Safety, efficacy, and dosing of recombinant human bone morphogenetic protein-2 for posterior cervical and cervicothoracic instrumented fusion with a minimum 2-year follow-up.

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Date

2011-07

Authors

Hamilton, D Kojo
Smith, Justin S
Reames, Davis L
Williams, Brian J
Chernavvsky, Daniel R
Shaffrey, Christopher I

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Abstract

Background

Considerable attention has focused on concerns of increased complications with recombinant human bone morphogenetic protein-2 (rhBMP-2) use for anterior cervical fusion, but few reports have assessed its use for posterior cervical fusions.

Objective

To assess the safety, efficacy, and dosing of rhBMP-2 as an adjunct for instrumented posterior cervical arthrodesis.

Methods

All patients treated by the senior author with posterior cervical or cervicothoracic instrumented fusion using rhBMP-2 from 2003 to 2008 with a minimum of 2 years of follow-up were included. Diagnosis, levels fused, rhBMP-2 dose, complications, and fusion were assessed.

Results

Fifty-three patients with a mean age of 55.7 years (range, 2-89 years) and an average follow-up of 40 months (range, 25-80 months) met inclusion criteria. Surgical indications included basilar invagination (n = 6), fracture (n = 6), atlantoaxial instability (n = 16), kyphosis/kyphoscoliosis (n = 22), osteomyelitis (n = 1), spondylolisthesis (n = 1), and cyst (n = 1). Fifteen patients had confirmed rheumatoid disease. The average rhBMP-2 dose was 1.8 mg per level, with a total of 282 levels treated (average, 5.3 levels; SD, 2.8 levels). Among 53 patients, only 2 complications (3.8%) were identified: a superficial wound infection and an adjacent-level degeneration. No cases of dysphagia or neck swelling requiring treatment were identified. At the last follow-up, all patients had achieved fusion.

Conclusion

Despite many of the patients in the present series having complex pathology and/or rheumatoid arthritis, a 100% fusion rate was achieved. Collectively, these data suggest that use of rhBMP-2 as an adjunct for posterior cervical fusion is safe and effective at an average dose of 1.8 mg per level.

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Cervical Vertebrae, Humans, Spinal Cord Diseases, Transforming Growth Factor beta, Recombinant Proteins, Tomography, X-Ray Computed, Treatment Outcome, Spinal Fusion, Retrospective Studies, Longitudinal Studies, Adolescent, Adult, Aged, Aged, 80 and over, Middle Aged, Child, Child, Preschool, Female, Male, Bone Morphogenetic Protein 2, Young Adult

Citation

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https://hdl.handle.net/10161/29236

Published Version (Please cite this version)

10.1227/neu.0b013e318214a9b1

Publication Info

Hamilton, D Kojo, Justin S Smith, Davis L Reames, Brian J Williams, Daniel R Chernavvsky and Christopher I Shaffrey (2011). Safety, efficacy, and dosing of recombinant human bone morphogenetic protein-2 for posterior cervical and cervicothoracic instrumented fusion with a minimum 2-year follow-up. Neurosurgery, 69(1). pp. 103–111. 10.1227/neu.0b013e318214a9b1 Retrieved from https://hdl.handle.net/10161/29236.

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