Hamilton D Kojo, Smith Justin S, Reames Davis L, Williams Brian J, Shaffrey Christopher I
Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland.
J Craniovertebr Junction Spine. 2010 Jul;1(2):107-12. doi: 10.4103/0974-8237.77674.
There have been few reports on the use of recombinant human bone morphogenetic protein (rhBMP)-2 in posterior spine. However, no study has investigated the dosing, safety, and efficacy of its use in the posterior atlantoaxial, and/or craniovertebral junction. Recent case report of the cytokine-mediated inflammatory reaction, following off label use of rhBMP-2 as an adjunct for cervical fusion, particularly in complex cases, has increased concern about complications associated with the product.
To assess the safety, efficacy, and dosing of rhBMP-2 as an adjunct for instrumented posterior atlantoaxial and/or craniovertebral junction arthrodesis.
We included all patients treated by the senior author that included posterior atlantoaxial and/or craniovertebral junction instrumented fusion using rhBMP-2 from 2003 to 2008 with a minimum two year follow-up. Diagnosis, levels fused, rhBMP-2 dose, complications, and fusion were assessed.
Twenty three patients with a mean age of 60.9 years (range 4 - 89 years) and an average follow-up of 45 months (range 27 to 84 months) met inclusion criteria. The indications for surgery included, atlantoaxial instability (n = 16), basilar invagination (n = 6), and kyphoscoliosis (n = 1). The specific pathologic diagnosis included type 2 dens fracture (n = 7), complex C1 and C2 ring fracture (n = 2), chordoma (n = 2), degenerative/osteoporosis (n = 3), rheumatoid disease (n = 8), and pseudogout (n = 1). The average rhBMP-2 dose was 2.38 mg/level, with a total of 76 levels treated (average 3.3 levels, SD= 1.4 levels). There were no complications. During the most recent follow-up, all patients had achieved fusion.
In a series of patients with complex pathology and/or rheumatoid arthritis, 100% fusion rate was achieved with adjunct use of rhBMP-2, with a safe and effective average rhBMP-2 dose of 2.38 mg per level.
关于重组人骨形态发生蛋白（rhBMP）-2在后路脊柱手术中的应用报道较少。然而，尚无研究探讨其在寰枢椎后路和/或颅颈交界区使用的剂量、安全性及有效性。近期有病例报告称，rhBMP-2在颈椎融合术中超适应证使用（尤其是在复杂病例中）后出现细胞因子介导的炎症反应，这增加了人们对该产品相关并发症的担忧。
评估rhBMP-2作为后路寰枢椎和/或颅颈交界区器械辅助融合术辅助用药的安全性、有效性及剂量。
纳入2003年至2008年间由资深作者治疗的所有患者，这些患者接受了使用rhBMP-2的后路寰枢椎和/或颅颈交界区器械辅助融合术，且随访时间至少为两年。评估诊断情况、融合节段、rhBMP-2剂量、并发症及融合情况。
23例患者符合纳入标准，平均年龄60.9岁（范围4 - 89岁），平均随访45个月（范围27至84个月）。手术适应证包括寰枢椎不稳（n = 16）、基底凹陷（n = 6）和脊柱侧凸（n = 1）。具体病理诊断包括Ⅱ型齿状突骨折（n = 7）、C1和C2复杂环形骨折（n = 2）、脊索瘤（n = 2）、退行性变/骨质疏松（n = 3）、类风湿病（n = 8）和假性痛风（n = 1）。rhBMP-2平均剂量为2.38 mg/节段，共治疗76个节段（平均3.3个节段，标准差= 1.4个节段）。未出现并发症。在最近一次随访时，所有患者均实现融合。
在一系列患有复杂病理情况和/或类风湿关节炎的患者中，联合使用rhBMP-2实现了100%的融合率，rhBMP-2平均剂量为2.38 mg/节段，安全有效。
