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

Backgroud The use of rhBMP-2 in anterior cervical discectomy and fusion (ACDF) is still “off-label” therapy because of higher incidence of potential complications such as adverse swelling, dysphagia, and airway compromise. The purpose of this study is to investigate whether the low dose rhBMP-2 (0.5 mg/level) decreases the incidence and severity of local complications in ACDF. Methods 173 consecutively patients from June 2015 to March 2016 at seven participating centers in the China were enrolled. All the patients had primary one- or two-level ACDF with either rhBMP-2(BMP, n=110) or iliac-crest bone autograft (IGB, n=63) were analyzed. Patients in both groups had compared preoperative pain and disability. The follow up timing was postoperative third days, postoperative-1, 3, 6 and 12 months. Results Patient demographics have no significantly difference between the BMP group and IGB group pre-operation (P>0.05). No significant difference in overall dysphagia incidence between the two groups (p > 0.05). There was significant difference of PSTS at C3 level between two groups at all interval time (P<0.01). There was significant difference of PSTS at C6 level at postoperative third days (P<0.01) and 3 months (0.010.05). No pseudarthrosis in both Groups. No significant difference in VAS scores, JOA and NDI .scores between two groups (P>0.05). Conclusion The 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 cage, and bilateral coverage of the carrier with excised local osteophytes.