AnteriorCervicalArthrodesisand-Dr.SanjayJatana,MD.pptVIP

* * * * * * * * * * * * * * * * * * * “Improve the Environment” Don’t Fuse Laminectomy Laminoplasty Multilevel arthroplasty Anterior Corpectomy/Discectomy Accept pseudoarthrsis rate and address as needed Mechanical – Plate, Screw designs Biological – Bone, Cells, BMP’s RhBMP-2 REFERENCES Williams, B.J., CSRS paper #20, 2010 Pradan, B. et al., CSRS 2006, poster 26 (Delamarter) Alexander, G.A., et al., CSRS 2007, paper 7 Shen, H.X., et al., CSRS 2007, poster 14 Bae, H., et al., CSRS 2007, poster 21 Miller, C. et al., CSRS 2007, paper 17 (Delamarter) Singh, K. et al., CSRS 2007, paper 52 rhBMP-2 and repeat surgery Allen, T.R. et al., SPINE 2007, 32:26, 2996-3006 rhBMP-2, osteomyelitis Pradhan, B.et al., CSRS 2004, paper 31 (Delamarter) Patel,V., et al., CSRS 2004, paper41 (Delamarter) Smucker, J.D. et al., CSRS 2005, paper 50 Smucker, J.D. et al., SPINE 31, 2006 Longley, C.L. et al. CSRS 2005, paper 7 Bae, H.W. et al., CSRS 2005, poster 23 (Delamarter) Burd, T.A. et al., CSRS 2006, paper 37 Sheilds et al. SPINE 31: 2006 Comparison of the Incidence of Complications of Anterior Cervical Fusion with and without BMP: A Report of the Scoliosis Research Society Morbidity and Mortality Committee 2004-7, 5184 Cases, BMP used in 622 (12%) Superficial deep infection, dysphagia, mortality 373 revisions (7.2%), BMP used in 107 (29%) Stat signif. Results Overall complication rate 5.8% v. 2.4% Overall infection rate 2.1% v. 0.4% Deep infection rate 1.2% v. 0.2% Williams, B.J., CSRS paper #20, 2010 POSITIVE RhBMP-2 use in the neck works Increase fusion rates Decrease pseudoarthrosis rates Decrease rate repeat surgery ? Cost is high Shen, H.X. et al., CSRS 2007 (Riew,D) Pseudoarthrosis in rhBMP-2 augmented multilevel ACF 127 cases, minimum 2 year follow up Fibular allograft and plate fixation 3 level - 77pts 4% 4 level - 32pts 16% 5 level - 8pts 17% Lowest level C6-7 - 14pts, C7-T1 - 2pts @6 mo. 10/16pts asymptomatic, @12 mo. 6/10pts fused Nonunion rate =