Complications of anterior cervical discectomy and fusion using recombinant human bone morphogenetic protein-2

Abstract

The use of bone morphogenetic protein-2 (rhBMP-2) in spinal fusion has increased dramatically since an FDA approval for its use in anterior lumbar fusion with the LT cage. There are several reports of its use in transforaminal lumbar interbody fusion, posterolateral fusion, and anterior cervical fusion. Reports on adverse effects of rhBMP-2 when used in spinal fusion are scarce in literature. An Institutional Review Board approved retrospective study was conducted in patients undergoing anterior spinal fusion and instrumentation following diskectomy at a single center. Forty-six consecutive patients were included. Twenty-two patients treated with rhBMP-2 and PEEK cages were compared to 24 in whom allograft spacers and demineralized bone matrix was used. Patients filled out Cervical Oswestry Scores, VAS for arm pain, neck pain, and had radiographs preoperatively as well at every follow up visit. Radiographic examination following surgery revealed end plate resorption in all patients in whom rhBMP-2 was used. This was followed by a period of new bone formation commencing at 6 weeks. In contrast, allograft patients showed a progressive blurring of end plate-allograft junction. Dysphagia was a common complication and it was significantly more frequent and more severe in patients in whom rhBMP-2 was used. Post operative swelling anterior to the vertebral body on lateral cervical spine X-ray was significantly larger in the rhBMP-2 group when measured from 1 to 6 weeks after which it was similar. These effects are possibly due to an early inflammatory response to rhBMP-2 and were observed to be dose related. With the parameters we used, there was no significant difference in the clinical outcome of patients in the two groups at 2 years. The cost of implants in patients treated with rhBMP-2 and PEEK spacers was more than three times the cost of allograft spacers and demineralized bone matrix in 1, 2, and 3-level cases. Despite providing consistently good fusion rates, we have abandoned using rhBMP-2 and PEEK cages for anterior cervical fusion, due to the side effects, high cost, and the availability of a suitable alternative.

Nanocomposite therapy as a more efficacious and less inflammatory alternative to bone morphogenetic protein‐2 in a rodent arthrodesis model

“…Since clinical data demonstrate a host response to rhBMP-2 after implantation, 13,14,17,27,28 four animals in the TrioMatrix 1 and rhBMP-2 groups underwent a modification of the posterolateral arthrodesis protocol followed by magnetic resonance imaging (MRI) evaluation of the lumbar spine to assess localized host response during the bone healing process at the 7-day time point. 29 In addition to arthrodesis, 1.06 AE 0.17 cc 3 of paraspinal muscle compartment was excised bilaterally to create an adjacent space next to the site of fusion.…”

Systemic Administration of Sclerostin Antibody Enhances Bone Repair in a Critical-Sized Femoral Defect in a Rat Model

“…RhBMP-2 is approved by the U.S. Food and Drug Administration for limited select indications. However, the high cost of rhBMPs, the variability of its efficacy in humans, and recent reports of serious side effects associated with its use are important factors limiting its clinical utility [8][9][10][11] . The systemic delivery of a therapeutic agent that can enhance bone repair in fractures and nonunions is an attractive option because it does not involve any surgery, can be administered to the patient in the office setting, and may allow for prolonged and frequent dosing 1 .…”

An update on bone substitutes for spinal fusion

“…Dodd et al conducted a case-control study of the use of autografts versus allografts which were from femoral heads in the surgery of idiopathic adolescent scoliosis. They reported that there was no difference, either in a Baskin et al [7] A prospective pilot trial for the use of rhBMP-2/collagen sponge with a fibular allograft and anterior cervical plate Shields et al [79] Retrospective review of patients who underwent an anterior cervical fusion using high-dose rhBMP-2/collagen sponge Vaidya et al [98] Retrospective review of patients undergoing anterior cervical spinal fusion and instrumentation…”