Abstract | BACKGROUND CONTEXT: Results recently reported in the literature have raised some concerns regarding the use of recombinant human bone morphogenetic protein (rhBMP-2) in the cervical spine. PURPOSE: We undertook a radiological and clinical review of cervical fusions performed at our institution with polyetheretherketone ( PEEK) interbody cage and rhBMP-2. STUDY DESIGN: Observational study. PATIENT SAMPLE: Perioperative clinical and radiologic data of all patients who underwent an anterior cervical discectomy and fusion using PEEK and rhBMP-2 for cervical spondylotic radiculopathy or myelopathy were collected. OUTCOME MEASURES: Images were examined for fusion, heterotopic ossification, end-plate resorption, subsidence, and segmental sagittal alignment. METHODS: All patients underwent detailed postoperative radiologic analysis using a computed tomography (CT) scan obtained at least 6 months postoperatively and plain X-rays obtained at regular intervals. RESULTS: Twenty-two patients had 38 levels fused using PEEK and varying doses of rhBMP-2. No anterior cervical swelling requiring additional procedures or longer than anticipated hospital stays occurred. Pseudoarthrosis, shown as a horizontal radiolucent fissure through the midportion of the PEEK cage on CT, occurred in four patients. Excessive bone growth into the spinal canal or foramina occurred in 26 (68%) patients but did not result in neurologic sequelae. Cystic regions in the core of the PEEK spacer were seen in most patients, with 15 levels (39%) having cysts measuring 3mm or greater. Moderate or severe osteolysis of the end plates occurred in 57% of levels, and this led to subsidence of the construct and loss of some of the segmental sagittal alignment (ie, lordosis) that had been achieved with surgery. CONCLUSIONS: The unlimited supply of PEEK spacers and rhBMP-2 and their ease of use make them attractive platforms to achieve fusion. This study has demonstrated that the fusion process using rhBMP-2 is a dynamic one, with osteolysis dominating the initial phase, leading to end-plate resorption and consequently loss of some of the disc space height and sagittal alignment that was achieved with surgery. There is a high incidence of bone growth beyond the core of the PEEK spacer and cystic regions within the cage. Given our experience, we currently reserve the use of PEEK and rhBMP-2 for use in those patients who are at greatest risk of pseudoarthrosis.
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Authors | Paul Klimo Jr, Michael W Peelle |
Journal | The spine journal : official journal of the North American Spine Society
(Spine J)
Vol. 9
Issue 12
Pg. 959-66
(Dec 2009)
ISSN: 1878-1632 [Electronic] United States |
PMID | 19574105
(Publication Type: Journal Article)
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Chemical References |
- Benzophenones
- Bone Morphogenetic Protein 2
- Bone Morphogenetic Proteins
- Ketones
- Polymers
- Recombinant Proteins
- Transforming Growth Factor beta
- recombinant human bone morphogenetic protein-2
- polyetheretherketone
- Polyethylene Glycols
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Topics |
- Adult
- Aged
- Benzophenones
- Bone Cysts
- Bone Morphogenetic Protein 2
- Bone Morphogenetic Proteins
(adverse effects)
- Bone Plates
(adverse effects)
- Cervical Vertebrae
(diagnostic imaging, surgery)
- Female
- Humans
- Ketones
(adverse effects)
- Male
- Middle Aged
- Osseointegration
- Ossification, Heterotopic
- Osteolysis
- Polyethylene Glycols
(adverse effects)
- Polymers
- Postoperative Complications
(etiology)
- Prosthesis Failure
- Pseudarthrosis
- Radiography
- Recombinant Proteins
(adverse effects)
- Spinal Fusion
(adverse effects, instrumentation, methods)
- Transforming Growth Factor beta
(adverse effects)
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