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Bone morphogenetic proteins in anterior cervical fusion: a systematic review and meta-analysis.
World Neurosurg. 2017 Mar 15;:
Authors: Zadegan SA, Abedi A, Jazayeri SB, Nasiri Bonaki H, Jazayeri SB, Vaccaro AR, Rahimi-Movaghar V
Abstract
OBJECTIVE: Bone morphogenetic proteins (BMPs) have been commonly used as a graft substitute in spinal fusion. Although the Food and Drug Administration (FDA) issued warning on life-threatening complications of recombinant human BMPs (rhBMPs) in cervical spine fusion in 2008, their off-label use has been continued. This investigation aimed to review the evidence for the use of rhBMP-2 and rhBMP-7 in anterior cervical spine fusions.
METHODS: A comprehensive search was performed through Ovid (MEDLINE), PubMed and Embase. The risk of bias assessment was according to the recommended criteria by the Cochrane Back and Neck group and the Methodological Index for Non-Randomized Studies (MINORS). A wide array of radiographic and clinical outcomes including the adverse events were collated.
RESULTS: Eighteen articles (1 randomized and 17 non-randomized) were eligible for inclusion. The fusion rate was higher with use of rhBMP in most studies and our meta-analysis of the pooled data from 4782 patients confirmed this finding (OR=5.45, p<0.00001). Altogether, the rhBMP and control groups were comparable in patient-reported outcomes. However, majority of studies tended to reveal a significantly higher incidence of overall complication rate, dysphagia/dysphonia, cervical swelling, re-admission, wound complications, neurological complications, and ossification.
CONCLUSIONS: Application of rhBMPs in cervical spine fusion yields a significantly higher fusion rate with similar patient-reported outcomes, yet increased risk of life-threatening complications. Thus, we do not recommend the use of rhBMP in anterior cervical fusions.
PMID: 28315798 [PubMed - as supplied by publisher]
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