{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T06:07:29Z","timestamp":1771049249218,"version":"3.50.1"},"reference-count":18,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2011,2]]},"abstract":"\nObject<\/jats:title>\nThe goal of this study was to demonstrate the incidence of fusion and soft-tissue swelling in multilevel anterior cervical discectomies and fusions (ACDFs) using polyetheretherketone (PEEK) spacers with recombinant human bone morphogenetic protein\u20132 (rhBMP-2) impregnated in a Type I collagen sponge and titanium plates.<\/jats:p><\/jats:sec>\n\nMethods<\/jats:title>\nA single surgeon performed 30 multilevel ACDFs using PEEK spacers with an rhBMP-2 impregnated collagen sponge (0.4 ml, or the equivalent of 0.6 mg rhBMP-2). Soft-tissue swelling was assessed using cervical spine radiographs on postoperative Day 1 and at 2, 6, and 10 weeks and 6 months after surgery. Incidence of dysphagia was assessed with the Cervical Spine Research Society Swallowing\u2013Quality of Life tool. Clinical success was evaluated with the Neck Disability Index, neck pain scores, and arm pain scores. Final fusion was assessed with CT by an independent neuroradiologist.<\/jats:p><\/jats:sec>\n\nResults<\/jats:title>\nPatients were followed for 6 months unless they had an incomplete fusion; those patients were reassessed at 9 months. Twenty-four patients underwent 2-level ACDFs and 6 underwent 3-level ACDFs were performed on patients with the following risk factors for pseudarthrosis: smoking (33%), diabetes (13%), and obesity (body mass index \u2265 30 [43%]). Seventeen percent of the patients had multiple risk factors. Soft-tissue swelling peaked at 2 weeks regardless of level of surgery or number of levels treated surgically and decreased to near preoperative levels by 6 months. At 2 weeks, Swallowing\u2013Quality of Life evaluation showed 19% of patients frequently choking on food, 4.8% frequently choking when drinking, and 47.6% with frequent food sticking in the throat. Scores continued to improve, and at 6 months, 0% had frequent choking on food, 6.7% had frequent difficulty drinking, and 6.7% had frequent food sticking in the throat. The Neck Disability Index, neck pain, and arm pain scores all improved progressively over 6 months. Incidence of fusion was 95% at 6 months and 100% at 9 months. There were no rehospitalizations or reoperations for soft-tissue swelling or dysphagia.<\/jats:p><\/jats:sec>\n\nConclusions<\/jats:title>\nMultilevel ACDF procedures using PEEK grafts and rhBMP-2 can be performed safely in patients with multiple risk factors for pseudarthrosis with excellent fusion outcomes.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2010.9.spine09828","type":"journal-article","created":{"date-parts":[[2010,12,24]],"date-time":"2010-12-24T14:59:14Z","timestamp":1293202754000},"page":"244-249","source":"Crossref","is-referenced-by-count":47,"title":["Analysis of prevertebral soft-tissue swelling and dysphagia in multilevel anterior cervical discectomy and fusion with recombinant human bone morphogenetic protein\u20132 in patients at risk for pseudarthrosis"],"prefix":"10.3171","volume":"14","author":[{"given":"Joseph B.","family":"Stachniak","sequence":"first","affiliation":[{"name":"Brain and Spine Center of Texas, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey D.","family":"Diebner","sequence":"additional","affiliation":[{"name":"Plano Radiology Associates, Plano, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Estee S.","family":"Brunk","sequence":"additional","affiliation":[{"name":"Brain and Spine Center of Texas, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shelley M.","family":"Speed","sequence":"additional","affiliation":[{"name":"Brain and Spine Center of Texas, and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-spine09828","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"23","DOI":"10.3171\/spi.2007.6.1.23","article-title":"Corpectomy followed by the placement of instrumentation with titanium cages and recombinant human bone morphogenetic protein-2 for vertebral osteomyelitis","volume":"6","author":"Aryan","year":"2007"},{"key":"b2-spine09828","series-title":"Spine","doi-asserted-by":"publisher","first-page":"1219","DOI":"10.1097\/01.BRS.0000065486.22141.CA","article-title":"A prospective, randomized, controlled cervical fusion study using recombinant human bone morphogenetic protein-2 with the CORNERSTONE-SR allograft ring and the ATLANTIS anterior cervical plate","volume":"28","author":"Baskin","year":"2003"},{"key":"b3-spine09828","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"521","DOI":"10.3171\/spi.2005.2.5.0521","article-title":"Anterior cervical discectomy and fusion involving a polyetheretherketone spacer and bone morphogenetic protein","volume":"2","author":"Boakye","year":"2005"},{"key":"b4-spine09828","series-title":"Spine","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1097\/00007632-200002010-00020","article-title":"The use of rhBMP-2 in interbody fusion cages. Definitive evidence of osteoinduction in humans: a preliminary report","volume":"25","author":"Boden","year":"2000"},{"key":"b5-spine09828","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"254","DOI":"10.3171\/spi.2004.1.3.0254","article-title":"Bone morphogenetic proteins in anterior lumbar interbody fusion: old techniques and new technologies. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004","volume":"1","author":"Burkus","year":"2004"},{"key":"b6-spine09828","series-title":"J Spinal Disord Tech","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1097\/00024720-200210000-00001","article-title":"Anterior lumbar interbody fusion using rhBMP-2 with tapered interbody cages","volume":"15","author":"Burkus","year":"2002"},{"key":"b7-spine09828","series-title":"Orthopedics","doi-asserted-by":"publisher","first-page":"723","DOI":"10.3928\/0147-7447-20040701-12","article-title":"The effectiveness of rhBMP-2 in replacing autograft: an integrated analysis of three human spine studies","volume":"27","author":"Burkus","year":"2004"},{"key":"b8-spine09828","series-title":"Spine","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1097\/01.brs.0000206357.88287.5a","article-title":"Influence of rhBMP-2 on the healing patterns associated with allograft interbody constructs in comparison with autograft","volume":"31","author":"Burkus","year":"2006"},{"issue":"6 Suppl","key":"b9-spine09828","series-title":"Spine J","doi-asserted-by":"publisher","first-page":"240S","DOI":"10.1016\/j.spinee.2005.02.014","article-title":"Bone morphogenetic proteins for spinal fusion","volume":"5","author":"Carlisle","year":"2005"},{"issue":"3","key":"b10-spine09828","series-title":"Neurosurg Focus","first-page":"E6","article-title":"Early findings in a pilot study of anterior cervical interbody fusion in which recombinant human bone morphogenetic protein-2 was used with poly(L-lactideco-D,L-lactide) bioabsorbable implants","volume":"16","author":"Lanman","year":"2004"},{"key":"b11-spine09828","series-title":"Dysphagia","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1007\/s00455-001-0109-1","article-title":"The SWAL-QOL and SWAL-CARE outcomes tool for oropharyngeal dysphagia in adults: III. Documentation of reliability and validity","volume":"17","author":"McHorney","year":"2002"},{"key":"b12-spine09828","series-title":"J Spinal Disord Tech","first-page":"399","article-title":"\u201cNormal\u201d prevertebral soft tissue swelling following elective anterior cervical decompression and fusion","volume":"19","author":"Sanfilippo","year":"2006"},{"key":"b13-spine09828","series-title":"Spine","doi-asserted-by":"publisher","first-page":"542","DOI":"10.1097\/01.brs.0000201424.27509.72","article-title":"Adverse effects associated with high-dose recombinant human bone morphogenetic protein-2 use in anterior cervical spine fusion","volume":"31","author":"Shields","year":"2006"},{"key":"b14-spine09828","series-title":"Spine","doi-asserted-by":"publisher","first-page":"1441","DOI":"10.1097\/01.BRS.0000129100.59913.EA","article-title":"Prospective analysis of incidence and risk factors of dysphagia in spine surgery patients: comparison of anterior cervical, posterior cervical, and lumbar procedures","volume":"29","author":"Smith-Hammond","year":"2004"},{"key":"b15-spine09828","series-title":"Spine","doi-asserted-by":"publisher","first-page":"2813","DOI":"10.1097\/01.brs.0000245863.52371.c2","article-title":"Increased swelling complications associated with off-label usage of rh-BMP-2 in the anterior cervical spine","volume":"31","author":"Smucker","year":"2006"},{"key":"b16-spine09828","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"529","DOI":"10.3171\/SPI\/2008\/8\/6\/529","article-title":"The safety and efficacy of anterior cervical discectomy and fusion with polyetheretherketone spacer and recombinant human bone morphogenetic protein-2: a review of 200 patients","volume":"8","author":"Tumial\u00e1n","year":"2008"},{"key":"b17-spine09828","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"1257","DOI":"10.1007\/s00586-007-0351-9","article-title":"Complications of anterior cervical discectomy and fusion using recombinant human bone morphogenetic protein-2","volume":"16","author":"Vaidya","year":"2007"},{"key":"b18-spine09828","series-title":"J Bone Joint Surg Br","first-page":"342","article-title":"Interbody fusion with allograft and rhBMP-2 leads to consistent fusion but early subsidence","volume":"89","author":"Vaidya","year":"2007"}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/14\/2\/article-p244.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/14\/2\/article-p244.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/14\/2\/article-p244.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T22:13:05Z","timestamp":1681596785000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/14\/2\/article-p244.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2011,2]]},"references-count":18,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2010.9.spine09828","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2011,2]]}}}