Hodges Scott D, Eck Jason C, Newton Danette
Center for Sports Medicine and Orthopaedics, Chattanooga Outpatient Center, Chattanooga, Tennessee 37404, USA.
Orthopedics. 2012 Jun;35(6):e895-8. doi: 10.3928/01477447-20120525-30.
Posterior cervical decompression and fusion can be performed for various spinal conditions. Previous rates of pseudoarthrosis have been reported in up to 38% of patients. The use of bone morphogenic protein (BMP) has been approved for use in certain anterior lumbar interbody fusion techniques to decrease the incidence of pseudoarthrosis. Bone morphogenic protein in the anterior cervical spine carries a potential increased risk of airway complications; however, few data exist on the safety and efficacy of BMP in the posterior cervical spine. The purpose of this study was to evaluate fusion success, safety, and heterotopic bone formation using BMP in posterior cervical fusion.Twenty-nine patients who received posterior cervical fusion with BMP were followed for a minimum of 12 months. Computed tomography scans were obtained at a minimum of 12 months postoperatively to evaluate for solid arthrodesis and the presence of heterotopic bone formation. Patients' demographic data and adverse events were evaluated. All patients underwent posterior cervical decompression and instrumented fusion of at least 1 level between 2006 and 2008. Of 37 patients eligible for the study, 29 agreed to participate. Three (10.3%) of 29 patients developed pseudoarthrosis, as found on computed tomography scan. None of these went on to further surgery. No evidence existed of heterotopic bone formation outside of the lateral masses or bone growth over the spinal canal or neuroforamen. No adverse events were related to the use of BMP in this series of posterior cervical fusions. Bone morphogenic protein can be used safely in posterior cervical spine fusion, but additional larger studies are recommended. Even with the use of bone morphogenic protein, the possibility of pseudoarthrosis exists.
后路颈椎减压融合术可用于治疗多种脊柱疾病。此前报道的假关节形成率在高达38%的患者中出现。骨形态发生蛋白（BMP）已被批准用于某些前路腰椎椎间融合技术，以降低假关节形成的发生率。颈椎前路使用骨形态发生蛋白会增加气道并发症的潜在风险；然而，关于BMP在颈椎后路的安全性和有效性的数据很少。本研究的目的是评估在颈椎后路融合术中使用BMP的融合成功率、安全性和异位骨形成情况。29例接受颈椎后路BMP融合术的患者至少随访了12个月。术后至少12个月进行计算机断层扫描，以评估坚固融合和异位骨形成情况。评估患者的人口统计学数据和不良事件。所有患者在2006年至2008年期间均接受了颈椎后路减压和至少1个节段的器械融合术。在37例符合研究条件的患者中，29例同意参与。计算机断层扫描发现，29例患者中有3例（10.3%）出现了假关节形成。这些患者均未继续接受进一步手术。在侧块以外没有异位骨形成的证据，也没有椎管或神经孔处的骨生长。在这一系列颈椎后路融合术中，没有不良事件与使用BMP相关。骨形态发生蛋白可安全用于颈椎后路融合术，但建议进行更多更大规模的研究。即使使用骨形态发生蛋白，假关节形成的可能性仍然存在。
