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Report of Adverse Effects from Using rh-BMP-2 in Neck Fusion

rh-BMP-2 (BMP) is a protein that helps bone heal. It has been used with good results in spinal fusion of the lumbar spine. BMP helps speed up the recovery rate after lumbar spinal fusion. It has not been approved by the FDA yet for use in the cervical (neck) spine.

Doctors at the Institute for Spinal Disorders in Los Angeles report on the case of one patient who had a bad reaction to BMP. A 54-year old man had an anterior cervical discectomy and fusion (ACDF). Several discs were removed and a metal plate attached to fuse the neck.

A bioresorbable implant called a cage was put in place of the disc to help hold the vertebrae until healing took place. Bone graft containing BMP was put inside the cage to stimulate bone growth and help speed up fusion.

Three days later, the patient started having neck swelling and trouble swallowing. On day five after surgery, he arrived at the emergency room with massive neck swelling. Neurologic signs were normal. The patient was able to breathe okay. Lab values were all normal.

MRIs showed the trachea was pushed over to the side and flattened by severe soft-tissue swelling. Several pockets of air (gas) could be seen on a CT scan. The gas appeared to be inside the track of fluid (swelling). The patient was treated in the ICU for three days and stabilized enough to go home again.

This is the first report describing an adverse response to rh-BMP-2 when used in the cervical spine. The authors suggest that the sponge used to hold the BMP may have released too much of the protein too fast.

BMP is designed to promote bone formation by setting up an inflammatory reaction. It's likely that reducing the amount of BMP used could tone down the inflammatory response and avoid the swelling seen in this case. This report is meant to alert other surgeons of the possible dose/carrier problems with BMP.

References: Brian Perri, DO, et al. Adverse Swelling Associated with Use of rh-BMP-2 in Anterior Cervical Discectomy and Fusion: A Case Study. In The Spine Journal. March 2007. Vol. 7. No. 2. Pp. 235-239.

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