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  • Use of Recombinant Human Bone Morphogenetic Protein-2 at the C1-2 Lateral Articulation in Posterior Atlantoaxial Fusion in Adult Patients with or Without Conventional Structural Bone Graft

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    Seba Ramhmdani M.D.; Wataru Ishida MD; Yuanxuan Xia BA; Risheng Xu AB AM MD PhD; Thomas Kosztowski BS; John Choi BS, MEd; Rafael De la Garza Ramos MD; Benjamin D. Elder MD, PhD; Ziya L. Gokaslan MD; Nicholas Theodore MD; Jean-Paul Wolinsky MD; Daniel M. Sciubba MD; Timothy F. Witham BS MD; Ali Bydon MD; Sheng-fu Larry Lo MD, MHSc

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    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Posterior atlantoaxial fusion is an important armamentarium for neurosurgeons to treat several pathologies involving the craniovertebral junction as well as the upper cervical region. Although the potential advantages of rhBMP-2 over autograft and/or allograft alone are well-documented in the lumbar spine, its indication in posterior atlantoaxial fusion has not been well-characterized. In our institution, for selected adult cases of posterior atlantoaxial fusion, we apply rhBMP-2 to the C1-2 joint, either (A) alone or with hydroxyapatite and/or locally harvested autograft chips, or (B) with conventional structural autogenic/allogenic bone graft (SAABG). Here, we will compare clinical outcomes of the two groups with special attention to their fusion rates to elucidate feasibility of the techniques.

    Methods: Single-center, retrospective data review from 2008 to 2014 identified 58 patients who underwent posterior atlantoaxial fusion with rhBMP-2: (A) 34 patients without SAABG and (B) 24 patients with SAABG. Clinical records of these 58 patients were collected and statistically analyzed. P values <.05 were regarded as statistically significant.

    Results: Baseline characteristics such as age, sex, BMI, and smoking status, no statistically significant differences were identified. The overall fusion rate was 94.8% (55/58), which was comparable to other conventional techniques documented in the literature. The (A) group had significantly shorter operative time (p=0.03) and less estimated blood loss than the (B) group (p=0.003). Long-term complication rates were similar between the two groups: one-year C1-2 instability/pseudoarthrosis rate, (A)5.8% versus (B)4.2%, p=1; one-year instrumentation failure rate, (A)8.8% versus (B)12.5%, p=0.68; one-year revision surgery rate, (A)8.8% versus (B)16.7%. p=0.43.

    Conclusions: Albeit retrospective, single-center nature of the study, it was demonstrated that the use of rhBMP-2 at the C1-2 joint without conventional SAABG was a safe, reasonable alternative with the long-term outcomes comparable to rhBMP-2 with SAABG or historical controls in the literature.

    Patient Care: Use of rhBMP-2 with or without structual allo/autogenic bone graft resulted in acceptable clinical outcomes in patients deemed to have a relatively higher risk of C1-2 pseudoarthrosis, and thus be beneficial to them, potentially reducing operative time and blood loss.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of ..., 2) Discuss, in small groups


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