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Radiographic and CT Evaluation of Recombinant Human Bone Morphogenetic Protein-2–assisted Cervical Spinal Interbody Fusion

Weisbrod, Luke J., BS*; Arnold, Paul M., MD; Leever, John D., MD

doi: 10.1097/BSD.0000000000000720
PRIMARY RESEARCH
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Study Design: This was a retrospective study.

Objective: To radiographically demonstrate the distinct fusion pattern of recombinant human bone morphogenetic protein-2 (rhBMP-2) in the setting of anterior cervical discectomy and fusion.

Summary of Background Data: Studies investigating spinal fusion assisted with rhBMP-2 have yielded promising results, suggesting rhBMP-2 is an efficacious alternative to iliac crest autografts. rhBMP-2-assisted spinal fusion both hastens healing and eliminates patient morbidity from iliac crest autograft. Unique to rhBMP-assisted spinal fusion is its distinct radiographic fusion pattern as fusion is achieved. Despite promising results and increased clinical use of rhBMP-2, there remains a paucity of literature documenting this radiographic process.

Materials and Methods: This study included 26 patients who underwent single-level anterior cervical discectomy and fusion using rhBMP-2. All data used for this study was collected from a prior FDA Investigational Device Exemption study.

Results: A polyetheretherketone cage was used as an interbody disk spacer in all 26 patients. Patients were evaluated between 2 and 6 weeks after surgery and subsequently at 3, 6, 12, and 24 months postoperative. All patients underwent plain radiography at every follow-up visit, and computed tomograhy evaluation was performed at 3, 6, 12, and 24 months as part of the study protocol. Earliest fusion was observed at 3 months in 38% of patients. Likely fusion was observed in all patients by 12 months postoperative.

Conclusions: rhBMP-2 leads to both successful interbody fusion and an enhanced fusion rate with unique imaging characteristics. Additional characteristics of BMP observed in 100% of patients included prevertebral soft-tissue swelling and early endplate resorption. Other common features included polyetheretherketone cage migration, heterotopic bone formation and cage subsidence.

*School of Medicine

Department of Neurosurgery

Department of Radiology, University of Kansas Medical Center, Kansas City, KS

The authors declare there are no sources of report requiring acknowledgment and that no funding was received from any of the following organizations: National Institutes of Health (NIH); Wellcome Trust, Howard Hughes Medical Institute (HHMI); or any others.

The authors declare no conflict of interest.

Reprints: Paul M. Arnold, MD, Department of Neurosurgery, University of Kansas Medical Center, 3901 Rainbow Blvd., Delp 5080, Mailstop 3021, Kansas City, KS 66160 (e-mail: parnold@kumc.edu).

Received February 28, 2018

Accepted August 15, 2018

© 2019 by Lippincott Williams & Wilkins, Inc.