Reoperation rates for symptomatic nonunions in posterior cervicothoracic fusions with and without bone morphogenetic protein in a cohort of 450 patients

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>Fusions across the cervicothoracic junction have been challenging because of the large biomechanical forces exerted resulting in frequent reoperations for nonunions. The objective of this study was to investigate a retrospective cohort using chart review of posterior cervicothoracic spine fusions with and without bone morphogenetic protein (BMP) and to determine the reoperation rates for symptomatic nonunions in both groups.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>Between January 2009 and September 2013, posterior cervicothoracic spine fusion cases were identified from a large spine registry (Kaiser Permanente). Demographics, diagnoses, operative times, lengths of stay, and reoperations were extracted from the registry. Reoperations for symptomatic nonunions were adjudicated via chart review. Logistic regression was used to estimate odds ratios and 95% confidence intervals. Kaplan-Meier curves for the non-BMP and BMP groups were generated and compared using the log-rank test.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>In this cohort there were 450 patients (32.7% with BMP) with a median follow-up of 1.4 years (interquartile range [IQR] 0.5–2.7 years). Kaplan-Meier curves showed no significant difference in reoperation rates for nonunions using the log-rank test (p = 0.088). In a subset of patients with more than 1 year of follow-up, 260 patients were identified (43.1% with BMP) with a median follow-up duration of 2.4 years (IQR 1.6–3.3 years). There was no statistically significant difference in the symptomatic operative nonunion rates for posterior cervicothoracic fusions with and without BMP (0.0% vs 2.7%, respectively; p = 0.137) for more than 1 year of follow-up.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>This study presents the largest series of patients using BMP in posterior cervicothoracic spine fusions. Reoperation rates for symptomatic nonunions with more than 1 year of follow-up were 0% with BMP and 2.7% without BMP. No statistically significant difference in the reoperation rates for symptomatic nonunions with or without BMP was found.</jats:p></jats:sec>

The Posterior Use of BMP-2 in Cervical Deformity Surgery Does Not Result in Increased Early Complications: A Prospective Multicenter Study

“…14,15,18,19,25 The majority of these studies report a higher radiographic fusion rate with BMP, but there may not be a substantial difference in clinically significant nonunion—defined as pseudarthrosis requiring revision—between these groups. 18,19,25 This question of clinical significance is important and is particularly relevant to the subject of BMP. The Yale Open Data Access (YODA) Project, for example, found that the use of BMP likely leads to an increased risk of complications.…”

“…Other authors, focusing on posterior BMP use at the cervicothoracic junction, found that the use of BMP did not result in a significantly different rate of symptomatic non-union requiring reoperation. 19 …”

“…Other authors, focusing on posterior BMP use at the cervicothoracic junction, found that the use of BMP did not result in a significantly different rate of symptomatic non-union requiring reoperation. 19 The existing literature on this topic is retrospective in nature, narrowly focused on radiographic outcomes and limited to patients with degenerative pathology. The rate of complications following BMP use in patients with cervical deformity is unknown.…”

Bone morphogenetic protein in the repair of cerebrospinal fluid leak after transsphenoidal surgery

“…[9,10] In clinical studies, the application of BMP demonstrated consistent osteoinduction which resulted in the "off-label" use of BMP in more than 85% of various spinal fusions. [11][12][13][14] Huang et al were able to show that recombinant human BMP (rhBMP)-2 created an increased inflammatory state in histological tissue sections and systemic blood samples of rats who had subcutaneously implanted BMP. [15] We postulate that these proinflammatory properties of BMP lead to increased healing rates by scarring and closure of the CSF fistula.…”

PLF Versus PLIF and the Fate of L5-S1

“…Reoperation rates for symptomatic nonunions (operative nonunions) is one way of combining the clinical and radiographic information. Several studies have shown measuring operative nonunion rates can be useful for comparing fusion techniques 33–36 …”