Analysis of prevertebral soft-tissue swelling and dysphagia in multilevel anterior cervical discectomy and fusion with recombinant human bone morphogenetic protein–2 in patients at risk for pseudarthrosis

Clinical article

Joseph B. Stachniak M.D. 1 , Jeffrey D. Diebner M.D. 2 , Estee S. Brunk B.S.N., R.N. 1 , and Shelley M. Speed M.S.N., R.N., A.C.N.P. 1
View More View Less
  • 1 Brain and Spine Center of Texas, and
  • 2 Plano Radiology Associates, Plano, Texas
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object

The goal of this study was to demonstrate the incidence of fusion and soft-tissue swelling in multilevel anterior cervical discectomies and fusions (ACDFs) using polyetheretherketone (PEEK) spacers with recombinant human bone morphogenetic protein–2 (rhBMP-2) impregnated in a Type I collagen sponge and titanium plates.

Methods

A single surgeon performed 30 multilevel ACDFs using PEEK spacers with an rhBMP-2 impregnated collagen sponge (0.4 ml, or the equivalent of 0.6 mg rhBMP-2). Soft-tissue swelling was assessed using cervical spine radiographs on postoperative Day 1 and at 2, 6, and 10 weeks and 6 months after surgery. Incidence of dysphagia was assessed with the Cervical Spine Research Society Swallowing–Quality of Life tool. Clinical success was evaluated with the Neck Disability Index, neck pain scores, and arm pain scores. Final fusion was assessed with CT by an independent neuroradiologist.

Results

Patients were followed for 6 months unless they had an incomplete fusion; those patients were reassessed at 9 months. Twenty-four patients underwent 2-level ACDFs and 6 underwent 3-level ACDFs were performed on patients with the following risk factors for pseudarthrosis: smoking (33%), diabetes (13%), and obesity (body mass index ≥ 30 [43%]). Seventeen percent of the patients had multiple risk factors. Soft-tissue swelling peaked at 2 weeks regardless of level of surgery or number of levels treated surgically and decreased to near preoperative levels by 6 months. At 2 weeks, Swallowing–Quality of Life evaluation showed 19% of patients frequently choking on food, 4.8% frequently choking when drinking, and 47.6% with frequent food sticking in the throat. Scores continued to improve, and at 6 months, 0% had frequent choking on food, 6.7% had frequent difficulty drinking, and 6.7% had frequent food sticking in the throat. The Neck Disability Index, neck pain, and arm pain scores all improved progressively over 6 months. Incidence of fusion was 95% at 6 months and 100% at 9 months. There were no rehospitalizations or reoperations for soft-tissue swelling or dysphagia.

Conclusions

Multilevel ACDF procedures using PEEK grafts and rhBMP-2 can be performed safely in patients with multiple risk factors for pseudarthrosis with excellent fusion outcomes.

Abbreviations used in this paper: ACDF = anterior cervical discectomy and fusion; BMI = body mass index; NDI = Neck Disability Index; PEEK = polyetheretherketone; rhBMP-2 = recombinant human bone morphogenetic protein–2; SWAL-QOL = Swallowing–Quality of Life.

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address correspondence to: Joseph B. Stachniak, M.D., Brain and Spine Center of Texas, 3060 Communications Parkway, Suite 201, Plano, Texas 75093. email: jstachniak@aol.com.

Please include this information when citing this paper: published online December 24, 2010; DOI: 10.3171/2010.9.SPINE09828.

  • 1

    Aryan HE, , Lu DC, , Acosta FL Jr, & Ames CP: Corpectomy followed by the placement of instrumentation with titanium cages and recombinant human bone morphogenetic protein-2 for vertebral osteomyelitis. J Neurosurg Spine 6:2330, 2007

    • Search Google Scholar
    • Export Citation
  • 2

    Baskin DS, , Ryan P, , Sonntag V, , Westmark R, & Widmayer MA: A prospective, randomized, controlled cervical fusion study using recombinant human bone morphogenetic protein-2 with the CORNERSTONE-SR allograft ring and the ATLANTIS anterior cervical plate. Spine 28:12191225, 2003

    • Search Google Scholar
    • Export Citation
  • 3

    Boakye M, , Mummaneni PV, , Garrett M, , Rodts G, & Haid R: Anterior cervical discectomy and fusion involving a polyetheretherketone spacer and bone morphogenetic protein. J Neurosurg Spine 2:521525, 2005

    • Search Google Scholar
    • Export Citation
  • 4

    Boden SD, , Zdeblick TA, , Sandhu HS, & Heim SE: The use of rhBMP-2 in interbody fusion cages. Definitive evidence of osteoinduction in humans: a preliminary report. Spine 25:376381, 2000

    • Search Google Scholar
    • Export Citation
  • 5

    Burkus JK: Bone morphogenetic proteins in anterior lumbar interbody fusion: old techniques and new technologies. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J Neurosurg Spine 1:254260, 2004

    • Search Google Scholar
    • Export Citation
  • 6

    Burkus JK, , Gornet MF, , Dickman CA, & Zdeblick TA: Anterior lumbar interbody fusion using rhBMP-2 with tapered interbody cages. J Spinal Disord Tech 15:337349, 2002

    • Search Google Scholar
    • Export Citation
  • 7

    Burkus JK, , Heim SE, , Gornet MF, & Zdeblick TA: The effectiveness of rhBMP-2 in replacing autograft: an integrated analysis of three human spine studies. Orthopedics 27:723728, 2004

    • Search Google Scholar
    • Export Citation
  • 8

    Burkus JK, , Sandhu HS, & Gornet MF: Influence of rhBMP-2 on the healing patterns associated with allograft interbody constructs in comparison with autograft. Spine 31:775781, 2006

    • Search Google Scholar
    • Export Citation
  • 9

    Carlisle E, & Fischgrund JS: Bone morphogenetic proteins for spinal fusion. Spine J 5:6 Suppl 240S249S, 2005

  • 10

    Lanman TH, & Hopkins TJ: Early findings in a pilot study of anterior cervical interbody fusion in which recombinant human bone morphogenetic protein-2 was used with poly(L-lactideco-D,L-lactide) bioabsorbable implants. Neurosurg Focus 16:3 E6, 2004

    • Search Google Scholar
    • Export Citation
  • 11

    McHorney CA, , Robbins J, , Lomax K, , Rosenbek JC, , Chignell K, & Kramer AE, : The SWAL-QOL and SWAL-CARE outcomes tool for oropharyngeal dysphagia in adults: III. Documentation of reliability and validity. Dysphagia 17:97114, 2002

    • Search Google Scholar
    • Export Citation
  • 12

    Sanfilippo JA Jr, , Lim MR, , Jacoby SM, , Laterra R, , Harrop JS, & Vaccaro AR, : “Normal” prevertebral soft tissue swelling following elective anterior cervical decompression and fusion. J Spinal Disord Tech 19:399401, 2006

    • Search Google Scholar
    • Export Citation
  • 13

    Shields LB, , Raque GH, , Glassman SD, , Campbell M, , Vitaz T, & Harpring J, : Adverse effects associated with high-dose recombinant human bone morphogenetic protein-2 use in anterior cervical spine fusion. Spine 31:542547, 2006

    • Search Google Scholar
    • Export Citation
  • 14

    Smith-Hammond CA, , New KC, , Pietrobon R, , Curtis DJ, , Scharver CH, & Turner DA: Prospective analysis of incidence and risk factors of dysphagia in spine surgery patients: comparison of anterior cervical, posterior cervical, and lumbar procedures. Spine 29:14411446, 2004

    • Search Google Scholar
    • Export Citation
  • 15

    Smucker JD, , Rhee JM, , Singh K, , Yoon ST, & Heller JG: Increased swelling complications associated with off-label usage of rh-BMP-2 in the anterior cervical spine. Spine 31:28132819, 2006

    • Search Google Scholar
    • Export Citation
  • 16

    Tumialán LM, , Pan J, , Rodts GE, & Mummaneni PV: The safety and efficacy of anterior cervical discectomy and fusion with polyetheretherketone spacer and recombinant human bone morphogenetic protein-2: a review of 200 patients. J Neurosurg Spine 8:529535, 2008

    • Search Google Scholar
    • Export Citation
  • 17

    Vaidya R, , Carp J, , Sethi A, , Bartol S, , Craig J, & Les CM: Complications of anterior cervical discectomy and fusion using recombinant human bone morphogenetic protein-2. Eur Spine J 16:12571265, 2007

    • Search Google Scholar
    • Export Citation
  • 18

    Vaidya R, , Weir R, , Sethi A, , Meisterling S, , Hakeos W, & Wybo CD: Interbody fusion with allograft and rhBMP-2 leads to consistent fusion but early subsidence. J Bone Joint Surg Br 89:342345, 2007

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 587 244 18
Full Text Views 155 31 0
PDF Downloads 166 18 1
EPUB Downloads 0 0 0