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The safety and utility of bone morphogenetic protein in anterior and posterior cervical-spine fusions

Lee, Richard Sa; White, Andrew Pb; Grauer, Jonathan Nc

Current Opinion in Orthopaedics:
doi: 10.1097/BCO.0b013e32810c00f6
Cervical spine
Abstract

Purpose of review: Interest in using recombinant human bone morphogenetic proteins in the cervical spine has been motivated by the desire to avoid the complications associated with autologous bone-graft harvest or bone-graft alternatives as well as to ensure successful fusion. Well-performed, prospective clinical studies have demonstrated the efficacy of recombinant human bone morphogenetic proteins to promote bony union in the long bones and in the lumbar spine. It is appealing to consider applying these highly osteoinductive molecules to cervical fusions, and this article summarizes the recent reports of such applications.

Recent findings: Several cohort studies have reported on recombinant human bone morphogenetic proteins being used with primary anterior cervical-spine surgery. In general, these studies indicate high fusion rates but also increase local complications such as soft-tissue edema. Although local swelling may be dose-dependent, this has not been studied as an independent variable. No posterior cervical-spine fusion series have been reported with recombinant human bone morphogenetic proteins at this point.

Summary: In considering recombinant human bone morphogenetic proteins for cervical-spine surgery, the appropriate dose, carrier, and surgical technique will need further defining and optimization. Additionally, implant costs and risks must be balanced against potential benefits.

Author Information

aDepartment of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut

bRothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA

cDepartment of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut, USA

Correspondence to Jonathan N. Grauer, Assistant Professor, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, PO Box 208071, New Haven, CT 06520-8071, USA Tel: +1 203 737 7463; fax: +1 203 785 7132; e-mail: jonathan.grauer@yale.edu

© 2007 Lippincott Williams & Wilkins, Inc.