Bellamy J Taylor, Dilbone Eric, Schell Adam, Premkumar Ajay, Geddes Benjamin, Leckie Steven, Moatz Bradley, Stephens Byron, Shenvi Neeta V, Heller John G
Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA, 30322, USA.
Department of Orthopaedic Surgery, Emory Spine Center, 59 Executive Park South, Suite 3000, Atlanta, GA, 30329, USA.
Spine J. 2022 Feb;22(2):256-264. doi: 10.1016/j.spinee.2021.09.001. Epub 2021 Sep 16.
Previous studies have called into question the safety of using rhBMP-2 in anterior cervical fusion due to the possibility of airway compromise and dysphagia. A retrospective chart review identified a significant increase in the severity of dysphagia after II-level ACDF with rhBMP-2 compared to patients who did not receive rhBMP-2. To date, this topic has not been studied prospectively.
Compare the incidence of dysphagia following anterior cervical discectomy and fusion (ACDF) when recombinant human bone morphogenetic protein-2 (rhBMP-2) is used with allograft compared to allograft alone.
Prospective cohort study.
A total of 114 patients completed a baseline SWAL-QOL survey and met the inclusion criteria. Thirty-nine patients underwent I- or II-level ACDF with allograft plus 0.5mg rhBMP-2/level. 44 patients underwent ACDF with allograft alone. Thirty-one patients undergoing a lumbar decompression were enrolled in a third cohort to control for dysphagia secondary to intubation.
The primary outcome measure was the 14-point SWAL-QOL dysphagia questionnaire. Other patient factors obtained from anesthesia and operative records were examined to evaluate their potential relationship to postoperative dysphagia.
The 14-point SWAL-QOL questionnaire was administered at multiple time points (pre-op, post-op 7 days, 6 weeks, 6 months, and at least 1 year). Multivariable repeated-measures analysis was applied to data.
Baseline adjusted SWAL-QOL means 7 days after surgery were significantly different between the three study groups. These differences resolved by 6 weeks postoperative, beyond which point there were no differences. At final follow-up, baseline adjusted SWAL-QOL means at 1 year were similar for the three study groups.
This single-center study of anterior cervical surgery demonstrated that the addition of rhBMP-2 to an ACDF increased postoperative dysphagia at 7 days after surgery, but these patients recover to levels comparable to those who underwent ACDF without rhBMP-2 or lumbar surgery within 6 weeks.
既往研究对在颈椎前路融合术中使用重组人骨形态发生蛋白-2（rhBMP-2）的安全性提出质疑，因为存在气道受压和吞咽困难的可能性。一项回顾性病历审查发现，与未接受rhBMP-2的患者相比，接受二级颈椎前路椎间盘切除融合术（ACDF）并使用rhBMP-2的患者吞咽困难的严重程度显著增加。迄今为止，该主题尚未进行前瞻性研究。
比较在颈椎前路椎间盘切除融合术（ACDF）中，使用重组人骨形态发生蛋白-2（rhBMP-2）联合同种异体骨与单纯使用同种异体骨后吞咽困难的发生率。
前瞻性队列研究。
共有114例患者完成了基线吞咽生活质量（SWAL-QOL）调查并符合纳入标准。39例患者接受了一级或二级ACDF，使用同种异体骨加0.5mg rhBMP-2/节段。44例患者接受了单纯同种异体骨ACDF。31例行腰椎减压术的患者纳入第三组，以控制插管引起的吞咽困难。
主要观察指标是14分的SWAL-QOL吞咽困难问卷。从麻醉和手术记录中获取的其他患者因素进行了检查，以评估它们与术后吞咽困难的潜在关系。
在多个时间点（术前、术后7天、6周、6个月和至少1年）发放14分的SWAL-QOL问卷。对数据应用多变量重复测量分析。
术后7天，三个研究组的基线调整后SWAL-QOL平均值有显著差异。这些差异在术后6周时消失，此后无差异。在最终随访时，三个研究组在1年时的基线调整后SWAL-QOL平均值相似。
这项关于颈椎前路手术的单中心研究表明，在ACDF中添加rhBMP-2会在术后7天增加吞咽困难，但这些患者在6周内恢复到与未使用rhBMP-2进行ACDF或接受腰椎手术的患者相当的水平。
