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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

                                                                                                                      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)
                                                                                                                      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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