Acute airway obstruction in cervical spinal procedures with bone morphogenetic proteins

Yaremchuk, Kathleen; Toma, Mark S.; Somers, Melissa L.; Peterson, Ed

doi:10.1002/lary.21096

Cited by 49 publications

(29 citation statements)

References 9 publications

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“…65,69,[145][146][147][148] Seroma formation 65,66,[149][150][151][152][153][154] Radiculopathy Nerve root compression/postoperative radiculitis However, the cellular effects of BMP-2 a far more pleiotropic than this would suggest. Indeed, among many contexts, BMP-2 activates peroxisome proliferator-activated receptor gamma (PPARg) signaling, 33 leading to adipogenesis differentiation and fat formation.…”

Section: Review Of Bmp-2 Signalingmentioning

confidence: 99%

A Review of the Clinical Side Effects of Bone Morphogenetic Protein-2

James

LaChaud

Shen

et al. 2016

Tissue Engineering Part B: Reviews

823

769

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Bone morphogenetic protein-2 (BMP-2) is currently the only Food and Drug Administration (FDA)-approved osteoinductive growth factor used as a bone graft substitute. However, with increasing clinical use of BMP-2, a growing and well-documented side effect profile has emerged. This includes postoperative inflammation and associated adverse effects, ectopic bone formation, osteoclast-mediated bone resorption, and inappropriate adipogenesis. Several large-scale studies have confirmed the relative frequency of adverse events associated with the clinical use of BMP-2, including life-threatening cervical spine swelling. In fact, the FDA has issued a warning of the potential life-threatening complications of BMP-2. This review summarizes the known adverse effects of BMP-2, including controversial areas such as tumorigenesis. Next, select animal models that replicate BMP-2's adverse clinical effects are discussed. Finally, potential molecules to mitigate the adverse effects of BMP-2 are reviewed. In summary, BMP-2 is a potent osteoinductive cytokine that has indeed revolutionized the bone graft substitute market; however, it simultaneously has accrued a worrisome side effect profile. Better understanding of these adverse effects among both translational scientists and clinicians will help determine the most appropriate and safe use of BMP-2 in the clinical setting.

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Section: Review Of Bmp-2 Signalingmentioning

confidence: 99%

A Review of the Clinical Side Effects of Bone Morphogenetic Protein-2

James

LaChaud

Shen

et al. 2016

Tissue Engineering Part B: Reviews

823

769

View full text Add to dashboard Cite

show abstract

“…

We read the study by Yaremchuk et al 1 with great interest because the authors' observations that patients who undergo anterior cervical spine surgery with the use of bone morphogenetic proteins (BMP) have a significantly longer hospital stay, higher tracheostomy rate, higher unplanned intubation rate, higher incidence of dysphagia/dyspnea/respiratory failure, and mortality completely contradict our experience. Although most patients who have anterior cervical spine surgery with BMP complain of neck swelling and initial swallowing difficulty after surgery, these complaints are usually self-limited.

…”

mentioning

confidence: 48%

In reference to acute airway obstruction in cervical spinal procedures with bone morphogenetic proteins

Buchowski¹,

Riew²,

Nussenbaum³

2011

The Laryngoscope

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We read the study by Yaremchuk et al. 1 with great interest because the authors' observations that patients who undergo anterior cervical spine surgery with the use of bone morphogenetic proteins (BMP) have a significantly longer hospital stay, higher tracheostomy rate, higher unplanned intubation rate, higher incidence of dysphagia/dyspnea/respiratory failure, and mortality completely contradict our experience. Although most patients who have anterior cervical spine surgery with BMP complain of neck swelling and initial swallowing difficulty after surgery, these complaints are usually self-limited. In our experience in more than 150 patients, airway compromise requiring reintubation has been rare and due to a hematoma rather than edema. We have had no deaths attributable to the use of BMP. Our experience has recently been published. 2 We have identified several issues with the study by Yaremchuk et al. that may be at least in part responsible for the discrepancy between their findings and our experience. First, the technique of BMP delivery, the dose of BMP used, the number of operated on levels, and whether steroids were used perioperatively or postoperatively are not described. Second, there is no description of comparison of patient demographics, comorbidities, and surgical factors (such as operative time, number of fusion levels, whether the surgery was a primary or revision surgery, whether only an anterior approach or a combined anterior/posterior approach was used, etc.) to know that the two patient groups (BMP group and control group) are comparable. Third, there is no cause of death analysis to determine what accounts for the alarming death within 90 days difference between the two groups (4.2% death rate in the BMP group compared with 1.7% in the no BMP group). Lastly, no spine surgeons seem to have been involved with this project design, data analysis, or data interpretation/conclusions as evidenced by the fact that no orthopedic or neurosurgeons are listed as authors or in the acknowledgments section.Because BMP has the potential to cause neck swelling and swallowing difficulty, it has to be used cautiously in anterior cervical spine surgery. Patients and surgeons should be aware of the potential for serious complications. However, we believe that when used appropriately, BMP appears to be generally safe and can dramatically increase the fusion rate.

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“…36 Controversy over its use, however, has also increased over the years 18,42 with several studies reporting complications. 3,8,10,30,41,[45][46][47][48]51,52,55 One of the justifications for its use has been its cost savings associated with prevention of fusion failures. 1,19,39 A few studies have advocated for its use in the posterior cervical spine because of its high fusion rates.…”

mentioning

confidence: 99%

Reoperation rates for symptomatic nonunions in posterior cervicothoracic fusions with and without bone morphogenetic protein in a cohort of 450 patients

Guppy

Harris

Chen

et al. 2016

SPI

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OBJECTIVE Fusions across the cervicothoracic junction have been challenging because of the large biomechanical forces exerted resulting in frequent reoperations for nonunions. The objective of this study was to investigate a retrospective cohort using chart review of posterior cervicothoracic spine fusions with and without bone morphogenetic protein (BMP) and to determine the reoperation rates for symptomatic nonunions in both groups. METHODS Between January 2009 and September 2013, posterior cervicothoracic spine fusion cases were identified from a large spine registry (Kaiser Permanente). Demographics, diagnoses, operative times, lengths of stay, and reoperations were extracted from the registry. Reoperations for symptomatic nonunions were adjudicated via chart review. Logistic regression was used to estimate odds ratios and 95% confidence intervals. Kaplan-Meier curves for the non-BMP and BMP groups were generated and compared using the log-rank test. RESULTS In this cohort there were 450 patients (32.7% with BMP) with a median follow-up of 1.4 years (interquartile range [IQR] 0.5–2.7 years). Kaplan-Meier curves showed no significant difference in reoperation rates for nonunions using the log-rank test (p = 0.088). In a subset of patients with more than 1 year of follow-up, 260 patients were identified (43.1% with BMP) with a median follow-up duration of 2.4 years (IQR 1.6–3.3 years). There was no statistically significant difference in the symptomatic operative nonunion rates for posterior cervicothoracic fusions with and without BMP (0.0% vs 2.7%, respectively; p = 0.137) for more than 1 year of follow-up. CONCLUSIONS This study presents the largest series of patients using BMP in posterior cervicothoracic spine fusions. Reoperation rates for symptomatic nonunions with more than 1 year of follow-up were 0% with BMP and 2.7% without BMP. No statistically significant difference in the reoperation rates for symptomatic nonunions with or without BMP was found.

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Acute airway obstruction in cervical spinal procedures with bone morphogenetic proteins

Cited by 49 publications

References 9 publications

A Review of the Clinical Side Effects of Bone Morphogenetic Protein-2

A Review of the Clinical Side Effects of Bone Morphogenetic Protein-2

In reference to acute airway obstruction in cervical spinal procedures with bone morphogenetic proteins

Reoperation rates for symptomatic nonunions in posterior cervicothoracic fusions with and without bone morphogenetic protein in a cohort of 450 patients

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