Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Bone morphogenetic proteins (BMPs) are increasingly used in spinal fusion surgery. Previous reports of BMP use in anterior cervical fusion have suggested high rates of complications related to soft tissue swelling. We evaluate the safety of using BMP-7 osteogenic protein (OP-1); Stryker, Kalamazoo, MI, USA) in a relatively contained form and controlled dose. A prospective consecutive cohort of 131 patients underwent anterior cervical discectomy and fusion using interbody cages. In 123 of these patients, BMP-7 was also used. The primary outcome measure was the presence (or otherwise) of clinical adverse events during the first 30 days. The secondary outcome was the extent of radiological soft tissue swelling as measured on plain radiographs in the early post-operative period. There was no mortality and no reoperation in this series; however, 2.4% of patients experienced complications of transient brachalgia (1 patient), and dysphagia (2 patients). The use of BMPs in spinal fusion is discussed, and the relevant literature reviewed, particularly as it relates to adverse clinical events. We concluded that BMP-7 can be used safely in anterior cervical fusion. The effect of BMP-7 on the rate and timing of fusion, as well as clinical outcome, is yet to be elucidated.
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PMID:BMP-7 (OP-1) safety in anterior cervical fusion surgery. 1966 82

The advent of recombinant DNA technology has substantially increased the intra-operative utilization of biologic augmentation in spine surgery over the past several years after the Food and Drug Administration approval of the bone morphogenetic protein (BMP) class of molecules for indications in the lumbar spine. Much less is known about the potential benefits and risks of the "off-label" use of BMP in the cervical spine. The history and relevant literature pertaining to the use of the "off-label" implantation of the BMP class of molecules in the anterior or posterior cervical spine are reviewed and discussed. Early prospective studies of BMP-2 implantation in anterior cervical spine constructs showed encouraging results. Later retrospective studies reported potentially "life threatening complications" resulting in a 2007 public health advisory by the FDA. Limited data regarding BMP-7 in anterior cervical surgery was available with one group reporting a 2.4% early (< 30 d) complication rate (brachialgia and dysphagia). BMP use in the decompressed posterior cervical spine may result in neurologic or wound compromise according to several retrospective reports, however, controlled use has been reported to increase fusion rates in select complex and pediatric patients. There were no cases of de novo neoplasia related to BMP implantation in the cervical spine. BMP-2 use in anterior cervical spine surgery has been associated with a high early complication rate. Definitive recommendations for BMP-7 use in anterior cervical spine surgery cannot be made with current clinical data. According to limited reports, select complex patients who are considered "high risk" for pseudoarthrosis undergoing posterior cervical or occipitocervical arthrodesis or children with congenital or traumatic conditions may be candidates for "off-label" use of BMP in the context of appropriate informed decision making. At the present time, there are no high-level clinical studies on the outcomes and complication rates of BMP implantation in the cervical spine.
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PMID:Bone morphogenetic protein in complex cervical spine surgery: A safe biologic adjunct? 2361 Jul 51