Hospital Outcomes and Complications of Anterior and Posterior Cervical Fusion With Bone Morphogenetic Protein

Fineberg, Steven J.; Ahmadinia, Kasra; Oglesby, Matthew; Patel, Alpesh A.; Singh, Kern

doi:10.1097/brs.0b013e31828f494c

Cited by 52 publications

(52 citation statements)

References 19 publications

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“…The overall complication rate of cervical spinal surgery is estimated to be 0.2% to 17.8%. 4,17,27,48 After 30 days, the most common complication is related to instrumentation dislodgement, breakage, or both, and occurs in 2% to 25% of cases of spinal fusion procedures. 27 Reoperation rate for instrumented spinal fusions is reported between 2% and 25%, with the majority related to pseudoarthrosis.…”

Section: Discussionmentioning

confidence: 99%

Misplaced Cervical Screws Requiring Reoperation

Peterson

Arnold

Smith

et al. 2017

Global Spine Journal

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Study Design:A multicenter, retrospective case series.Objective:In the past several years, screw fixation of the cervical spine has become commonplace. For the most part, this is a safe, low-risk procedure. While rare, screw backout or misplaced screws can lead to morbidity and increased costs. We report our experiences with this uncommon complication.Methods:A multicenter, retrospective case series was undertaken at 23 institutions in the United States. Patients were included who underwent cervical spine surgery from January 1, 2005, to December 31, 2011, and had misplacement of screws requiring reoperation. Institutional review board approval was obtained at all participating institutions, and detailed records were sent to a central data center.Results:A total of 12 903 patients met the inclusion criteria and were analyzed. There were 11 instances of screw backout requiring reoperation, for an incidence of 0.085%. There were 7 posterior procedures. Importantly, there were no changes in the health-related quality-of-life metrics due to this complication. There were no new neurologic deficits; a patient most often presented with pain, and misplacement was diagnosed on plain X-ray or computed tomography scan. The most common location for screw backout was C6 (36%).Conclusions:This study represents the largest series to tabulate the incidence of misplacement of screws following cervical spine surgery, which led to revision procedures. The data suggest this is a rare event, despite the widespread use of cervical fixation. Patients suffering this complication can require revision, but do not usually suffer neurologic sequelae. These patients have increased cost of care. Meticulous technique and thorough knowledge of the relevant anatomy are the best means of preventing this complication.

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Section: Discussionmentioning

confidence: 99%

Misplaced Cervical Screws Requiring Reoperation

Peterson

Arnold

Smith

et al. 2017

Global Spine Journal

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“…Dysphagia is a well-known complication after anterior surgeries [73]. Multilevel surgery and bone morphogenetic protein have been raised as risk factors [74,75]. Newer low profile implants and perioperative steroid administration were shown to be effective in reducing dysphagia by reducing retropharyngeal edema [76,77].…”

Section: Complicationsmentioning

confidence: 99%

Degenerative Cervical Myelopathy

et al. 2015

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Cervical myelopathy is the most common cause of acquired spinal cord compromise. The concept of degenerative cervical myelopathy (DCM), defined as symptomatic myelopathy associated with degenerative arthropathic changes in the spine axis, is being introduced. Given its progressive nature, treatment options have to be chosen in a timely manner. Surgical options include anterior discectomy and fusion (ACDF), anterior corpectomy and fusion (ACCF), arthroplasty (in highly select cases), posterior laminectomy with/without fusion, and laminoplasty. Indications for each should be carefully considered in individual patients. Riluzole, a sodium-glutamate antagonist, is a promising option to optimize neurologic outcomes post-surgery and is being examined in the CSM-Protect Randomized Controlled Trial. Preoperative risk assessment is mandatory for prognostication. Sagittal alignment is known to play an important role to optimize surgical outcome. Guidelines for optimal management of DCM are in process. In principle, all but the mildest cases of DCM should be offered surgery for optimal outcome.

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“…To note, hospital charges only indirectly correlate with the expenditure health-care related resources and hospital collections. During a comparable time period, Fineberg et al [20] found BMP use was associated with increased costs for all cervical fusions. On average, there was a $5092 and $6272 increase in hospital costs for ACFs and PCFs, respectively.…”

Section: Costmentioning

confidence: 99%

“…Given the ongoing uncertainty with the risks and benefits of using BMP in certain off-label applications, various groups have studied the utilization and cost impacts of BMP on a national scale before and after the FDA warnings [2,4,16,20,26,27]. Although the recommended guidelines for limited BMP utilization in spinal fusions have not changed, the rate and type of procedures with BMP continue to increase.…”

Section: Introductionmentioning

confidence: 99%

Epidemiologic trends in the utilization, demographics, and cost of bone morphogenetic protein in spinal fusions

Louie

Hassanzadeh

Singh

2014

Curr Rev Musculoskelet Med

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Bone morphogenetic protein (BMP) utilization as an adjunct for spinal arthrodesis has gained considerable momentum among spine surgeons. Despite carrying Food and Drug Administration approval for only single level anterior lumbar interbody fusion from L4-S1, the majority of BMP administration is in "off label" settings. Over the last decade, BMP utilization has increased in all facets of spine surgery with the only exception being the anterior cervical spine, in which a downward trend resulted following the 2008 Food and Drug Administration warnings. The future application of BMP in spinal fusion, especially in anterior cervical fusions, will need to be further clarified in terms of efficacy, complications, and cost-effectiveness.

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Hospital Outcomes and Complications of Anterior and Posterior Cervical Fusion With Bone Morphogenetic Protein

Cited by 52 publications

References 19 publications

Misplaced Cervical Screws Requiring Reoperation

Misplaced Cervical Screws Requiring Reoperation

Degenerative Cervical Myelopathy

Epidemiologic trends in the utilization, demographics, and cost of bone morphogenetic protein in spinal fusions

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