Comparative Complications Associated With BMP Use In Patients Undergoing ACDF for Degenerative Spinal Conditions: Systematic Review and Meta-Analysis

Christopher T Martin; Kenneth Holton; Samuel E Broida; Anne-Katrin Hickmann; Caitlin Bakker; Paul A Lender; Kota Watanabe; Hans Jörg Meisel; Zorica Buser; Steven M Presciutti; Sangwook Tim Yoon; AO Spine Knowledge Forum Degenerative

doi:10.1177/21925682231166325

Comparative Complications Associated With BMP Use In Patients Undergoing ACDF for Degenerative Spinal Conditions: Systematic Review and Meta-Analysis

Global Spine J. 2024 Feb;14(2_suppl):94S-109S. doi: 10.1177/21925682231166325.

Affiliations

¹ Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA.
² Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA.
³ Department of Neurosurgery, Kantonsspital St.Gallen, Switzerland.
⁴ Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
⁵ Department of Neurosurgery, BG Klinikum Bergmannstrost Halle, Germany.
⁶ Gerling Institute, Brooklyn, NY, USA.
⁷ Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA.

Abstract

Study design: Systematic Review and Meta-Analysis.

Objectives: To compare complication incidence in patients with or without the use of recombinant human Bone Morphogenic Protein-2 (BMP2) undergoing anterior cervical discectomy and fusion (ACDF) for degenerative conditions.

Methods: A systematic search of eight online databases was conducted using PRISMA guidelines. Inclusion criteria included English language studies with a minimum of 10 adult patients undergoing instrumented ACDF surgery for a degenerative spinal condition in which BMP2 was used in all patients or one of the treatment arms. Studies with patients undergoing circumferential fusions, with non-degenerative indications, or which did not report post-operative complication data were excluded. Patients with and without BMP2 were compared in terms of the incidence of dysphagia/dysphonia, anterior soft tissue complications (hematoma, seroma, infection, dysphagia/dysphonia), nonunion, medical complications, and new neurologic deficits.

Results: Of 1832 preliminary search results, 27 manuscripts were included. Meta-analysis revealed the relative risk of dysphagia or dysphonia (RR = 1.39, CI 95% 1.18 - 1.64, P = <.001), anterior soft tissue complications (RR = 1.43, CI 95% 1.25-1.64, P = <.001), and medical complications (RR = 1.32, CI 95% 1.06-1.66, P = .013) were statistically significant in the BMP2 group while the relative risk of non-union (RR = .5, CI 95% .23 - 1.13, P = .09) trended lower in the BMP2 group. Neurological deficit (RR = 1.06, CI 95% .82-1.37, P = .66), and additional medical complications (RR = 1.53, CI 95% .98-2.38, P = .06) were not found to be statistically different between the groups.

Conclusions: This meta-analysis identified a high rate of arthrodesis when BMP2 was used in ACDF, but confirmed increased rates of dysphagia and anterior soft tissue complications. Surgeons may consider reserving BMP2 implementation for cases with a high risk of non-union, and should be aware of the risk of airway compromise.

Keywords: ACDF; BMP; degenerative.