Retrospective study of posterior cervical fusions with rhBMP-2

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Fusion Techniques

Background:

• Posterior cervical decompression and fusion are used for spinal conditions, with prior pseudoarthrosis rates up to 38%.
• Bone morphogenic protein (BMP) is approved for anterior lumbar fusion but its use in posterior cervical fusion is less understood.
• Potential airway complications exist with anterior cervical BMP, but safety data for posterior cervical application is limited.

Purpose of the Study:

• To evaluate the fusion success, safety, and heterotopic bone formation of BMP in posterior cervical fusion.
• To assess the incidence of pseudoarthrosis and adverse events associated with BMP use in this region.
• To investigate the occurrence of heterotopic bone formation after posterior cervical fusion with BMP.

Main Methods:

• A retrospective study of 29 patients undergoing posterior cervical decompression and instrumented fusion with BMP between 2006 and 2008.
• Follow-up for a minimum of 12 months, with computed tomography (CT) scans at least 12 months postoperatively.
• Evaluation of fusion success via CT, assessment of heterotopic bone formation, and review of demographic data and adverse events.

Main Results:

• A pseudoarthrosis rate of 10.3% (3 out of 29 patients) was observed on CT scans, with no subsequent surgeries required.
• No heterotopic bone formation was detected outside the lateral masses or encroaching on the spinal canal or neuroforamen.
• No adverse events were attributed to the use of BMP in this cohort.

Conclusions:

• Bone morphogenic protein (BMP) can be safely utilized in posterior cervical spine fusion procedures.
• The use of BMP in posterior cervical fusion is associated with a lower incidence of pseudoarthrosis compared to historical controls.
• Larger studies are recommended to further confirm the safety and efficacy of BMP in posterior cervical fusion, while acknowledging that pseudoarthrosis remains a possibility.