Use of polyetheretherketone spacer and recombinant human bone morphogenetic protein-2 in the cervical spine

a radiographic analysis

Paul Klimo, Michael W. Peelle

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background context: Results recently reported in the literature have raised some concerns regarding the use of recombinant human bone morphogenetic protein (rhBMP-2) in the cervical spine. Purpose: We undertook a radiological and clinical review of cervical fusions performed at our institution with polyetheretherketone (PEEK) interbody cage and rhBMP-2. Study design: Observational study. Patient sample: Perioperative clinical and radiologic data of all patients who underwent an anterior cervical discectomy and fusion using PEEK and rhBMP-2 for cervical spondylotic radiculopathy or myelopathy were collected. Outcome measures: Images were examined for fusion, heterotopic ossification, end-plate resorption, subsidence, and segmental sagittal alignment. Methods: All patients underwent detailed postoperative radiologic analysis using a computed tomography (CT) scan obtained at least 6 months postoperatively and plain X-rays obtained at regular intervals. Results: Twenty-two patients had 38 levels fused using PEEK and varying doses of rhBMP-2. No anterior cervical swelling requiring additional procedures or longer than anticipated hospital stays occurred. Pseudoarthrosis, shown as a horizontal radiolucent fissure through the midportion of the PEEK cage on CT, occurred in four patients. Excessive bone growth into the spinal canal or foramina occurred in 26 (68%) patients but did not result in neurologic sequelae. Cystic regions in the core of the PEEK spacer were seen in most patients, with 15 levels (39%) having cysts measuring 3 mm or greater. Moderate or severe osteolysis of the end plates occurred in 57% of levels, and this led to subsidence of the construct and loss of some of the segmental sagittal alignment (ie, lordosis) that had been achieved with surgery. Conclusions: The unlimited supply of PEEK spacers and rhBMP-2 and their ease of use make them attractive platforms to achieve fusion. This study has demonstrated that the fusion process using rhBMP-2 is a dynamic one, with osteolysis dominating the initial phase, leading to end-plate resorption and consequently loss of some of the disc space height and sagittal alignment that was achieved with surgery. There is a high incidence of bone growth beyond the core of the PEEK spacer and cystic regions within the cage. Given our experience, we currently reserve the use of PEEK and rhBMP-2 for use in those patients who are at greatest risk of pseudoarthrosis.

Original languageEnglish (US)
Pages (from-to)959-966
Number of pages8
JournalSpine Journal
Volume9
Issue number12
DOIs
StatePublished - Dec 1 2009
Externally publishedYes

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Spine
Pseudarthrosis
Osteolysis
Bone Development
Tomography
Heterotopic Ossification
Diskectomy
Lordosis
Radiculopathy
Spinal Canal
recombinant human bone morphogenetic protein-2
polyetheretherketone
Spinal Cord Diseases
Nervous System
Observational Studies
Cysts
Length of Stay
X-Rays
Outcome Assessment (Health Care)
Incidence

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Surgery

Cite this

Use of polyetheretherketone spacer and recombinant human bone morphogenetic protein-2 in the cervical spine : a radiographic analysis. / Klimo, Paul; Peelle, Michael W.

In: Spine Journal, Vol. 9, No. 12, 01.12.2009, p. 959-966.

Research output: Contribution to journalArticle

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abstract = "Background context: Results recently reported in the literature have raised some concerns regarding the use of recombinant human bone morphogenetic protein (rhBMP-2) in the cervical spine. Purpose: We undertook a radiological and clinical review of cervical fusions performed at our institution with polyetheretherketone (PEEK) interbody cage and rhBMP-2. Study design: Observational study. Patient sample: Perioperative clinical and radiologic data of all patients who underwent an anterior cervical discectomy and fusion using PEEK and rhBMP-2 for cervical spondylotic radiculopathy or myelopathy were collected. Outcome measures: Images were examined for fusion, heterotopic ossification, end-plate resorption, subsidence, and segmental sagittal alignment. Methods: All patients underwent detailed postoperative radiologic analysis using a computed tomography (CT) scan obtained at least 6 months postoperatively and plain X-rays obtained at regular intervals. Results: Twenty-two patients had 38 levels fused using PEEK and varying doses of rhBMP-2. No anterior cervical swelling requiring additional procedures or longer than anticipated hospital stays occurred. Pseudoarthrosis, shown as a horizontal radiolucent fissure through the midportion of the PEEK cage on CT, occurred in four patients. Excessive bone growth into the spinal canal or foramina occurred in 26 (68{\%}) patients but did not result in neurologic sequelae. Cystic regions in the core of the PEEK spacer were seen in most patients, with 15 levels (39{\%}) having cysts measuring 3 mm or greater. Moderate or severe osteolysis of the end plates occurred in 57{\%} of levels, and this led to subsidence of the construct and loss of some of the segmental sagittal alignment (ie, lordosis) that had been achieved with surgery. Conclusions: The unlimited supply of PEEK spacers and rhBMP-2 and their ease of use make them attractive platforms to achieve fusion. This study has demonstrated that the fusion process using rhBMP-2 is a dynamic one, with osteolysis dominating the initial phase, leading to end-plate resorption and consequently loss of some of the disc space height and sagittal alignment that was achieved with surgery. There is a high incidence of bone growth beyond the core of the PEEK spacer and cystic regions within the cage. Given our experience, we currently reserve the use of PEEK and rhBMP-2 for use in those patients who are at greatest risk of pseudoarthrosis.",
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