Adverse swelling associated with use of rh-BMP-2 in anterior cervical discectomy and fusion: a case study

BACKGROUND CONTEXT: The use of recombinant bone morphogenetic protem-2 (rh-BMP-2) is effective in augmenting lumbar spinal fusions. A safe, effective dosage of rh-BMP-2 in the cervical spine has yet to be determined. Use of rh-BMP-2 is currently being evaluated and is only indicated for use in the cervical spine on Investigational Device Exempt cases. PURPOSE: To present a potentially serious adverse event that may occur when using rh-BMP-2 in cervical spine surgery. STUDY DESIGN: An emergent sequence of events including physical examination, radiographic studies, intubation, and surgical exploration were performed upon arrival to the emergency department. METHODS: We report a case of a 54-year-old male patient presenting with neck swelling and difficulty swallowing 5 days after anterior cervical discectomy and fusion (ACDF) using rh-BMP-2. RESULTS: The patient was found to have massive neck swelling including the pharyngeal tissue. The patient was admitted to the intensive care unit where parenteral steroids were administered for 24 hours during monitored intubation. The patient was extubated on the second hospital day and discharged home on the fourth hospital day after swelling subsided. CONCLUSIONS: Caution should be exercised with rh-BMP-2 use in ACDF surgery as the correct dose and technique for application is not yet determined. Respiratory distress and dysphagia may result secondary to rh-BMP-2 induced anterior neck swelling. (c) 2007 Elsevier Inc. All rights reserved.