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BMP and Peek for Cervical ACDF

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:28 AM in Back Surgery and Neck Surgery
I was just curious if anyone else has had BMP and Peek used in a cervical ACDF. If so, how was the outcome?




  • Hi Laurie;
    Looks like from your auto-signature, you are aware of the BMP risks. I know I've seen posts from other cervical fusion folks here who used BMP but I don't know if they are still around or posting.

    Since your last fusion is not yet fusing, at what point does your surgeon consider it a failed surgery? Certainly keep up the bone growth stimulator and I hope the pain mgmt doc can give you some relief. Good luck to you.
  • Laurie, although Zach is correct about BMP not being FDA approved for cervical surgeries, many surgeons can get around that by using off-label BMP. When I read my op report, it stated that my surgeon used off-label BMP in my fusion. I believe this is more common than some people realize.

    In any case, my fusion has been very good and I have not had any post-op issues with regards to BMP.

  • Thank you all for your replies. I was beginning to think that I was the only one that has had this done (three times). I know some hospitals won't let my doctor do this procedure. I had a very good fusion rate until the last surgery on C6-7. I will find out how this one is coming along in the beginning of April. That surgery is the only one that caused me chronic pain in my trapezius muscle which is why the PM doctor is trying the SNRB and trigger point injections. I will be having the second set of injections this Tuesday and I really am hoping they work as the first ones did not.

    Thanks again and best wishes to all of you.

  • I had a 4 level cervical fusion (C3-4 4-5 5-6 6-7) in early December 2009. My surgeon used the Peek Prevail disk and BMP. I was made aware of the previous issues of using BMP with cervical fusions but was confident in my surgeon how he described those problems and how he was going to avoid those same issues with me. I asked a lot of questions and took notes so that I could look up any of his answers. I velt very confident is his ability and so far it has proven to be a good choice. I have read nothing but horror stories of people who had cages and allografts as well as autografts. I am glad I had my fusion done with the BMP. I am not completely pain free but a lot of that has to do with what I do for a living (a very stressful desk job where it is not feasible to get and move around) I am still on pain meds but over all I would say that this surgery was a success and I would choose to have it again. I believe that you have to have a surgeon who has experience with the BMP and knows how to use it in conjunction with the Peek Prevail disk.
  • jlrfryejjlrfrye ohioPosts: 1,110
    I have had 5 cervical fusion surgeries. 4 of them failed. My doctor used BMP in my last surgery and 6 months later I have totally fused. So for me it worked.
    Good luck with your surgery.
  • I am a spine surgeon. If you have BMP (Infuse) put in your neck you could be in for a whole lot of trouble. I saw a patient recently who had a 4 level discectomy and fusion using PEEK cages and BMP. Post op he developed a lot of prevertebral soft tissue swelling that required a tracheostomy and gastrostomy. It has been over a year and he still can't swallow well. The fusion rate for allograft bone is over 92% (Neurosurgery Journal, volume 77, number 4, April 2010). BMP should only be used in VERY select cases as the potential risks can be life threatening. Medtronic, the makers of Infuse (BMP) made a written statement warning of it's use in the cervical spine July of 2008.
  • I did have some major swelling and was placed on a 5 day pack of steroids 6 days after surgery. That made a world of difference. I still had swallowing issues for a very long time. Now I seem to be okay.I am hoping at the 3 month check there will be some bone growth. Concerned.

    12/9/2010 ACDF C5-6 C6-7
    PEEK, BMP, bone fragments, plate and screws
    DDD, severe arthritis
    4 hours with a bone stimulator per day
    no bone growth yet
    PT starts Monday had eval (painful)
    Went to work as a teacher 2/14/2010
  • The swelling is more of an issue initially for breathing. Sounds like you are past the time for swelling that would affect your breathing. Swallowing trouble can continue for many months, rare cases is permanent. If you are a healthy person with normal bone you should question your surgeon as to why he would have used BMP particularly with the well known risks associated with swelling of the soft tissues. Bone growth can take 6-12 months to see on a plain x-ray.
  • Frenchfri,

    Have you mentioned this to your surgeon yet? My fusions are a little over a year apart, and I had the crappy voice, tightness and swallow issues for a couple of weeks, then it settled down.

    5 months post op I started having choke outs, voice loss and have this "sticky" feeling low in the back of my throat. I was still working at that time (law enforcement) and we had a renowned Neurosurgeon from Buffalo speaking to our officers about blunt trauma, partial and complete spinal cord damage. I went to ask him a question, and my voice was scantly a whisper.

    We spoke during a break, and he felt my hardware was moving, or I suddenly paralyzed a vocal cord. I got with my ENT, had flex/ext x-rays, a new MRI and then he scoped me with the aaaahhhs and eeeessszzz. He found (even though I showed concern on x-ray to my surgeon - was pooh pooed!) the C6 vertebra was (still is) cracked through just below the bottom screw on the top hardware, and the movement was irritating my vocal cords. He put me on steroids for a week to see if that helped - it did, and within a few days of being off of them, the voice went back to crap, choke outs returned.

    Your fusion was all done together, so hopefully it is just part of the healing process. I have to watch how I drink liquids, chew everything tiny and watch my head position. Head down is the worse. I am hopefull going back to my Neurologist will get back into "game plan" mode, but was warned revision is likely, and too C7/T1 (C8 nerve) level is going, so...Hoping you have answers soon!!!


    Ps.. After my voice issues, my NS no longer uses that stupid wing thing I have!! (G)

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Sos sorry for all of the issues you have had with your voice. My voice was weak for a week or so, but seems fine now. I would be in trouble without my voice as I am a teacher. My swallowing issues are minor now and I can live with them. I have spoke with both the OSS and the PA. I feel that they really listen to all of my concerns and issues. For instance, they only use a soft collar, but I expresses my need for a hard collar for the time right after surgery. SO they said if it would make me feel more comfortable to have one, then they would write a script. Which they did. I wore it for a few days and then switched to a soft collar. Much more comfortable. They were ready to send me home after 4 days and I didn't feel I was ready so they made sure I could stay until I was ready. My biggest issue is my strength and ROM in my neck. I'm sure that will come in time. I also have difficulty sleeping. I still use the soft collar for sleeping and tend to toss and turn. I will have to deal with less sleep when I go back to work on Monday. Nervous that work will cause me to be so tired and achy until my body gets accustomed to the schedule again. Have a great weekend. Hope you are not getting too much snow if you are near Buffalo.
  • As far as I know, never had a problem breathing. I have a copy of the paperwork from while I was in the hospital. No problems were ever mentioned.
    I don't have too much of a problem now with swallowing. I just prefer not to have large amounts of bread.This situation has caused me to increase my water intake which is a positive affect.
    Are you saying that there can be bone growth prior to being seen on a regular x ray. At my 3 month visit should I ask for something different?
    Thanks for your response.
  • If you are doing well, don't worry about what the x-ray looks like. You could get a x-ray about a year from your surgery and you should see the solid fusion by then. Otherwise, go about your normal activity, eat what you can, etc. I think you should ask your surgeon, however, why he/she used BMP!
  • i will ask him why he chose to use the BMP. But I am concerned about fusion and bone growth. With DDD and severe arthritis I just want to make sure all is on track and behaving the way it should. As a teacher I am constantly moving my neck in all directions, reaching and not always thinking about my movements or posture. I am concerned about the levels above and below the fusion. I would have loved to have an ADR but my OSS did not feel I was a good candidate as he had done trials with them. :( Thanks for your input.
  • I was just wondering what "BMP" stands for? I'm having neck surgery in a couple of weeks for two nerves compressing my spinal cord big time, and he's also doing a fusion by taking bone from my hip.
  • Mindy,

    Here you go, straight from here....


    As a rule, they don't use BMP in cervical fusions due to overgrowth, but on some cases, they have used it successfully. Hope this helps.

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Sorry, I missed this reply somehow! I live in South Florida by the way - use to live up near ya...Elmira!!

    I've got issues at C2/3 which are numbing my neck, and now I am getting this feeling of fingers pressing on my trachea which is really annoying, and if in the wrong position, kick me into a choking fit!

    My C6 vertebra is cracked, and per my ENT moving, and fubaring my vocal cords, and swallowing. I'm hoping to get my scripts on Friday for a Sagital CT scan with contrast, updated flex/ext x-rays for my neck and lumbar, and updated MRI for my cervical (maybe Lumbar as well), and yeah, if he wants another NVC/EMG, that's fine. I would just hear more upper motor neuron lesions for a 3rd time - sigh. At any rate, I pretty well know what is messing up my voice a year and a half post op. Now the fun begins on the game plan to address it....

    As for sleeping, have you tried wedge pillows? It's funny, for my C5/6 I lived in my recliner for months, but for my C6/7, me and my bed got along fine? Weird huh? I guess what I am suggesting is that you try different venues for getting restful sleep. We never know what works. I came home from the hospital ready to hit that recliner, and the bed was the trick!! Wishing you restful/quality sleep!!

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • That article was very interesting.
  • Mindy,

    There is a search box at the top of the web page on here. You can type in key words like "BMP", "ACDF" etc., and get doctor written articles that explain most of what we have to have done, or procedures and such. :)

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • I had bmp placed on my fourth surgery as I had already had psuedoarthrosis using my bone. But I am here to say I would never recommend it, as the swelling issues almost did me in. I had it put in about a month before the official warning came out in July of 08. But there is a reason for that warning. I do have some permanent damage from the BMP and the swelling that took place following the surgery. I do and will always have swallowing issues. I know there are surgeons out there whom still use it as a first line of bone grafting material, as the surgeon whom used that on me said he will continue to use it everyday and he is not worried about the warning. But I live with the results of it so I have a bit different take on the issue.
  • Bone Morphogenic Protein. Trade name Infuse by Medtronic.
  • DON'T DO IT! I had 2 cervical surgeries ACDF C4/5 then 20 Yrs later started having problems again. Had ACDF C6/7 both without BMP. Excelent relief. Then at my 8 Wk postop I was told by my neurosugeon fusion was slipping. MRI reviewed by Thoracic surgeon. This surgeon did my 3rd surgery. PCDF C4 to C7. I was in severe pain following surgery. By day 2 couldn't sit up w/o horrible spine pain and cramping in upper extremities. Given large doses of prednisone and valium. The thoracic surgeon couldn't be found to confer with. By Monday pain was unbearable without morphine. My neurosugeon investigated the OR note and found BMP had been used. I had no risks for not healing, no reason to use BMP. The thoracic surgeon had quit and moved to Montana. Took 6 mo to get off prednisone and valium. It's been 8 yrs since surgery still have terrible hand cramping, headaches, neck pain, paresthesia. Neurosurgeon tried taking posterior plates out but only able to remove one side.
    Bottom line there is a reason it's not approved for this surgery. Know what your surgeon is doing. Get a second even third opinion. And never allow the surgeon to use off label process. NEVER ALLOW BMP FOR YOUR CERVICAL FUSION. Have them check for allergies prior to use for other levels.
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