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Use of recombinant human bone morphogenetic protein-2 as an adjunct for instrumented posterior arthrodesis in the occipital cervical region: An analysis of safety, efficacy, and dosing

Publication ,  Journal Article
Hamilton, DK; Smith, JS; Reames, DL; Williams, BJ; Shaffrey, CI
Published in: Journal of Craniovertebral Junction and Spine
July 1, 2010

Background: There have been few reports on the use of recombinant human bone morphogenetic protein (rhBMP)-2 in posterior spine. However, no study has investigated the dosing, safety, and efficacy of its use in the posterior atlantoaxial, and/or craniovertebral junction. Recent case report of the cytokine-mediated inflammatory reaction, following off label use of rhBMP-2 as an adjunct for cervical fusion, particularly in complex cases, has increased concern about complications associated with the product. Objective: To assess the safety, efficacy, and dosing of rhBMP-2 as an adjunct for instrumented posterior atlantoaxial and/or craniovertebral junction arthrodesis. Materials and Methods: We included all patients treated by the senior author that included posterior atlantoaxial and/or craniovertebral junction instrumented fusion using rhBMP-2 from 2003 to 2008 with a minimum two year follow-up. Diagnosis, levels fused, rhBMP-2 dose, complications, and fusion were assessed. Results: Twenty three patients with a mean age of 60.9 years (range 4 - 89 years) and an average follow-up of 45 months (range 27 to 84 months) met inclusion criteria. The indications for surgery included, atlantoaxial instability (n = 16), basilar invagination (n = 6), and kyphoscoliosis (n = 1). The specific pathologic diagnosis included type 2 dens fracture (n = 7), complex C1 and C2 ring fracture (n = 2), chordoma (n = 2), degenerative/osteoporosis (n = 3), rheumatoid disease (n = 8), and pseudogout (n = 1). The average rhBMP-2 dose was 2.38 mg/level, with a total of 76 levels treated (average 3.3 levels, SD= 1.4 levels). There were no complications. During the most recent follow-up, all patients had achieved fusion. Conclusions: In a series of patients with complex pathology and/or rheumatoid arthritis, 100% fusion rate was achieved with adjunct use of rhBMP-2, with a safe and effective average rhBMP-2 dose of 2.38 mg per level.

Duke Scholars

Published In

Journal of Craniovertebral Junction and Spine

DOI

ISSN

0974-8237

Publication Date

July 1, 2010

Volume

1

Issue

2

Start / End Page

107 / 112

Related Subject Headings

  • 3209 Neurosciences
  • 3202 Clinical sciences
  • 1109 Neurosciences
  • 1103 Clinical Sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Hamilton, D. K., Smith, J. S., Reames, D. L., Williams, B. J., & Shaffrey, C. I. (2010). Use of recombinant human bone morphogenetic protein-2 as an adjunct for instrumented posterior arthrodesis in the occipital cervical region: An analysis of safety, efficacy, and dosing. Journal of Craniovertebral Junction and Spine, 1(2), 107–112. https://doi.org/10.4103/0974-8237.77674
Hamilton, D. K., J. S. Smith, D. L. Reames, B. J. Williams, and C. I. Shaffrey. “Use of recombinant human bone morphogenetic protein-2 as an adjunct for instrumented posterior arthrodesis in the occipital cervical region: An analysis of safety, efficacy, and dosing.” Journal of Craniovertebral Junction and Spine 1, no. 2 (July 1, 2010): 107–12. https://doi.org/10.4103/0974-8237.77674.
Hamilton DK, Smith JS, Reames DL, Williams BJ, Shaffrey CI. Use of recombinant human bone morphogenetic protein-2 as an adjunct for instrumented posterior arthrodesis in the occipital cervical region: An analysis of safety, efficacy, and dosing. Journal of Craniovertebral Junction and Spine. 2010 Jul 1;1(2):107–12.
Hamilton, D. K., et al. “Use of recombinant human bone morphogenetic protein-2 as an adjunct for instrumented posterior arthrodesis in the occipital cervical region: An analysis of safety, efficacy, and dosing.” Journal of Craniovertebral Junction and Spine, vol. 1, no. 2, July 2010, pp. 107–12. Scopus, doi:10.4103/0974-8237.77674.
Hamilton DK, Smith JS, Reames DL, Williams BJ, Shaffrey CI. Use of recombinant human bone morphogenetic protein-2 as an adjunct for instrumented posterior arthrodesis in the occipital cervical region: An analysis of safety, efficacy, and dosing. Journal of Craniovertebral Junction and Spine. 2010 Jul 1;1(2):107–112.

Published In

Journal of Craniovertebral Junction and Spine

DOI

ISSN

0974-8237

Publication Date

July 1, 2010

Volume

1

Issue

2

Start / End Page

107 / 112

Related Subject Headings

  • 3209 Neurosciences
  • 3202 Clinical sciences
  • 1109 Neurosciences
  • 1103 Clinical Sciences