Department of Orthopedic Surgery, Kansas University Medical Center, Kansas City, KS 66160, USA.
Spine (Phila Pa 1976). 2011 May 1;36(10):E682-6. doi: 10.1097/BRS.0b013e3181f8f4d3.
Case report.
Two cases are presented in which the use of recombinant bone morphogenetic protein-2 (rh-BMP-2) in a posterior cervical decompression and instrumented arthrodesis may have contributed to seroma formation and cord compression.
The use of rh-BMP-2 has been proven effective in promoting bone formation in anterior lumbar spine arthrodesis. Whether rh-BMP-2 is safe and/or effective in the cervical spine has not been determined. Adverse effects when it is used for anterior cervical fusion procedures have been reported but its role in posterior cervical decompression and instrumented fusions has yet to be determined.
We report on two cases. The first is a 68-year-old man presenting with a substantial decline in his neurologic status approximately 2 weeks after surgery. The second is a 44-year-old man presenting with a substantial decline in his neurologic status approximately 5 days after surgery. Both complications occurred after a posterior cervical laminectomy and instrumented arthrodesis when rh-BMP-2 was used as a bone graft substitute.
Both patients were found to have a moderate-to-large seroma causing severe compression on the spinal cord and were urgently taken to an operating room for evacuation of the seromas. Both showed improvement of their neurologic status immediately after surgery. As rh-BMP-2 is known to occasionally cause seroma formation it is postulated that it may have been the cause of the seromas.
Caution should be exercised with rh-BMP-2 use in posterior cervical applications when a laminectomy has been performed. The safe and effective dose and technique for application have yet to be determined. Seroma formation is possible, which can cause acute stenosis with cord compression and neurologic compromise.
病例报告。
报告两例病例，在后路颈椎减压和器械性融合术中使用重组骨形态发生蛋白-2（rh-BMP-2）可能导致血清肿形成和脊髓压迫。
rh-BMP-2 已被证明在促进前路腰椎融合术中骨形成方面是有效的。rh-BMP-2 在颈椎中是否安全和/或有效尚未确定。已经报道了在前路颈椎融合术使用 rh-BMP-2 时出现的不良反应，但尚未确定其在后路颈椎减压和器械性融合中的作用。
我们报告了两例病例。第一例是一名 68 岁男性，术后约 2 周时其神经状态显著下降。第二例是一名 44 岁男性，术后约 5 天时其神经状态显著下降。这两种并发症均发生在后路颈椎椎板切除术和器械性融合术后，当时 rh-BMP-2 被用作骨移植物替代物。
两名患者均发现有中等至大量的血清肿，导致脊髓严重受压，并紧急送往手术室进行血清肿清除。手术后，两名患者的神经状态均立即得到改善。由于 rh-BMP-2 偶尔会引起血清肿形成，因此推测它可能是血清肿的原因。
后路颈椎应用中使用 rh-BMP-2 时应谨慎，其安全有效剂量和应用技术仍有待确定。血清肿形成是可能的，这可能导致急性狭窄和脊髓压迫及神经功能障碍。
