Adverse Effects Associated With High-Dose Recombinant Human Bone Morphogenetic Protein-2 Use in Anterior Cervical Spine Fusion

Abstract

In Brief Study Design. A retrospective review of patients who underwent an anterior cervical fusion using recombinant human bone morphogenetic protein (rhBMP)-2 with an absorbable collagen sponge (INFUSE®; Medtronic Sofamor Danek, Minneapolis, MN). Objective. To ascertain the complication rate after the use of high-dose INFUSE® in anterior cervical fusions. Summary of Background Data. The rhBMP-2 has been primarily investigated in lumbar spine fusions, where it has significantly enhanced the fusion rate and decreased the length of surgery, blood loss, and hospital stay. Methods. We present 151 patients who underwent either an anterior cervical discectomy and fusion (n = 138) or anterior cervical vertebrectomy and fusion (n = 13) augmented with high-dose INFUSE® between July 2003 and March 2004. The rhBMP-2 (up to 2.1 mg/level) was used in the anterior cervical discectomy and fusions. Results. A total of 35 (23.2%) patients had complications after the use of high-dose INFUSE® in the cervical spine. There were 15 patients diagnosed with a hematoma, including 11 on postoperative day 4 or 5, of whom 8 were surgically evacuated. Thirteen individuals had either a prolonged hospital stay (>48 hours) or hospital readmission because of swallowing/breathing difficulties or dramatic swelling without hematoma. Conclusions. A significant rate of complications resulted after the use of a high dose of INFUSE® in anterior cervical fusions. We hypothesize that in the cervical area, the putative inflammatory effect that contributes to the effectiveness of INFUSE® in inducing fusion may spread to adjacent critical structures and lead to increased postoperative morbidity. A thorough investigation is warranted to determine the optimal dose of rhBMP-2 that will promote cervical fusion and minimize complications. INFUSE® Bone Graft (Medtronic Sofamor Danek, Minneapolis, MN) combines recombinant human bone morphogenetic protein-2 with an absorbable collagen sponge to promote osteoinduction. Recombinant human bone morphogenetic protein-2 in the lumbar spine has significantly enhanced fusion rate. High-dose INFUSE® may account for a high rate of complications after anterior cervical fusions.