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Safety, Efficacy, and Dosing of Recombinant Human Bone Morphogenetic Protein-2 (rhBMP-2) for Posterior Cervical and Cervico-thoracic Instrumented Fusion with a Minimum Two-year Follow-up D. Kojo Hamilton MD; Justin S. Smith MD PhD; Davis Reames MD; Brian Jeremy Williams MD; Daniel R. Chernavvsky MD; Christopher I. Shaffrey MD, FACS Departments of Neurosurgery: 1) University of Maryland School of Medicine and 2)University of Virginia School of Medicine Introduction Fig1 Considerable attention has focused on concerns of increased complications with rhBMP-2 use for anterior cervical fusion, but few reports have assessed its use for posterior cervical fusions. This study evaluates the safety, efficacy, and dosing of recombinant human bone morphogenetic protein (rhBMP)-2 as an adjunct for instrumented posterior cervical arthrodesis using a retrospective Results consecutive case series. 53 patients (22 men/31 women) met inclusion criteria, with a mean age of 55.7 years and an Conclusions Methods average follow-up of 40 months. Surgical Augmentation of posterior cervical fusion with rhBMP All patients were treated by the senior author with indications included basilar invagination (n=6), -2 appears to be safe and has a very low posterior cervical or cervico-thoracic instrumented fracture (n=6), atlanto-axial instability (n=16), complication rate. Despite complex pathology fusion augmentated with rhBMP-2 and had kyphosis/kyphoscoliosis (n=22), osteomyelitis and/or rheumatoid arthritis, a 100% fusion rate was minimum follow-up of two-years. Diagnosis, levels (n=1), spondylolisthesis (n=1), cyst (n=1). 15 achieved, which is considerably higher than fused, rhBMP-2 dose, complications, and fusion: patients had confirmed rheumatoid disease. The comparable historical comparisons without rhBMP-2 Lenke grade (Table 1) applied by two average rhBMP-2 dose was 1.79mg/level with a (62-94%). This data suggest that use of rhBMP-2 as neuroradiologists) were assessed. In all cases, total of 282 levels treated. Among 53 patients, only an adjunct for posterior cervical fusion is safe and following instrumentation and decortication of fusion 2 complications (3.8%) were identified, a superficial effective at an average dose of 1.8mg per level. bed, the sponges and morselized allograft/ wound infection and an adjacent level degeneration. At last follow-up, all patients had achieved fusion. Learning Objectives autograft were placed laterally over the facets and Based on this consecutive series of 53 patients, rhBMP-2 as an transverse processes when there was a medial adjunct for posterior cervical fusion is safe and effective at an decompression, or included laminar placement if no average dose of 1.8mg/level. Despite many of the patients decompression was performed (Figure 1). having complex pathology and/or rheumatoid arthritis, the complication rate was only 3.8% and a 100% fusion rate was achieved. 1. Urist MR, Huo YK, Brownell AG, et al: Purification of bovine bone morphogenetic protein by hydroxyapatite chromatography. Proc Natl Acad Sci U S A 1984;81:371-5. 2. Boden SD, Kang J, Sandhu H, et al: Use of recombinant human bone morphogenetic protein-2 to achieve posterolateral lumbar spine fusion in humans: a prospective, randomized clinical pilot trial: 2002 Volvo Award in clinical studies. Spine (Phila Pa 1976) 2002;27:2662-73. 3. Hamilton DK, Jones-Quaidoo SM, Sansur C, et al: Outcomes of bone morphogenetic protein-2 in mature adults: posterolateral non-instrument-assisted lumbar decompression and fusion. Surg Neurol 2008;69:457-61; discussion 461-2. 4. Hiremath GK, Steinmetz MP, Krishnaney AA: Is it safe to use recombinant human bone morphogenetic protein in posterior cervical fusion? Spine (Phila Pa 1976) 2009;34:885-9. 5. Lenke LG, Bridwell KH, Bullis D, et al: Results of in situ fusion for isthmic spondylolisthesis. J Spinal Disord 1992;5:433-42.
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