Pseudarthrosis in Multilevel Anterior Cervical Fusion With rhBMP-2 and Allograft Analysis of One Hundred Twenty-Seven Cases With Minimum Two-Year Follow-up
Pseudarthrosis in Multilevel Anterior Cervical Fusion With rhBMP-2 and Allograft Analysis of One Hundred Twenty-Seven Cases With Minimum Two-Year Follow-up
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DOI：
10.1097/brs.0b013e3181bc3420
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发表时间：
2010-04-01
期刊：
影响因子：
3
通讯作者：
Riew, K. Daniel
中科院分区：
文献类型：
--
作者：
Shen, Hong Xing;Buchowski, Jacob M.;Riew, K. Daniel
研究设计。连续病例系列。目的。本研究的目的是分析重组人骨形态发生蛋白-2 （rhBMP-2）增强多水平（>= 3个水平）颈椎前路融合术后假关节的发生率。背景资料摘要。据报道，颈椎前路融合术后假关节发生率在单节段融合术中为0% - 20%，在多节段融合术中高达50%。有推测认为，使用rhBMP-2可降低假关节的发生率。由经验丰富的独立脊柱外科医生对连续一系列接受rhBMP-2颈椎前路融合术、同种异体结构移植和钢板固定的颈椎病和/或椎间盘突出患者进行了至少2年的随访分析。共检查127例患者（男性54例，女性73例，平均年龄54±10岁[范围，32-79]）。75例（59.1%）患者行3节段融合术，34例（26.7%）行4节段融合术，18例（14.2%）行5节段融合术。在451个融合节段中，127例患者中13例（10.2%）的14个节段（3.1%）在术后6个月出现假关节。13例假关节患者中，3例行3节段融合（3/75例[4.0%]），6例行4节段融合（6/34例[17.4%]），4例行5节段融合（4/18例[22.2%]）。5例患者无症状，未进行翻修，但其余8例患者需要额外手术。在13例假关节患者中，12例不愈合发生在最低融合水平和颈胸交界处。发生假关节的唯一有统计学意义的危险因素是融合节段的数量。在一系列rhBMP-2增强多节段融合术中，术后6个月假关节发生率为10.2%。由于假关节的风险随着融合水平的增加而增加，较长的融合杠杆臂可能会在生物力学上压倒rhBMP-2的生物学优势。虽然已知rhBMP-2可以提高融合率，但它并不能保证在所有情况下都能融合。
Study Design. Consecutive case series.Objective. The purpose of this study was to analyze the pseudarthrosis rate in a large series of recombinant human bone morphogenetic protein-2 (rhBMP-2) augmented multilevel (>= 3 levels) anterior cervical fusions.Summary of Background Data. The reported pseudarthrosis rate following anterior cervical fusion varies from 0% to 20% for single-level and up to 50% for multilevel fusions. It has been postulated that the use of rhBMP-2 may decrease the pseudarthrosis rate.Methods. A consecutive series of patients with cervical spondylosis and/or disc herniation who underwent anterior cervical fusion with rhBMP-2, structural allograft, and plate fixation with a minimum 2-year follow-up were analyzed by experienced, independent spine surgeons.Results. A total of 127 patients (54 men and 73 women with mean age of 54 +/- 10 years [range, 32-79]) were examined. Seventy-five (59.1%) patients underwent a 3-level fusion, 34 (26.7%) underwent a 4-level fusion, and 18 (14.2%) underwent a 5-level fusion. Of the 451 fusion segments, 14 segments (3.1%) in 13 of 127 patients (10.2%) had evidence of pseudarthrosis at 6 months following surgery. Of the 13 patients with a pseudarthrosis, 3 had a 3-level fusion (3/75 patients [4.0%]), 6 had a 4-level fusion (6/34 patients [17.4%]), and 4 had a 5-level fusion (4/18 patients [22.2%]). Five patients were asymptomatic and were not revised, but the remaining 8 patients required additional surgery. In 12 of 13 patients with a pseudarthrosis, the nonunion occurred at the lowest fusion level and at the cervicothoracic junction. The only statistically significant risk factor for developing a pseudarthrosis was the number of fusion levels.Conclusion. In a large series of rhBMP-2 augmented multilevel fusions, the pseudarthrosis rate was 10.2% at 6 months following surgery. Since the risk of pseudarthrosis increases with the number of fusion levels, a long fusion lever arm may biomechanically overwhelm the biologic advantage of rhBMP-2. While rhBMP-2 is known to enhance fusion rates, it does not guarantee fusion in all situations.