Xu Risheng, Bydon Mohamad, Sciubba Daniel M, Witham Timothy F, Wolinsky Jean-Paul, Gokaslan Ziya L, Bydon Ali
Medical Scientist Training Program, Johns Hopkins School of Medicine.
Surg Neurol Int. 2011;2:109. doi: 10.4103/2152-7806.83726. Epub 2011 Aug 13.
Many studies offer excellent demonstration of the ability of bone morphogenic protein (BMP) to enhance fusion rates in anterior as well as posterior lumbar surgery. Recently, BMP has also been shown to increase arthrodesis rates in anterior cervical surgery, albeit with concomitant increases in complication rates. To date, however, few studies have investigated the safety and efficacy of BMP in cervical surgeries approached posteriorly.
We retrospectively reviewed 204 consecutive patients with degenerative cervical spinal conditions necessitating posterior cervical fusion at a single institution over the past 4 years. The incidence of postoperative mechanical neck pain, fusion rates, as well as neurologic outcomes were compared between patients who received BMP vs those who did not receive BMP intraoperatively.
There were no significant differences in preoperative variables between the non-BMP vs the BMP cohorts. Over an average follow-up of 24.2 months, there were no significant differences between the two cohorts in duration of hospitalization, cerebrospinal fluid leakage, deep vein thrombosis, pulmonary embolism, hyperostosis, infection, pneumonia, hematoma, C5 palsy, wound dehiscence, reoperation rates, or Nurick/ASIA scores. Eleven (7.1%) patients in the non-BMP group experienced instrumentation failure vs none in the BMP group (P=0.06). Patients receiving BMP had a significantly increased rate of fusion by the chi-square test (P=0.01) and the log-rank test (P=0.02). However, patients receiving BMP also had the highest rates of recurrent/persistent neck pain by the chi-square test (P=0.003) and the log-rank test (P=0.01).
To date, few studies have evaluated the safety and efficacy of BMP in the posterior cervical spine. Here, we show that BMP usage does not increase complication rates, but it significantly increases arthrodesis rates and also may increase the rate of recurrent/persistent neck pain.
许多研究充分证明了骨形态发生蛋白（BMP）在腰椎前路和后路手术中提高融合率的能力。最近，BMP也已被证明可提高颈椎前路手术的融合率，尽管并发症发生率也随之增加。然而，迄今为止，很少有研究探讨BMP在颈椎后路手术中的安全性和有效性。
我们回顾性分析了过去4年在单一机构连续接受颈椎后路融合术治疗的204例退行性颈椎疾病患者。比较术中接受BMP与未接受BMP的患者术后机械性颈部疼痛的发生率、融合率以及神经功能结果。
非BMP组和BMP组术前变量无显著差异。平均随访24.2个月，两组在住院时间、脑脊液漏、深静脉血栓形成、肺栓塞、骨质增生、感染、肺炎、血肿、C5麻痹、伤口裂开、再次手术率或Nurick/ASIA评分方面均无显著差异。非BMP组有11例（7.1%）患者出现内固定失败，而BMP组无此情况（P = 0.06）。通过卡方检验（P = 0.01）和对数秩检验（P = 0.02），接受BMP的患者融合率显著提高。然而，通过卡方检验（P = 0.003）和对数秩检验（P = 0.01），接受BMP的患者复发性/持续性颈部疼痛的发生率也最高。
迄今为止，很少有研究评估BMP在颈椎后路手术中的安全性和有效性。在此，我们表明使用BMP不会增加并发症发生率，但会显著提高融合率，并且可能会增加复发性/持续性颈部疼痛的发生率。
