Abstract
Background context
Anterior cervical discectomy and fusion (ACDF) using autogenous iliac bone graft may
lead to donor-site morbidity. This has led some surgeons to use alternatives to iliac
bone graft, but often the alternatives have greater rates of nonunion and delayed
union. Bone morphogenic protein (BMP) studies have found high arthrodesis rates in
lumbar fusions.
Purpose
The objective of this pilot study was to compare the success of BMP combined with
bone allograft with iliac bone autograft in ACDF patients.
Study design/setting
The institutional review board approved a prospective but nonrandomized study of 66
consecutive patients who had primary one- to three-level ACDF with either iliac-crest
bone autograft or BMP allograft (0.9 mg BMP per level) followed prospectively over
a 2- to 3-year period.
Patient sample
Consecutive patients who had primary one- to three-level ACDF with either iliac-crest
bone autograft (n=36) or BMP-allograft (n=30). Patients in both iliac bone graft and
BMP-allograft groups had comparable preoperative pain and disability.
Outcome measures
Visual analog scale pain, pain drawing, Oswestry index, pain medication use, opinion
of treatment success, and neurological recovery.
Results
Given the nonrandomized nature of the study, the study groups were not matched. Within
this limitation, both groups of patients had similar improvement in all outcome scales
(visual analog scale pain, pain drawing, Oswestry index, pain medication use, and
opinion of treatment success) and neurological recovery over the 2- to 3-year follow-up
period. Patients in the iliac bone graft group had two pseudarthroses and two complications
of the iliac-crest donor site. In the BMP-allograft group, one patient had a pseudarthrosis,
but 50% had neck swelling presenting as dysphagia, which was substantially more common
than the 14% present in the iliac bone graft group. Patients in the BMP-allograft
group had slightly shorter surgery time, but implant and hospitalization costs were
higher.
Conclusions
ACDF performed with BMP (0.9 mg BMP per level) allograft is as effective as iliac
bone graft in terms of patient outcomes and fusion rates. Safety concerns related
to neck swelling and higher initial costs were associated with patients in the bone
morphogenic protein group.
Keywords
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Article info
Publication history
Published online: November 02, 2007
Accepted:
December 30,
2006
Received:
August 31,
2006
Footnotes
FDA device/drug status: approved but not for this indication.
Nothing of value received from a commercial entity related to this manuscript.
Identification
Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
