Comparison of Recombinant Human Bone Morphogenetic Protein-2 and Iliac Crest Autografts in Anterior Cervical Discectomy and Fusion

Abstract

Background: This study compared the use of low-dose (0.5 mg/level) recombinant human bone morphogenetic protein-2 (rhBMP-2) and iliac crest autographs for anterior cervical discectomy and fusion (ACDF) and determined whether the incidence and severity of local complications were reduced with rhBMP-2. Methods: A total of 173 patients were enrolled in this retrospective study between June 2017 and March 2019. All patients who underwent primary one- or two-level ACDF procedures with either rhBMP-2 (the BMP group, n = 110) or iliac crest bone autografts (the IBG group, n = 63) were analyzed. The patients in both groups had comparable preoperative pain and disability. Follow-ups were conducted within 1 week after the operation and at 3, 6, 12, and 24 months postoperatively. The scores of the Neck Disability Index (NDI) and the Japanese Orthopedic Association (JOA) questionnaires were used to evaluate the clinical outcomes. Results: There was no significant difference in patient demographics between the BMP and IBG groups before the operation (p > 0.05), and there was no significant difference in the overall incidence of dysphagia between the two groups (p > 0.05). There was a significant difference in prevertebral soft tissue swelling (PSTS) at the C3 level between the two groups at all intervals (p < 0.01). There was a significant difference in PSTS at the C6 level within 1 week postoperatively (p < 0.01), while there was no difference at 3, 6, 12, and 24 months postoperatively (p > 0.05). Neither group had a case of pseudarthrosis. Finally, there was no significant difference in the NDI and JOA scores between the two groups (p > 0.05). Conclusions: Adverse events associated with low-dose rhBMP-2 for one- and two-level ACDF are rare. We recommend placing the rhBMP-2 carrier in the center of interbody fusion cage and bilaterally covering the carrier with excised local osteophytes.