1Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester; and.
Departments of2Neurologic Surgery and.
J Neurosurg Spine. 2024 May 3;41(2):174-187. doi: 10.3171/2024.2.SPINE23941. Print 2024 Aug 1.
Use of bone morphogenetic protein (BMP)-an osteoinductive agent commonly used in lumbar arthrodesis-is off-label for cervical arthrodesis. This study aimed to identify the effect of BMP use on clinical and radiological outcomes in instrumented cervical arthrodesis.
A comprehensive systematic review of the literature was performed to identify studies directly comparing outcomes between cervical arthrodeses with and without using BMP. Outcomes were analyzed separately for cases of anterior cervical discectomy and fusion (ACDF) and posterior cervical fusion (PCF).
A total of 20 studies with 5828 patients (1948 with BMP and 3880 without BMP) were included. In the ACDF cases, BMP use was associated with higher fusion rates (98.9% vs 93.6%, risk difference [RD] 8%; risk ratio [RR] 1.12, p = 0.02), lower reoperation rates (2.2% vs 3.1%, RD 3%; RR 0.48, p = 0.04), and higher risk of dysphagia (24.7% vs 8.1%, RD 11%; RR 1.93, p = 0.02). No significant differences in the Neck Disability Index, neck pain, or arm pain scores were associated with the use of BMP. On subgroup meta-analysis of ACDF cases, older age (≥ 50 years) and higher BMP dose (≥ 0.9 mg/level) were associated with significantly higher fusion rates and relatively lower risk for dysphagia, whereas arthrodesis of fewer segments (< 2 levels) showed significantly higher dysphagia rates without a significant increase in fusion rates. In the PCF cases, the use of BMP was not associated with significant differences in fusion (p = 0.38) or reoperation (p = 0.61) rates but was associated with significantly higher blood loss during surgery (mean difference 146.7 ml, p ≤ 0.01).
Use of BMP in ACDF offers higher rates of augmented fusion and lower rates of all-cause reoperation but with an increased risk of dysphagia. The benefit of fusion outweighs the risk of dysphagia with a higher BMP dose in older patients being operated on for < 2 levels. The use of BMP in PCF seems to have a less important effect on clinical and radiological outcomes.
骨形态发生蛋白（BMP）是一种常用于腰椎融合术的成骨诱导剂，在颈椎融合术中的使用属于超适应证。本研究旨在确定在颈椎融合术的应用中，BMP 的使用对临床和影像学结果的影响。
对文献进行全面系统的回顾，以确定直接比较颈椎融合术使用和不使用 BMP 后结果的研究。对前路颈椎间盘切除融合术（ACDF）和后路颈椎融合术（PCF）分别进行分析。
共纳入 20 项研究，共计 5828 例患者（1948 例使用 BMP，3880 例未使用 BMP）。在 ACDF 病例中，BMP 的使用与更高的融合率（98.9%比 93.6%，风险差异[RD]8%；风险比[RR]1.12，p=0.02）、更低的再次手术率（2.2%比 3.1%，RD 3%；RR 0.48，p=0.04）和更高的吞咽困难风险（24.7%比 8.1%，RD 11%；RR 1.93，p=0.02）相关。BMP 的使用与 Neck Disability Index、颈部疼痛或手臂疼痛评分均无显著差异。在 ACDF 病例的亚组荟萃分析中，年龄较大（≥50 岁）和较高的 BMP 剂量（≥0.9mg/节段）与更高的融合率和相对较低的吞咽困难风险相关，而融合节段较少（<2 节段）与融合率无显著增加但吞咽困难率显著升高相关。在 PCF 病例中，BMP 的使用与融合（p=0.38）或再次手术（p=0.61）率无显著差异，但与术中失血更多相关（平均差值 146.7ml，p≤0.01）。
在 ACDF 中使用 BMP 可提高增强融合率和降低全因再手术率，但增加吞咽困难风险。对于接受<2 个节段手术的年龄较大的患者，较高剂量的 BMP 可能增加吞咽困难的风险，但融合的益处大于风险。BMP 在 PCF 中的使用对临床和影像学结果的影响似乎较小。
