Is It Safe to Use Recombinant Human Bone Morphogenetic Protein in Posterior Cervical Fusion?

Study Design. A retrospective chart review of all patients who underwent posterior cervical fusion during a 1-year time period. Objective. To analyze the safety profile of recombinant human bone morphogenetic protein (rhBMP)-2 in posterior cervical fusion. Summary of Background Data. Use of rhBMP-2 in anterior cervical spine surgery has been associated with complications including postoperative edema, dysphagia, and hematoma formation. No literature exists regarding the safety of rhBMP-2 use for posterior cervical fusion. Methods. We reviewed all posterior cervical fusions performed during 1 year at our hospital following institutional review board permission. Results. A total of 83 patients underwent posterior cervical fusion. Sixty-seven (81%) did not receive rhBMP (control group), whereas 16 (19%) underwent fusion with rhBMP. The most common reason for the use of rhBMP was a failure of an anterior cervical fusion resulting in persistent neck pain, myelopathy, or radiculopathy. The average dose of rhBMP used was 1.3 mL per level. Immediate postoperative medical complications occurred in 5 (7%) in the control group and 2 (13%) in the rhBMP group. A new neurologic deficit after surgery was found in 3 (4%) in the control group and 1 (6%) in the rhBMP group. Wound infection requiring further surgery occurred in 8 (12%) in the control group, and in none in the rhBMP group. One ( 6%) patient in the rhBMP group had significant postoperative neck swelling, but improved with steroid treatment over 1 week, and without any compromise of vital neck structures. No postoperative hematomas were seen in either group. chi(2) analysis revealed that no complication variable reached significance (P < 0.05) when the 2 groups were compared. Conclusion. rhBMP can safely be used in patients undergoing posterior cervical fusion, as it does not produce complications at the rate previously seen with its use in the anterior cervical spine.