• Wataru Ishida, Seba Ramhmdani, Yuanxuan Xia, Thomas A Kosztowski, Risheng Xu, John Choi, Rafael De la Garza Ramos, Benjamin D Elder, Nicholas Theodore, Ziya L Gokaslan, Daniel M Sciubba, Timothy F Witham, Ali Bydon, Jean-Paul Wolinsky, and Lo Sheng-Fu L SL Department of Neurosurgery, The Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA. Electronic address: larrylo@jhmi.edu..
• Department of Neurosurgery, The Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA.
• World Neurosurg. 2019 Mar 1; 123: e69-e76.

BackgroundPosterior atlantoaxial fusion is an important armamentarium for neurosurgeons to treat several pathologies involving the craniovertebral junction. Although the potential advantages of recombinant human bone morphogenetic protein-2 (rhBMP-2) are well documented in the lumbar spine, its indication for C1-C2 fusion has not been well characterized. In our institution, we apply rhBMP-2 to the C1-C2 joint either alone or with hydroxyapatite, locally harvested autograft chips, and/or morselized allogenic bone graft for selected cases-without conventional posterior structural bone graft. We report the clinical outcomes of the surgical technique to elucidate its feasibility.MethodsWe performed a single-center, retrospective review of data from 2008 to 2016 and identified 69 patients who had undergone posterior atlantoaxial fusion with rhBMP-2. The clinical records of these patients were reviewed, and the baseline characteristics, operative data, and postoperative complications were collected and statistically analyzed.ResultsThe average age of the 69 patients was 60.8 ± 4.5 years, and 55.1% were women. With an average follow-up period of 21.1 ± 4.2 months, the C1-C2 fusion rate was 94.3% (65 of 69), and the average time to fusion was 11.4 ± 2.6 months (range, 5-23). The overall reoperation rate was 10.1% (7 of 69), with instrumentation failure in 7 patients (10.1%), adjacent segment disease in 2 (2.9%), and postoperative dysphagia and dyspnea in 2 patients (2.9%). No ectopic bone formation or soft tissue edema developed.ConclusionsAlthough retrospective and from a single center, our study has shown that rhBMP-2 usage at the C1-C2 joint without posterior structural bone grafting is a safe and reasonable surgical option.Copyright © 2018 Elsevier Inc. All rights reserved.

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