STUDY DESIGN Retrospective chart review of patients who underwent anterior cervical discectomy and fusion (ACDF) using low-dose recombinant human bone morphogenic protein (rhBMP)-2. OBJECTIVE Determine whether severity and incidence of respiratory complications after ACDF surgery are decreased when using a low-dose BMP-infused sponge within a constrained carrier and postoperative IV and oral steroids. SUMMARY OF BACKGROUND DATA Many physicians avoid using BMP in anterior cervical spine fusions because of concern for an increased incidence of dysphagia, significant prevertebral swelling, and airway edema compromise. Pilot studies have shown that the local application of steroids may decrease the incidence of postoperative airway edema and dysphagia. We performed a retrospective study to evaluate the safety of immediate postoperative tapered steroid use following low-dose rhBMP-2 completely contained inside either an allograft or PEEK cage in reducing the severity and incidence of respiratory complications following ACDF. MATERIALS AND METHODS Forty-seven patients between 33 and 74 years of age, undergoing 1-, 2-, 3-, or 4-level ACDFs augmented with a fraction of a small sponge of rhBMP-2 (0.525 mg/level) within an allograft or PEEK cage and prescribed IV and oral postoperative steroids between January 1, 2008 and November 1, 2016. The incidence of complications such as dyspnea, dysphagia, airway issues, edema ectopic bone osteolysis, radiculitis, and nonunion were collected using medical charts. Additional data regarding length of hospital stay and readmissions were also recorded. RESULTS No life-threatening respiratory events, such as prolonged intubation, re-intubation, or readmission for labored breathing, were observed. No complications referable to steroids such as delayed healing, uncontrollable blood sugar, or diabetes were encountered in this series. CONCLUSIONS This study provides evidence that a tapered dose of steroids and a contained delivery route significantly decreases postoperative respiratory compromise incidence and magnitude following anterior cervical spine fusion using low-dose rhBMP-2.

中文翻译：

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颈椎前路小剂量rhBMP-2融合后的封闭分娩途径和术后类固醇给药可降低呼吸功能受损的程度。

研究设计使用低剂量重组人骨形态发生蛋白（rhBMP）-2进行颈椎前路椎间盘切除融合术（ACDF）的患者的回顾性图表回顾。目的确定在约束性载体内使用低剂量BMP注入的海绵以及术后静脉内和口服类固醇激素治疗后，ACDF手术后呼吸并发症的严重程度和发生率是否降低。背景技术概述由于担心吞咽困难的发生率增加，严重的椎前肿胀和气道水肿受损，许多医生避免在颈椎前路融合术中使用BMP。初步研究表明，局部应用类固醇可能会降低术后气道水肿和吞咽困难的发生率。我们进行了一项回顾性研究，以评估同种异体移植物或PEEK笼中完全包含的低剂量rhBMP-2后立即使用锥形类固醇的安全性，以降低ACDF后呼吸系统并发症的严重程度和发生率。材料与方法47名年龄在33至74岁之间的患者接受了1、2、3或4级ACDF强化治疗，其中一小部分的rhBMP-2海绵（0.525 mg /级）在2008年1月1日至2016年11月1日期间，使用同种异体移植物或PEEK笼子并开具静脉和口服类固醇处方。使用医学图表收集并发症的发生率，例如呼吸困难，吞咽困难，气道问题，水肿异位骨溶解，神经根炎和骨不连。还记录了有关住院时间和再入院率的其他数据。结果未观察到威胁生命的呼吸事件，例如长时间插管，再次插管或再次入院以缓解呼吸困难。在该系列中，没有遇到与类固醇有关的并发症，如延迟治愈，血糖失控或糖尿病。结论这项研究提供证据表明，使用低剂量rhBMP-2进行颈椎前路融合后，逐渐减少剂量的类固醇和封闭的递送途径可显着降低术后呼吸损害的发生率和幅度。