Anterior cervical discectomy and fusion involving a polyetheretherketone spacer and bone morphogenetic protein

Abstract

<jats:p content-type="fine-print"><jats:italic>Object.</jats:italic> The authors reviewed clinical and radiographic outcomes in patients who had undergone anterior cervical discectomy and fusion (ACDF) involving the placement of polyetheretherketone (PEEK) spacers filled with recombinant human bone morphogenetic protein (rhBMP)—2.</jats:p> <jats:p content-type="fine-print"><jats:italic>Methods.</jats:italic> Data obtained in 24 cases were retrospectively evaluated. The follow-up period ranged from 12 to 16 months (mean 13 months). Fifteen patients presented with radiculopathy, eight with myeloradiculopathy, and one with quadriparesis. Single-level ACDF was performed in 12 patients, two-level ACDF in nine, and three-level ACDF in three. Clinical outcomes were assessed using Odom criteria, and fusion was assessed by examining flexion—extension radiographs and computerized tomography scans in cases in which arthrodesis was questionable. Follow-up data were available for 23 patients. One patient died of medical complications unrelated to surgery 4 weeks after ACDF. Clinical outcomes were rated as good/excellent in 22 patients (95%) and fair in one (5%). Solid radiographically documented fusion, with evidence of solid bridging bone and no instability on flexion—extension x-ray films, was present in all cases. Complications included transient recurrent laryngeal nerve injury in one case, transient C-5 paresis in one, cerebrospinal fluid leakage in one, and transient dysphagia in two.</jats:p> <jats:p content-type="fine-print"><jats:italic>Conclusions.</jats:italic> Analysis of the results indicated that ACDF involving an rhBMP-2—filled PEEK spacer leads to good clinical outcomes (by Odum criteria) and solid fusion (even in multilevel cases) while avoiding the complications associated with harvesting iliac crest bone grafts.</jats:p>

Bone graft substitutes in anterior cervical discectomy and fusion

“…At 24 months, the rhBMP-2 group had significantly better improvement in neck (P \ 0.03) and arm (P \ 0.03) pain than autograft, had no complications attributable to rhBMP, and had avoided statistically significant pain (P \ 0.007) from the harvest site at 6 weeks. Boakye et al in a retrospective review of 23 patients with one-to three-level procedures similarly found 1.05 mg/level of rhBMP-2 in PEEK cages induced solid fusion with good clinical outcomes and no significant morbidity [14]. However ectopic bone formation was observed to occur in three patients who were early on in the series and had received twice that amount.…”

“…Recently, a number of clinical studies have focused on its appropriateness in the human cervical spine, with consistently reported fusion rates of 100% [10,14,51,84,99,101,102]. Baskin et al conducted the first prospective randomized controlled trial for anterior cervical interbody fusion, comparing rhBMP-2 with IC autograft, both placed within a fibula allograft and supplemented with anterior plating [10].…”

Lessons from the infuse trials: do we need a classification of bias in scientific publications and editorials?

“…The authors of the original industry-sponsored or industry-associated studies of rhBMP-2 all reported the efficacy in applications including both anterior and posterior cervical and lumbar fusion surgery [3][4][5][6][7][8][9][10][11][12][13][14]. Additionally, the authors of these studies stated similar safety profiles with no adverse effects or complications attributable to rhBMP-2 in any study.…”

Polyetheretherketone (PEEK) cage filled with bone morphogenic protein and demineralised bone matrix in anterior cervical discectomy and fusion

“…We have used this technique successfully in hundreds of patients and preface the use of BMP in the cervical spine with a warning. The use of BMP in ACDF has become highly controversial with reports of retropharyngeal swelling and in a larger series of patients complication rates were well above 20% in patients [4]. Smucker et al reported that over 27% of patients undergoing ACDF with the use of BMP suffered adverse retropharyngeal swelling [4].…”