Sayama Christina, Hadley Caroline, Monaco Gina N, Sen Anish, Brayton Alison, Briceño Valentina, Tran Brandon H, Ryan Sheila L, Luerssen Thomas G, Fulkerson Daniel, Jea Andrew
Neuro-Spine Program, Division of Pediatric Neurosurgery, and.
Department of Neurosurgery, Baylor College of Medicine, Houston, Texas; and.
J Neurosurg Pediatr. 2015 Jul;16(1):14-20. doi: 10.3171/2015.2.PEDS14533. Epub 2015 Apr 10.
OBJECT The purpose of this study focusing on fusion rate was to determine the efficacy of recombinant human bone morphogenetic protein-2 (rhBMP-2) use in posterior instrumented fusions of the craniocervical junction in the pediatric population. The authors previously reported the short-term (mean follow-up 11 months) safety and efficacy of rhBMP-2 use in the pediatric age group. The present study reports on their long-term results (minimum of 12 months' follow-up) and focuses on efficacy. METHODS The authors performed a retrospective review of 83 consecutive pediatric patients who had undergone posterior occipitocervical or atlantoaxial spine fusion at Texas Children's Hospital or Riley Children's Hospital during the period from October 2007 to October 2012. Forty-nine patients were excluded from further analysis because of death, loss to follow-up, or lack of CT evaluation of fusion at 12 or more months after surgery. Fusion was determined by postoperative CT scan at a minimum of 12 months after surgery. The fusion was graded and classified by a board-certified fellowship-trained pediatric neuroradiologist. Other factors, such as patient age, diagnosis, number of vertebral levels fused, use of allograft or autograft, dosage of bone morphogenetic protein (BMP), and use of postoperative orthosis, were recorded. RESULTS Thirty-four patients had a CT scan at least 12 months after surgery. The average age of the patients at surgery was 8 years, 1 month (range 10 months-17 years). The mean follow-up was 27.7 months (range 12-81 months). There were 37 fusion procedures in 34 patients. Solid fusion (CT Grade 4 or 4-) was achieved in 89.2% of attempts (33 of 37), while incomplete fusion or failure of fusion was seen in 10.8%. Based on logistic regression analysis, there was no significant association between solid fusion and age, sex, BMP dose, type of graft material, use of postoperative orthosis, or number of levels fused. Three of 34 patients (8.8%) required revision surgery. CONCLUSIONS Despite the large number of adult studies reporting positive effects of BMP on bone fusion, our long-term outcomes using rhBMP-2 in the pediatric population suggest that rates of fusion failure are higher than observed in contemporary adult and pediatric reports of occipitocervical and atlantoaxial spine fusions.
目的 本研究聚焦融合率，旨在确定重组人骨形态发生蛋白-2（rhBMP-2）在儿科人群颅颈交界区后路器械融合术中的疗效。作者之前报道了rhBMP-2在儿科年龄组中的短期（平均随访11个月）安全性和疗效。本研究报告其长期结果（至少12个月随访）并聚焦疗效。方法 作者对2007年10月至2012年10月期间在德克萨斯儿童医院或莱利儿童医院接受后路枕颈或寰枢椎融合术的83例连续儿科患者进行了回顾性研究。49例患者因死亡、失访或术后12个月或更长时间缺乏融合的CT评估而被排除在进一步分析之外。融合情况通过术后至少12个月时的CT扫描确定。融合情况由一名经过委员会认证且接受过研究员培训的儿科神经放射科医生进行分级和分类。记录其他因素，如患者年龄、诊断、融合的椎体节段数、同种异体移植物或自体移植物的使用、骨形态发生蛋白（BMP）的剂量以及术后支具的使用情况。结果 34例患者术后至少12个月进行了CT扫描。手术时患者平均年龄为8岁1个月（范围10个月至17岁）。平均随访27.7个月（范围12至81个月）。34例患者共进行了37次融合手术。89.2%（37例中的33例）实现了牢固融合（CT分级4级或4-级），而10.8%出现了融合不完全或融合失败情况。基于逻辑回归分析，牢固融合与年龄、性别、BMP剂量、移植物材料类型、术后支具的使用或融合节段数之间无显著关联。34例患者中有3例（8.8%）需要翻修手术。结论 尽管大量成人研究报告了BMP对骨融合的积极作用，但我们在儿科人群中使用rhBMP-2的长期结果表明融合失败率高于当代成人和儿科枕颈及寰枢椎融合术报告中的观察结果。
