketone plastic fusion spacers during a 2-year period with either rhBMP2 (n = 84, 46%) or bTCP (n = 107, 56%) was performed. Patients underwent 1- (35%), 2- (41%), 3- (20%), and 4- (4%) level operations. The primary outcome measure was mature arthrodesis, with secondary measures including clinical outcomes and complication occurrence. Fusion was graded on plain lateral radiographs, with median length of follow-up of 12 months. RESULTS: Rates of cervical fusion were significantly greater for patients treated with rhBMP2 than bTCP at both 6 months (70% vs. 26%, P = 0.000) and 12 months (99% vs. 85%, P = 0.000). Postoperative dysphagia was reported in 35 patients (18%), with no difference in dysphagia incidence between rhBMP2 and bTCP (20% vs. 17%, P = 0.5); however, dysphagia was more severe in the rhBMP2 group, with greater rates of readmission and steroid use (both P < 0.05). A multivariable sensitivity analyses to control for patient characteristics and number of spinal fusion levels showed no differences in dysphagia rate between rhBMP2 and bTCP. CONCLUSIONS: In our cohort, the rate of mature arthrodesis after ACDF was greater with rhBMP2 compared with bTCP with no increased incidence of postoperative dysphagia; however, dysphagia severity was greater in the rhBMP2 cohort.
INTRODUCTION: Anterior cervical discectomy and fusion (ACDF) is one of the most common spinal procedures performed. A direct comparison of the fusion and complication rates between recombinant humanbone morphogenetic protein-2 (rhBMP2) and beta-tricalcium phosphate (bTCP) has not been reported. METHODS: A retrospective study of 191 consecutive patients who underwent ACDF with polyetheretherketone plastic fusion spacers during a 2-year period with either rhBMP2 (n = 84, 46%) or bTCP (n = 107, 56%) was performed. Patients underwent 1- (35%), 2- (41%), 3- (20%), and 4- (4%) level operations. The primary outcome measure was mature arthrodesis, with secondary measures including clinical outcomes and complication occurrence. Fusion was graded on plain lateral radiographs, with median length of follow-up of 12 months. RESULTS: Rates of cervical fusion were significantly greater for patients treated with rhBMP2 than bTCP at both 6 months (70% vs. 26%, P = 0.000) and 12 months (99% vs. 85%, P = 0.000). Postoperative dysphagia was reported in 35 patients (18%), with no difference in dysphagia incidence between rhBMP2 and bTCP (20% vs. 17%, P = 0.5); however, dysphagia was more severe in the rhBMP2 group, with greater rates of readmission and steroid use (both P < 0.05). A multivariable sensitivity analyses to control for patient characteristics and number of spinal fusion levels showed no differences in dysphagia rate between rhBMP2 and bTCP. CONCLUSIONS: In our cohort, the rate of mature arthrodesis after ACDF was greater with rhBMP2 compared with bTCP with no increased incidence of postoperative dysphagia; however, dysphagia severity was greater in the rhBMP2 cohort.
Authors: Timothy A Peppers; Dennis E Bullard; Jed S Vanichkachorn; Scott K Stanley; Paul M Arnold; Erik I Waldorff; Rebekah Hahn; Brent L Atkinson; James T Ryaby; Raymond J Linovitz Journal: J Orthop Surg Res Date: 2017-04-26 Impact factor: 2.359