Fusion rates in multilevel, instrumented anterior cervical fusion for degenerative disease with and without the use of bone morphogenetic protein

Mark B. Frenkel, Kevin S. Cahill, Ramin J. Javahary, George Zacur, Barth A Green, Allan D Levi

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Object. The goal of this study was to compare the rates of solid arthrodesis and complications following multilevel, instrumented anterior cervical fusion in patients treated with and without bone morphogenetic protein (BMP). Methods. The authors conducted a retrospective cohort study of patients who underwent multilevel (2+ level) anterior cervical fusions performed for degenerative disc disease with or without the concurrent use of BMP-2 from 1997 to 2012. The dosage throughout the study ranged from 2.1 to 0.26 mg/level (mean 1.0 mg/level). All patients were evaluated postoperatively by means of radiographs and CT scans to determine fusion status. Results. The overall fusion rate for the patients treated without BMP (n = 23) was 82.6% compared with a 100% fusion rate in the group treated with BMP (n = 22) (p = 0.04). The pseudarthrosis rates increased with number of fusion levels in patients who did not receive BMP, whereas all patients in the group treated with BMP had solid arthrodesis. Furthermore, there were 2 instrumentation failures in the non-BMP group. There was a direct correlation between the incidence of complications and the dosage of BMP used per level, with no complications reported at doses equal to or less than 1.1 mg/level. Conclusions. The overall rate of bony arthrodesis was increased following the use of BMP in multilevel anterior cervical fusion. Traditional methods without BMP had a high rate of pseudarthrosis. The complications associated with the use of BMP appeared to be dose related and of low incidence when BMP is used in doses equal to or less than 1.1 mg/level.

Original languageEnglish
Pages (from-to)269-273
Number of pages5
JournalJournal of Neurosurgery: Spine
Volume18
Issue number3
DOIs
StatePublished - Mar 1 2013

Fingerprint

Bone Morphogenetic Proteins
Arthrodesis
Pseudarthrosis
Bone Morphogenetic Protein 2
Incidence
Cohort Studies
Retrospective Studies

Keywords

  • Bone morphogenetic protein
  • Cervical spine
  • Fusion
  • Instrumentation

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Neurology

Cite this

Fusion rates in multilevel, instrumented anterior cervical fusion for degenerative disease with and without the use of bone morphogenetic protein. / Frenkel, Mark B.; Cahill, Kevin S.; Javahary, Ramin J.; Zacur, George; Green, Barth A; Levi, Allan D.

In: Journal of Neurosurgery: Spine, Vol. 18, No. 3, 01.03.2013, p. 269-273.

Research output: Contribution to journalArticle

@article{c4ec108aaa6344cbaab31059609fb2a8,
title = "Fusion rates in multilevel, instrumented anterior cervical fusion for degenerative disease with and without the use of bone morphogenetic protein",
abstract = "Object. The goal of this study was to compare the rates of solid arthrodesis and complications following multilevel, instrumented anterior cervical fusion in patients treated with and without bone morphogenetic protein (BMP). Methods. The authors conducted a retrospective cohort study of patients who underwent multilevel (2+ level) anterior cervical fusions performed for degenerative disc disease with or without the concurrent use of BMP-2 from 1997 to 2012. The dosage throughout the study ranged from 2.1 to 0.26 mg/level (mean 1.0 mg/level). All patients were evaluated postoperatively by means of radiographs and CT scans to determine fusion status. Results. The overall fusion rate for the patients treated without BMP (n = 23) was 82.6{\%} compared with a 100{\%} fusion rate in the group treated with BMP (n = 22) (p = 0.04). The pseudarthrosis rates increased with number of fusion levels in patients who did not receive BMP, whereas all patients in the group treated with BMP had solid arthrodesis. Furthermore, there were 2 instrumentation failures in the non-BMP group. There was a direct correlation between the incidence of complications and the dosage of BMP used per level, with no complications reported at doses equal to or less than 1.1 mg/level. Conclusions. The overall rate of bony arthrodesis was increased following the use of BMP in multilevel anterior cervical fusion. Traditional methods without BMP had a high rate of pseudarthrosis. The complications associated with the use of BMP appeared to be dose related and of low incidence when BMP is used in doses equal to or less than 1.1 mg/level.",
keywords = "Bone morphogenetic protein, Cervical spine, Fusion, Instrumentation",
author = "Frenkel, {Mark B.} and Cahill, {Kevin S.} and Javahary, {Ramin J.} and George Zacur and Green, {Barth A} and Levi, {Allan D}",
year = "2013",
month = "3",
day = "1",
doi = "10.3171/2012.12.SPINE12607",
language = "English",
volume = "18",
pages = "269--273",
journal = "Journal of Neurosurgery: Spine",
issn = "1547-5654",
publisher = "American Association of Neurological Surgeons",
number = "3",

}

TY - JOUR

T1 - Fusion rates in multilevel, instrumented anterior cervical fusion for degenerative disease with and without the use of bone morphogenetic protein

AU - Frenkel, Mark B.

AU - Cahill, Kevin S.

AU - Javahary, Ramin J.

AU - Zacur, George

AU - Green, Barth A

AU - Levi, Allan D

PY - 2013/3/1

Y1 - 2013/3/1

N2 - Object. The goal of this study was to compare the rates of solid arthrodesis and complications following multilevel, instrumented anterior cervical fusion in patients treated with and without bone morphogenetic protein (BMP). Methods. The authors conducted a retrospective cohort study of patients who underwent multilevel (2+ level) anterior cervical fusions performed for degenerative disc disease with or without the concurrent use of BMP-2 from 1997 to 2012. The dosage throughout the study ranged from 2.1 to 0.26 mg/level (mean 1.0 mg/level). All patients were evaluated postoperatively by means of radiographs and CT scans to determine fusion status. Results. The overall fusion rate for the patients treated without BMP (n = 23) was 82.6% compared with a 100% fusion rate in the group treated with BMP (n = 22) (p = 0.04). The pseudarthrosis rates increased with number of fusion levels in patients who did not receive BMP, whereas all patients in the group treated with BMP had solid arthrodesis. Furthermore, there were 2 instrumentation failures in the non-BMP group. There was a direct correlation between the incidence of complications and the dosage of BMP used per level, with no complications reported at doses equal to or less than 1.1 mg/level. Conclusions. The overall rate of bony arthrodesis was increased following the use of BMP in multilevel anterior cervical fusion. Traditional methods without BMP had a high rate of pseudarthrosis. The complications associated with the use of BMP appeared to be dose related and of low incidence when BMP is used in doses equal to or less than 1.1 mg/level.

AB - Object. The goal of this study was to compare the rates of solid arthrodesis and complications following multilevel, instrumented anterior cervical fusion in patients treated with and without bone morphogenetic protein (BMP). Methods. The authors conducted a retrospective cohort study of patients who underwent multilevel (2+ level) anterior cervical fusions performed for degenerative disc disease with or without the concurrent use of BMP-2 from 1997 to 2012. The dosage throughout the study ranged from 2.1 to 0.26 mg/level (mean 1.0 mg/level). All patients were evaluated postoperatively by means of radiographs and CT scans to determine fusion status. Results. The overall fusion rate for the patients treated without BMP (n = 23) was 82.6% compared with a 100% fusion rate in the group treated with BMP (n = 22) (p = 0.04). The pseudarthrosis rates increased with number of fusion levels in patients who did not receive BMP, whereas all patients in the group treated with BMP had solid arthrodesis. Furthermore, there were 2 instrumentation failures in the non-BMP group. There was a direct correlation between the incidence of complications and the dosage of BMP used per level, with no complications reported at doses equal to or less than 1.1 mg/level. Conclusions. The overall rate of bony arthrodesis was increased following the use of BMP in multilevel anterior cervical fusion. Traditional methods without BMP had a high rate of pseudarthrosis. The complications associated with the use of BMP appeared to be dose related and of low incidence when BMP is used in doses equal to or less than 1.1 mg/level.

KW - Bone morphogenetic protein

KW - Cervical spine

KW - Fusion

KW - Instrumentation

UR - http://www.scopus.com/inward/record.url?scp=84874685792&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84874685792&partnerID=8YFLogxK

U2 - 10.3171/2012.12.SPINE12607

DO - 10.3171/2012.12.SPINE12607

M3 - Article

C2 - 23350532

AN - SCOPUS:84874685792

VL - 18

SP - 269

EP - 273

JO - Journal of Neurosurgery: Spine

JF - Journal of Neurosurgery: Spine

SN - 1547-5654

IS - 3

ER -