Safety and efficacy of rhBMP2 in posterior cervical spinal fusion for subaxial degenerative spine disease: Analysis of outcomes in 204 patients

Risheng Xu, Mohamad Bydon, Daniel M Sciubba, Timothy F Witham, Jean-Paul Wolinsky, Ziya L Gokaslan, Ali Bydon, Risheng Xu, Mohamad Bydon, Daniel M Sciubba, Timothy F Witham, Jean-Paul Wolinsky, Ziya L Gokaslan, Ali Bydon

Abstract

Background: Many studies offer excellent demonstration of the ability of bone morphogenic protein (BMP) to enhance fusion rates in anterior as well as posterior lumbar surgery. Recently, BMP has also been shown to increase arthrodesis rates in anterior cervical surgery, albeit with concomitant increases in complication rates. To date, however, few studies have investigated the safety and efficacy of BMP in cervical surgeries approached posteriorly.

Methods: We retrospectively reviewed 204 consecutive patients with degenerative cervical spinal conditions necessitating posterior cervical fusion at a single institution over the past 4 years. The incidence of postoperative mechanical neck pain, fusion rates, as well as neurologic outcomes were compared between patients who received BMP vs those who did not receive BMP intraoperatively.

Results: There were no significant differences in preoperative variables between the non-BMP vs the BMP cohorts. Over an average follow-up of 24.2 months, there were no significant differences between the two cohorts in duration of hospitalization, cerebrospinal fluid leakage, deep vein thrombosis, pulmonary embolism, hyperostosis, infection, pneumonia, hematoma, C5 palsy, wound dehiscence, reoperation rates, or Nurick/ASIA scores. Eleven (7.1%) patients in the non-BMP group experienced instrumentation failure vs none in the BMP group (P=0.06). Patients receiving BMP had a significantly increased rate of fusion by the chi-square test (P=0.01) and the log-rank test (P=0.02). However, patients receiving BMP also had the highest rates of recurrent/persistent neck pain by the chi-square test (P=0.003) and the log-rank test (P=0.01).

Conclusions: To date, few studies have evaluated the safety and efficacy of BMP in the posterior cervical spine. Here, we show that BMP usage does not increase complication rates, but it significantly increases arthrodesis rates and also may increase the rate of recurrent/persistent neck pain.

Keywords: Arthrodesis; cervical; fusion; neck pain; non-fusion; pseudoarthrodesis.

Figures

Figure 1
Figure 1
Kaplan-Meier plots of postoperative nonfusion. Patients who did not receive bone morphogenic protein had a significantly higher chance of non-fusion over time (P=0.026) when compared with patients who received bone morphogenic protein
Figure 2
Figure 2
Kaplan-Meier plots of postoperative recurrent neck pain over time. Patients who received bone morphogenic protein had a significantly higher chance of recurrent neck pain (P=0.010) compared to patients who did not receive bone morphogenic protein

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Source: PubMed

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