Department of Orthopedic Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Department of Orthopedics, Pohang Semyeong Christianity Hospital, Pohang, Korea.
Spine J. 2022 Jul;22(7):1079-1088. doi: 10.1016/j.spinee.2022.02.005. Epub 2022 Feb 16.
Arthrodesis is important for the success of posterior cervical fusion (PCF), however, there exists limited data regarding the safety and efficacy of bone morphogenic protein (BMP) in PCF.
The primary objective was to evaluate early postoperative complications associated with BMP in PCF and determine whether BMP leads to adverse early clinical outcomes. A secondary objective was to determine the optimal location for BMP sponge placement, within the facet joint (IF) or elsewhere, and the optimal dosage/level.
Retrospective, consecutive case-control study.
Seven hundred sixty-five patients who underwent PCF OUTCOME MEASURES: Patient-reported outcomes (PROs), complications, arthrodesis, optimum dose/level of BMP METHODS: Surgical data, including preoperative diagnosis, levels fused, type of bone graft, BMP dose (when used), and fusion technique were recorded. Complications were assessed by reviewing the medical record encompassing the first 6-weeks postoperative. These included medical, neurological, and wound-related complications and reoperation. Neurological complications were defined as any new weakness, radicular pain, or numbness. PROs were collected, including SF36, VAS, EQ-5D, and NDI scores. To determine the optimal dosage and location for BMP placement, a sub-analysis was performed.
There were no significant differences between the BMP and no BMP group with regards to wound complications, neurological complications, or reoperation. There were no differences in PROs between BMP and no BMP. Placement of BMP for IF and at a dose of 0.87 mg/level minimized wound-related complications. The BMP group had a higher fusion rate compared to the no BMP group (96% vs. 91%, p=.02) when assessed 1 year post-operatively.
BMP was not associated with a higher rate of early complications after PCF when the dose was minimized. Complications thought to be associated with BMP, such as compressive seroma, radiculitis, and wound-related complications were not seen at a higher rate. PROs at early follow-up were similar. Placement of BMP for IF and at lower doses than previously reported may minimize complications.
关节融合对于颈椎后路融合术（PCF）的成功至关重要，然而，关于骨形态发生蛋白（BMP）在 PCF 中的安全性和有效性的数据有限。
主要目的是评估 BMP 在 PCF 中与早期术后并发症相关，并确定 BMP 是否导致不良的早期临床结果。次要目的是确定 BMP 海绵放置的最佳位置，在关节突关节（IF）内或其他位置，以及最佳剂量/水平。
回顾性、连续病例对照研究。
765 例接受 PCF 的患者。
患者报告的结果（PROs）、并发症、融合、BMP 最佳剂量/水平。
手术数据，包括术前诊断、融合节段、植骨类型、BMP 剂量（如果使用）和融合技术，均被记录。并发症通过回顾术后 6 周内的医疗记录进行评估，包括医疗、神经和伤口相关并发症以及再次手术。神经并发症定义为任何新的无力、神经根痛或麻木。PROs 包括 SF36、VAS、EQ-5D 和 NDI 评分。为了确定 BMP 放置的最佳剂量和位置，进行了一项亚分析。
在伤口并发症、神经并发症或再次手术方面，BMP 组与无 BMP 组之间无显著差异。BMP 组和无 BMP 组的 PROs 无差异。IF 内放置 BMP 和 0.87mg/水平的剂量可最大程度地减少与伤口相关的并发症。与无 BMP 组相比，BMP 组在术后 1 年时融合率更高（96% vs. 91%，p=.02）。
当剂量最小化时，BMP 与 PCF 后的早期并发症发生率增加无关。与 BMP 相关的并发症，如压迫性血清肿、神经根炎和伤口相关并发症的发生率并没有增加。早期随访的 PROs 相似。在 IF 内放置和使用低于先前报道的剂量的 BMP 可能会减少并发症。
