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Complications of Anterior Cervical Fusion using a Low-dose Recombinant Human Bone Morphogenetic Protein-2
Sunil Kukreja1, Osama I Ahmed1, Justin Haydel1
1Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.
Objective:
There are several reports, which documented a high incidence of complications following the use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in anterior cervical fusions (ACFs). The objective of this study is to share our experience with low-dose rhBMP-2 in anterior cervical spine.
Methods:
We performed a retrospective analysis of 197 patients who underwent anterior cervical fusion (ACF) with the use of recombinant human bone morphogenetic protein-2 (rhBMP-2) during 2007-2012. A low-dose rhBMP-2 (0.7mg/level) sponge was placed exclusively within the cage. In 102 patients demineralized bone matrix (DBM) was filled around the BMP sponge. Incidence and severity of dysphagia was determined by 5 points SWAL-QOL scale.
Results:
Two patients had prolonged hospitalization due to BMP unrelated causes. Following the discharge, 13.2%(n=26) patients developed dysphagia and 8.6%(n=17) patients complained of neck swelling. More than half of the patients (52.9%, n=9) with neck swelling also had associated dysphagia; however, only 2 of these patients necessitated readmission. Both of these patients responded well to the intravenous dexamethasone. The use of DBM did not affect the incidence and severity of complications (p>0.05). Clinico-radiological evidence of fusion was not observed in 2 patients.
Conclusion:
A low-dose rhBMP-2 in ACFs is not without risk. However, the incidence and severity of complications seem to be lower with low-dose BMP placed exclusively inside the cage. Packing DBM putty around the BMP sponge does not affect the safety profile of rhBMP-2 in ACFs.
Insights
Low-dose recombinant human bone morphogenetic protein-2 (rhBMP-2) in anterior cervical fusions (ACFs) may reduce complications. Placing rhBMP-2 exclusively in the cage, with or without demineralized bone matrix (DBM), showed a manageable safety profile.
Area of Science:
- Spine Surgery
- Orthopedic Surgery
- Biomaterials in Medicine
Background:
- Recombinant human bone morphogenetic protein-2 (rhBMP-2) use in anterior cervical fusions (ACFs) is associated with a high incidence of complications.
- Previous studies have documented significant risks, necessitating investigation into safer application methods.
Purpose of the Study:
- To evaluate the safety and efficacy of a low-dose rhBMP-2 regimen in anterior cervical spine procedures.
- To assess complications associated with rhBMP-2 when placed exclusively within the interbody cage.
Main Methods:
- Retrospective analysis of 197 patients undergoing ACF with low-dose rhBMP-2 (0.7mg/level) between 2007-2012.
- rhBMP-2 sponge was placed solely within the cage; 102 patients also received demineralized bone matrix (DBM) around the cage.
- Dysphagia incidence and severity were assessed using the SWAL-QOL scale.
Main Results:
- 13.2% of patients developed dysphagia and 8.6% experienced neck swelling post-discharge.
- Neck swelling and dysphagia co-occurred in over half of affected patients, with only 2 readmissions.
- Demineralized bone matrix (DBM) did not significantly impact complication rates (p>0.05); 2 patients showed no fusion.
Conclusions:
- Low-dose rhBMP-2 in ACFs carries risks, but placement exclusively within the cage may lower complication incidence and severity.
- The addition of DBM putty around the rhBMP-2 sponge did not alter the safety profile in ACFs.
- Further research is warranted to optimize rhBMP-2 use in anterior cervical spine surgery.
