Posterior Cervical Fusion With Recombinant Human Bone Morphogenetic Protein-2: Issues and Fusion Price at Minimal 2-Yr Comply with-Up.
Clin Backbone Surg. 2016 Jul;29(6):E276-81
Authors: Dorward IG, Buchowski JM, Stoker GE, Zebala LP
STUDY DESIGN: Retrospective case sequence.
OBJECTIVE: The aim of this research was to find out the fusion fee and consider the issues related to the applying of recombinant human bone morphogenetic protein-2 (rhBMP-2) in posterior cervical fusion.
SUMMARY OF BACKGROUND DATA: The charges of fusion and issues related to the usage of rhBMP-2 in posterior cervical fusion is unclear, although latest work has proven as much as a 100% fusion fee.
METHODS: We independently reviewed consecutive sequence of sufferers who underwent posterior cervical, occipitocervical, or cervicothoracic instrumented fusion augmented with rhBMP-2. Two surgeons at a tertiary-referral, tutorial medical heart carried out all operations, and every affected person had a minimal of 2-year follow-up. Fusion standing was decided by bony bridging on computed tomography scans, absence of radiolucency round instrumentation, and absence of movement on lateral flexion/extension radiographs.
RESULTS: Fifty-seven sufferers with a imply age of 56.7±13.2 years and imply follow-up of 37.7±20.6 months have been analyzed. Forty-eight sufferers (84.2%) had undergone earlier cervical surgical procedure, and 42.1% had a preexisting nonunion. Constructs spanned 5.6±2.6 ranges; 19.three% concerned the occiput, whereas 61.four% crossed the cervicothoracic junction. The imply rhBMP-2 dose was 21.1±eight.7 mg per operation. Iliac crest autograft was used for 29.eight% of sufferers. Six sufferers (10.5%) skilled nonunion; solely 2 required revision. In every case of nonunion, instrumentation crossed the occipitocervical or cervicothoracic junction. Nevertheless, not one of the analyzed variables was statistically related to nonunion. Fourteen sufferers (24.6%) suffered issues, with 7 requiring extra surgical procedure.
CONCLUSIONS: The noticed fusion fee of rhBMP-2-augmented posterior cervical, occipitocervical, and cervicothoracic fusions was 89.5%. This displays the sophisticated nature of the sufferers included within the present research and demonstrates that rhBMP-2 can’t all the time overcome the biomechanical challenges entailed in spanning the occipitocervical or cervicothoracic junction.
PMID: 27137152 [PubMed – indexed for MEDLINE]