Adverse swelling associated with use of rh-BMP-2 in anterior cervical discectomy and fusion: a case study
Adverse swelling associated with use of rh-BMP-2 in anterior cervical discectomy and fusion: a case study
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DOI：
10.1016/j.spinee.2006.04.010
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发表时间：
2007-03-01
期刊：
影响因子：
4.5
通讯作者：
Anand, Neel
中科院分区：
文献类型：
--
作者：
Perri, Brian;Cooper, Martin;Anand, Neel
背景：使用重组骨形态发生蛋白-2 （rh-BMP-2）在腰椎融合中是有效的。在颈椎中使用rh-BMP-2的安全有效剂量尚未确定。rh-BMP-2的使用目前正在评估中，仅适用于研究器械豁免病例的颈椎。目的：介绍在颈椎手术中使用rh-BMP-2时可能发生的潜在严重不良事件。研究设计：在到达急诊科后进行一系列紧急事件，包括体格检查、放射学检查、插管和手术探查。方法：我们报告了一例54岁男性患者，在使用rh-BMP-2前路颈椎椎间盘切除术和融合（ACDF）后5天出现颈部肿胀和吞咽困难。结果：患者颈部有大量肿胀，包括咽部组织。患者被送入重症监护病房，在监测插管期间给予24小时的静脉注射类固醇。患者于住院第2天拔管，肿胀消退后第4天出院。结论：在ACDF手术中使用rh-BMP-2应谨慎，因为正确的剂量和应用技术尚未确定。呼吸窘迫和吞咽困难可能继发于rh-BMP-2诱导的前颈部肿胀。(c) 2007爱思唯尔公司版权所有。
BACKGROUND CONTEXT: The use of recombinant bone morphogenetic protem-2 (rh-BMP-2) is effective in augmenting lumbar spinal fusions. A safe, effective dosage of rh-BMP-2 in the cervical spine has yet to be determined. Use of rh-BMP-2 is currently being evaluated and is only indicated for use in the cervical spine on Investigational Device Exempt cases.PURPOSE: To present a potentially serious adverse event that may occur when using rh-BMP-2 in cervical spine surgery.STUDY DESIGN: An emergent sequence of events including physical examination, radiographic studies, intubation, and surgical exploration were performed upon arrival to the emergency department.METHODS: We report a case of a 54-year-old male patient presenting with neck swelling and difficulty swallowing 5 days after anterior cervical discectomy and fusion (ACDF) using rh-BMP-2.RESULTS: The patient was found to have massive neck swelling including the pharyngeal tissue. The patient was admitted to the intensive care unit where parenteral steroids were administered for 24 hours during monitored intubation. The patient was extubated on the second hospital day and discharged home on the fourth hospital day after swelling subsided.CONCLUSIONS: Caution should be exercised with rh-BMP-2 use in ACDF surgery as the correct dose and technique for application is not yet determined. Respiratory distress and dysphagia may result secondary to rh-BMP-2 induced anterior neck swelling. (c) 2007 Elsevier Inc. All rights reserved.