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
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
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