Anterior Cervical Fusion Surgery Research Articles

Race as an Independent Predictor of Temporal Delay in Time to Diagnosis and Treatment in Patients with Cervical Stenosis: A Study of 133 Patients with Anterior Cervical Discectomy and Fusion

Prompt decompression in clinically significant cervical stenosis is important in the prevention of neurological sequelae. Disparities exist along the continuum on spine care, with black patients receiving less surgery and experiencing worse postoperative outcomes. The aim of this study was to assess whether black race was an independent predictor for a prolonged time to diagnosis and treatment. The medical records of 133 patients undergoing elective anterior cervical discectomy and fusion surgery at a major academic medical center between 2010 and 2012 were reviewed. All patients had prospectively collected patient-reported outcomes measures including visual analogue scale (VAS) of pain. Data on patient demographics, comorbidities, and postoperative complication rates were retrospectively collected. Multivariate analysis was performed on variables that trended with delay in diagnosis and treatment on univariate analysis to determine independent predictors of delay in diagnosis and treatment. Patient demographics of the cohort included 45.87% male, 80.30% white, 71.97% married, 53.72% employed, 18.8% with a history of depression, and 19.55% with anxiety. The mean ± standard deviation age was 54.02 ± 11.74 years and baseline VAS-neck pain was 4.87 ± 3.19. In a multivariate analysis, race was the only statistically significant variable (P= 0.0212) to predict increased duration of preoperative pain before treatment. Other variables in the model included depression, anxiety, age, gender, employment status, marital status, body mass index, and baseline VAS-neck pain score. Our study demonstrates that race is an independent risk factor for a temporal delay in diagnosis and treatment of symptomatic cervical stenosis.

Comparison of Subdermal Needle and Surface Adhesive Stimulating Electrodes for Somatosensory Evoked Potential Monitoring during Anterior Cervical Discectomy and Fusion

ABSTRACTIntroduction: Needle stick injuries remain a physical and psychological burden to healthcare workers. Noninvasive surface adhesive stimulating electrodes used to generate somatosensory evoked potentials can help decrease this risk.Methods: We performed a retrospective observational study of patients who underwent anterior cervical discectomy and fusion (ACDF) surgery to determine the utility and variability of using surface adhesive stimulating electrodes. Our analysis for utility compared alarm (significant changes) frequency, defined by established alarm criteria, between subdermal needle (Group I) and surface adhesive electrodes (Group II). We compared the variability by comparing the frequency of alarms based on establishing baselines during various stages of the procedure.Results: Between Group I and Group II, no significant differences were found in demographic, age, number of levels decompressed and fused, and length of surgery variability. However, stimulation intensity was significantly higher in Group II. Significant differences in the mean frequency of alarm of cortical, subcortical, and Erb’s somatosensory evoked potential (SSEP) responses for the upper extremities between the two groups were only observed for the upper left Erb’s point amplitude (p = 0.03) at retraction and upper right cortical amplitude at incision (p = 0.02).The frequency of alarms of the amplitude of left ulnar cortical responses from SSEPs using surface adhesives when baselines were established at the beginning of the procedure, at the time of incision, and at placement of retractors were 13.83 % (±14.08%), 7.50 % (±7.56%) and 3.42 % (±3.48%), respectively. Comparatively, the frequencies of alarms of the amplitude of left ulnar cortical responses from SSEPs using needle electrodes were 18.07 % (±22.85%), 12.13 % (±17.30%) and 7.37 % (±11.82%), respectively. Similar results were observed from frequency for alarms from the right ulnar SSEPs.Conclusion: This study found little significant difference between the frequencies of alarm in patients who had SSEP responses obtained using surface adhesive electrodes when compared to needle electrodes. This lack of significant difference was observed even when alarms were established at various stages of the surgery before any major manipulation. For short procedures monitoring the upper extremities only, surface adhesive electrodes may provide a reliable alternative to invasive needle electrodes.

Can Dysphagia Following Anterior Cervical Fusions With rhBMP-2 Be Reduced With Local Depomedrol Application?: A Prospective, Randomized, Placebo-Controlled, Double-Blind Trial.

A prospective, randomized, placebo-controlled, double-blind trial. The aim of this study was to investigate whether the local administration of depomedrol decreases the severity of dysphagia after anterior cervical discectomy and fusion (ACDF) surgery using bone morphogenetic protein (BMP). Although recombinant human BMP-2 is effective in promoting arthrodesis, many physicians avoid using it in anterior cervical spine fusions due to concern for increased incidence of dysphagia, significant pre-vertebral swelling, and airway compromise. Pilot studies have shown that the local application of depomedrol may decrease the incidence of postoperative dysphagia. We performed a prospective, randomized trial to evaluate the efficacy of local depomedrol application in reducing the severity of postoperative dysphagia following anterior cervical fusions using low-dose rhBMP-2. We hypothesized that locally administered depomedrol reduces dysphagia following such surgeries. Fifty patients between 18 and 70 years of age, undergoing 1, 2, and 3-level ACDFs, were randomized to 1 of 2 groups: BMP-2 with depomedrol or BMP-2 with saline. Patients were followed for 4 weeks postoperatively by the study administrator. Dysphagia was measured at 5 time intervals (postoperative days 1, 4, 7, 14, and 28) using a 4-point Modified Dysphagia Scoring System. Additional data regarding overall length of hospital stay and the administration of dysphagia-directed treatments were also recorded. Twenty-seven patients were randomized to the treatment (depomedrol) group and 23 were randomized to the control (saline) group. The 2 groups were nearly identical in terms of their demographic and operative characteristics. Patients receiving depomedrol experienced decreased dysphagia incidence and magnitude at all time intervals, with differences reaching statistical significance on postoperative days 4, 7, 14, and 28 (P < 0.05). This study provides Level 1 evidence that locally administered depomedrol on a collagen sponge significantly decreases postoperative dysphagia incidence and magnitude following anterior cervical spine fusion using low-dose rhBMP-2. 1.

A cohort study of the morbidity of combined anterior-posterior cervical spinal fusions: incidence and predictors of postoperative dysphagia.

To identify risk factors that may lead to the development of dysphagia after combined anterior and posterior (360°) cervical fusion surgery. A single center, retrospective analysis of patients who had same-day, 360° fusion at Henry Ford Hospital between 2008 and 2012 was performed. Variables analyzed included demographics, medical co-morbidities, levels fused, and degree of dysphagia. The overall dysphagia rate was 37.7%. Patients with dysphagia had a longer mean length of stay (p<0.001), longer mean operative time (p<0.001), greater intraoperative blood loss (p=0.002), and fusion above the fourth cervical vertebra, C4, (p=0.007). There were no differences in the rates of dysphagia when comparing patients undergoing primary or revision surgery (p=0.554). Prolonged surgery and fusion above C4 lead to higher rates of dysphagia after 360° fusions. Prior anterior cervical fusion does not increase the risk of dysphagia development.

Prognosis of posterior osteophyte after anterior cervical decompression and fusion in patients with cervical spondylotic myelopathy using three-dimensional computed tomography study.

Inadequacy of posterior osteophyte resection in anterior cervical decompression and fusion (ACDF) surgery has long been a clinical concern as it may influence surgical outcome. There has been no agreement on the prognosis in the presence of remnant posterior osteophytes. This study retrospectively investigated 26 cervical spondylotic myelopathy patients after ACDF in whom a remnant posterior osteophyte was identified by long-term follow-up CT scans (minimum of 2years). Remnant posterior osteophytes and osseous spinal canal were measured and compared between pre-operation CT and long-term post-operation CT. The post-operative clinical outcomes were also studied. The remnant osteophytes did not obviously decrease in size in any patient and significantly enlarged in 10 patients, with a new posterior osteophyte developing in one patient. In patients whose remnant osteophyte is enlarged, the incidence of pseudoarthrosis, as well as clinical deterioration during follow-up was significantly higher than patients with stable osteophytes. Contrary to previous reports, none of the remnant posterior osteophytes decreased obviously in size during follow up. Despite the persistence of posterior osteophytes, ACDF is still effective in CSM treatment. Posterior osteophyte enlargement at fused segment appears to be associated with symptomatic pseudoarthrosis and clinical deterioration after surgery.

Identification of head control deficits following anterior cervical discectomy and fusion in patients with cervical spondylotic myelopathy.

To investigate the presence of head control deficits and its course of recovery after anterior cervical discectomy and fusion (ACDF) surgery in cervical spondylotic myelopathy (CSM) patients. Thirty-seven CSM patients were assessed for their C2-C7 cervical lordosis, neck Range of Motion (ROM), repositioning accuracy, neck strength as well as surface electromyography of the neck muscle activities during slow head motions. Assessments were performed preoperatively and then at 3- and 6-month postoperatively. No significant difference was found for the C2-C7 cervical lordosis postoperatively at 6-month. ROM was restricted immediately after surgery but recovered over time, however, neck strength remained significantly reduced postoperatively. Reposition accuracy improved immediately after surgery but declined again at 6-month follow-up. In addition, muscle activities required to control head motions showed a continuous reduction postoperatively. Adequate C2-C7 cervical lordosis was maintained in the current study with improvement of slow head motion control and ROM at 6-month. However, improvement in head position sense was not maintained and neck strength showed continuous declination overtime. Assessment and monitoring of head control deficits should be routinely considered in CSM patients.

Return to Play in Athletes Receiving Cervical Surgery: A Systematic Review

Study Design Systematic review. Clinical Questions Among athletes who undergo surgery of the cervical spine, (1) What proportion return to play (RTP) after their cervical surgery? (2) Does the proportion of those cleared for RTP depend on the type of surgical procedure (artificial disk replacement, fusion, nonfusion foraminotomies/laminoplasties), number of levels (1, 2, or more levels), or type of sport? (3) Among those who return to their presurgery sport, how long do they continue to play? (4) Among those who return to their presurgery sport, how does their postoperative performance compare with their preoperative performance? Objectives To evaluate the extent and quality of published literature on the topic of return to competitive athletic completion after cervical spinal surgery. Methods Electronic databases and reference lists of key articles published up to August 19, 2015, were searched to identify studies reporting the proportion of athletes who RTP after cervical spine surgery. Results Nine observational, retrospective series consisting of 175 patients were included. Seven reported on professional athletes and two on recreational athletes. Seventy-five percent (76/102) of professional athletes returned to their respective sport following surgery for mostly cervical herniated disks. Seventy-six percent of recreational athletes (51/67) age 10 to 42 years RTP in a variety of sports following surgery for mostly herniated disks. No snowboarder returned to snowboarding (0/6) following surgery for cervical fractures. Most professional football players and baseball pitchers returned to their respective sport at their presurgery performance level. Conclusions RTP decisions after cervical spine surgery remain controversial, and there is a paucity of existing literature on this topic. Successful return to competitive sports is well described after single-level anterior cervical diskectomy and fusion surgery for herniated disk. RTP outcomes involving other cervical spine diagnoses and surgical procedures remain unclear. Additional quality research is needed on this topic.

A randomized comparative study between Airtraq and Mccoy for intubation in patients with cervical spine injury

Background: This study was done to compare Airtraq and McCoy for intubation characteristics and hemodynamic parameters following endotracheal intubation in patients undergoing anterior cervical discectomy and fusion (ACDF) surgery. Materials and Methods: After Institutional Ethical Committee approval, a prospective randomized comparative study was designed on forty American Society of Anesthesiologists I and II patients involving single level ACDF surgery. Following standard anesthesia protocol and manual in-line stabilization applied along with a cervical collar or pin traction for immobilization, tracheal intubation was performed either with Airtraq or McCoy. The time taken for intubation, intubation difficulty score (IDS), comfort grading, and hemodynamic parameters were noted following intubation. The categorical data were compared using Chi-square test and the continuous variables were compared between the groups using paired sample t -test. Repeated ANOVA was tested for hemodynamic data at each measurement time point and Tukey post hoc was used for within the group comparisons at different timings following intubation. Results: The mean intubation time was 24.41 ± 14.8 s in Airtraq group (Group A) which was statistically significant compared to McCoy group (Group M) 38.96 ± 15.55 s ( P = 0.001). The IDS and comfort grading was statistically significant in Group A compared to Group M. The changes in hemodynamic vitals following intubation were comparable in both the groups. Conclusion: Airtraq improves the grade of glottic visualization with minimal assistance. It also minimized the time taken for intubation had stable hemodynamics with increased comfort to the anesthetist.

Embolisation of Vertebral Artery Damaged Following Cervical Disc Removal

Introduction: The incidence of vertebral artery (VA) injury during cervical spine surgery is rare. Even though tamponade is effective in many cases, early consultation of an endovascular team is recommended if bleeding cannot be controlled. We report a case of emergent endovascular embolisation of left VA due to iatrogenic injury during anterior cervical disc removal and fusion. Case: A 47-year-old woman was admitted to our emergency department with serious arterial bleeding from the neck only hours after undergoing anterior cervical disc removal and fusion surgery. She was intubated and mechanically ventilated, however hemorrhage could not be successfully controlled by packing with surgical hemostatic agents. Cranial computed tomography, computed tomography of the cervical spine and CT angiography confirmed the suspected diagnosis of injury to the VA. Emergent endovascular embolisation successfully stopped the bleeding. Occlusion of the vessel was achieved by vascular plugging. The patient was discharged from our hospital 14 days after the intervention, receiving a revision surgery of the cervical spine on the day of embolisation. At the date of discharge she presented without any focal neurological deficit. Conclusion: Pre-operative radiographic imaging of the cervical spine should be used routinely to identify anatomic abnormalities of the vertebral arteries. Endovascular embolisation appears to be effective in treating acute iatrogenic dissection of the vertebral arteries.

Women's experiences of daily life after anterior cervical decompression and fusion surgery—a qualitative interview study

Objective: To explore and describe women’s experiences of daily life after anterior cervical decompression and fusion surgery. Design: Qualitative explorative design. Subjects: Fourteen women aged 39–62 years (median 52 years) were included 1.5–3 years after anterior cervical decompression and fusion for cervical disc disease. Methods: Individual semi-structured interviews were analysed by qualitative content analysis with an inductive approach. Results: The women described their experiences of daily life in 5 different ways: being recovered to various extents; impact of remaining symptoms on thoughts and feelings; making daily life work; receiving support from social and occupational networks; and physical and behavioural changes due to interventions and encounters with healthcare professionals. Conclusion: This interview study provides insight into women’s daily life after anterior cervical decompression and fusion. Whilst the subjects improved after surgery, they also experienced remaining symptoms and limitations in daily life. A variety of mostly active coping strategies were used to manage daily life. Social support from family, friends, occupational networks and healthcare professionals positively influenced daily life. These findings provide knowledge about aspects of daily life that should be considered in individualized postoperative care and rehabilitation in an attempt to provide better outcomes in women after anterior cervical decompression and fusion.

ACDF Graft Selection by Surgeons: Survey of AOSpine Members

Introduction The choice of graft material for anterior cervical disc fusion (ACDF) surgery is presumed to be very important in achieving fusion. Worldwide, a large diversity of graft options exists but no published data exist on actual use. Our objective is to determine the most commonly used graft materials in ACDF, whether the choice is affected by surgeon's training, years in practice, geographical location of practice setting, or surgeon's perceived difficulty in achieving fusion for a particular case. We also want to confirm our previous assumption that surgeons feel that the choice of graft material is important for outcome and that there is sufficiently good comparative and safety data on the most common grafts. Materials and Methods A 23-question survey was sent out to 5,334 surgeons using the Global AOSpine database. Response data were then stratified into surgeon training, years of practice, practice type, and global region. To further characterize type of ACDF graft, we classified common graft materials into structural and nonstructural components. Results Nearly all surgeons, 94.6%, performing ACDF believe that cervical disc fusion is important for a successful patient outcome. Overall, 89.3% of the surgeons believe that graft impacts fusion rates and 86.0% affect time to fusion. The use of a cage is currently the most common structural graft component used worldwide at 64.1%. Of the surgeons who use cages, the PEEK cage makes up for 84% of them. North American surgeons have stopped this trend and use composite allograft more commonly. Surgeon experience seems to be positively related to the use of a cage because surgeons with a greater number of years of practice are more likely to select a cage. The choice to add a nonstructural graft component was reported at 74%. This result was similar for performing multilevel fusions at 72.8%. The most common nonstructural graft material depends on the type of surgery, simple or complex. For simple cases, local autograft is most common and for multilevel fusions, allograft iliac cancellous is most widely used. Most surgeons are not satisfied with the available literature comparing the effectiveness of grafts, but believed there was sufficient evidence to support the use of their chosen graft. Conclusion Almost all surgeons believe that fusion is important to ACDF surgery outcomes and that most surgeons believe choice of graft impacts fusion. However, this survey indicates that there is great variability in the type of graft material used by spine surgeons across the world and surgeons feel that there is insufficient comparative data to help choose between graft types. This variability in surgeon practice and gap in the literature indicate an important opportunity to change surgeon practice with well-conducted comparative studies.

Anterior cervical discectomy and fusion surgery for cervical radiculopathy: is time of essence?

Burneikiene S, Nelson EL, Mason A, Rajpal S, Villavicencio AT. The duration of symptoms and clinical outcomes in patients undergoing anterior cervical discectomy and fusion for degenerative disc disease and radiculopathy. Spine J 2015;15:427-32 (in this issue).

Preoperative predictors of increased hospital costs in elective anterior cervical fusions: a single-institution analysis of 1,082 patients

Background contextThe frequency of anterior cervical fusion (ACF) surgery and total hospital costs in spine surgery have substantially increased in the last several years. PurposeTo determine which patient comorbidities are associated with increased total hospital costs after elective one- or two-level ACFs. Study design/SettingRetrospective cohort analysis. Patient sampleIndividuals who have undergone elective one- or two-level ACFs at our single institution. The total number of patients amounted to 1,082. Outcome measuresTotal hospital costs during single admission. MethodsMultivariate linear regression models were used to analyze independent effects of preoperative patient characteristics on total hospital costs. Univariate analysis was used to examine association of these characteristics on operative time, length of hospital stay (LOS), and complications. ResultsAge, obesity, and diabetes were independently associated with increased average hospital costs of $1,404 (95% confidence interval [CI], $857–$1,951; p<.001), $681 (95% CI, $285–$1,076; p=.001), and $1,877 (95% CI, $726–$3,072; p=.001), respectively. Age was associated with increased LOS (p<.001) and complications (p<.001) but not operative time (p=.431). Diabetes was associated with increased LOS (p<.001) and complications (p=.042) but not operative time (p=.234). Obesity was not associated with increased LOS (p=.164), complications (p=.890), or operative time (p=.067). ConclusionsThis study highlights the patient comorbidities associated with increased hospital costs after one- or two-level ACFs and the potential drivers of these costs.

Commentary on the effect of steroid use in anterior cervical discectomy and fusion surgery; a randomized controlled trial by Shiveindra B. et al. Journal of Neurosurgery Spine 2015;23:137-43.

Background:Steroids are often used in patients undergoing anterior cervical discectomy and fusion (ACDF) surgery to limit postoperative dysphagia. However, a major concern remains steroids’ impact is on fusion.Methods:In this prospective, randomized, double-blinded controlled study, the authors assessed the impact of steroids on swallowing/airway and fusion rates in 112 patients undergoing multilevel ACDF. The patients were randomly assigned to saline or dexamethasone groups prior to surgery; multiple other variables including different outcome analyses were also utilized over a 2-year postoperative period. The patients were followed for 1, 3, 6, 12, and 24 months postoperatively, and computed tomography (CT) studies were performed at 6, 12, and 24 postoperative months to establish fusion.Results:The authors found no significant 2-year differences in the clinical parameters or surgical outcomes for patients undergoing ACDF with or without steroids. Steroids reduced dysphagia in the 1st postoperative month, produced a “trend” for reducing postoperative airway complications (e.g., intubation), and length of stay. Notably, CT-fusion rates with steroids were reduced at the 6th postoperative month but equalized by the 1st postoperative year.Conclusions:The authors concluded that dexamethasone administered at the time of ACDF surgery improved swallowing within the 1st postoperative month, reduced perioperative airway complications, reduced the length of stay, and reduced 6 month but not 12 month fusion rates. Although the findings regarding postoperative dysphagia are helpful, the performance of multiple 3D-CT scans postoperatively to document fusion would appear to subject these patients to excessive radiation exposure without sufficient clinical indications.

Clinical Use of the Nanohydroxyapatite/Polyamide Mesh Cage in Anterior Cervical Corpectomy and Fusion Surgery

Purpose. This study was to report the clinical use of biomimetic nanohydroxyapatite/polyamide 66 (n‐HA/PA 66) mesh cages in anterior cervical corpectomy and fusion (ACCF) surgery. Method. 95 patients who underwent single level anterior cervical corpectomy and fusion for cervical spondylosis myelopathy (CSM) in our hospital were reviewed and divided into 2 groups according to using nanohydroxyapatite/polyamide mesh cage and titanium mesh cage (TMC). Demographic data of patients and surgical, clinical, and radiological data before operation and at last follow‐up were collected and compared. Result. The operation time, surgical blood loss, complications, and Japanese Orthopaedic Association scores (JOA scores) of two groups were similar. At the last follow‐up both the two groups obtained 100% solid bone fusion, but the TMC group had higher rate of severe cage subsidence than the n‐HA/PA 66 group (27% versus 2%). Conclusion. Nanohydroxyapatite/polyamide 66 mesh cage is safe and effective in ACCF and can be a substitution to titanium mesh cage.

Women's experiences of daily life after anterior cervical decompression and fusion surgery: A qualitative interview study.

To explore and describe women's experiences of daily life after anterior cervical decompression and fusion surgery. Qualitative explorative design. Fourteen women aged 39-62 years (median 52 years) were included 1.5-3 years after anterior cervical decompression and fusion for cervical disc disease. Individual semi-structured interviews were analysed by qualitative content analysis with an inductive approach. The women described their experiences of daily life in 5 different ways: being recovered to various extents; impact of remaining symptoms on thoughts and feelings; making daily life work; receiving support from social and occupational networks; and physical and behavioural changes due to interventions and encounters with healthcare professionals. This interview study provides insight into women's daily life after anterior cervical decompression and fusion. Whilst the subjects improved after surgery, they also experienced remaining symptoms and limitations in daily life. A variety of mostly active coping strategies were used to manage daily life. Social support from family, friends, occupational networks and healthcare professionals positively influenced daily life. These findings provide knowledge about aspects of daily life that should be considered in individualized postoperative care and rehabilitation in an attempt to provide better outcomes in women after anterior cervical decompression and fusion.

The Effect of Esophageal Contents on Postoperative Dysphagia Following Primary Anterior Cervical Discectomy and Fusion Surgery: A Prospective Randomized Trial

The Effect of Esophageal Contents on Postoperative Dysphagia Following Primary Anterior Cervical Discectomy and Fusion Surgery: A Prospective Randomized Trial

Preliminary evaluation of dorsal muscle activity during resisted cervical extension in patients with longstanding pain and disability following anterior cervical decompression and fusion surgery

ObjectivesTo compare mechanical activity (deformation and deformation rate) of the dorsal neck muscles between individuals with longstanding symptoms after anterior cervical decompression and fusion (ACDF) surgery and healthy controls. DesignPreliminary cross-sectional study. SettingNeurosurgery clinic. ParticipantsTen individuals {mean age 60 [standard deviation (SD) 7.1]} who had undergone ACDF surgery 10 to 13 years previously and 10 healthy age- and sex-matched controls. Main outcomesMechanical activity of the different layers of dorsal neck muscles, measured at the C4 segment using ultrasonography (speckle tracking analysis) during a standardised, resisted cervical extension task. ResultsA significant group×muscle interaction was found for muscle deformation (P<0.03) but not for deformation rate (P>0.79). The ACDF group showed significantly less deformation of the semispinalis capitis muscle during the extension task compared with the control group [mean 3.12 (SD 2.06) and 6.64 (SD 4.17), respectively; mean difference 3.34 (95% confidence interval −0.54 to 7.21)]. ConclusionsAs the semispinalis capitis muscle is a powerful neck extensor, the finding of altered activation following ACDF surgery lends support to the inclusion of exercise to train neck muscle performance in the management of these patients.

Anterior Cervical Discectomy and Fusion with Polyether ether Ketone Cage

IntroductionThe use of polyether ether ketone (PEEK) cage prosthetic devices in anterior cervical discectomy with fusion (ACDF) has increased rapidly. The authors present preliminary outcomes data ...

RhBMP use in cervical spine surgery: associated factors and in-hospital complications.

Widespread use of recombinant human bone morphogenetic protein (rhBMP) in cervical spine surgery has continued despite the U.S. Food and Drug Administration's 2008 notification regarding its adverse effects. Our study goals were to analyze how patient, surgical, and institutional factors influenced rhBMP use in cervical spinal fusion surgery and to examine the cervical-spine-specific in-hospital complications associated with rhBMP use. The Nationwide Inpatient Sample database was used to identify 1,064,372 patients eighteen years or older who had undergone cervical spinal fusion surgery from 2003 through 2010. Of these patients, 84,726 (7.96%) received rhBMP. Multivariate logistic regression models were used to analyze patient, surgical, and institutional factors associated with rhBMP use, and the relationship between rhBMP use and the development of in-hospital complications. On multivariate analysis, patient age and sex, insurance type, surgical approach, use of autograft bone, and hospital teaching status, size, and region were significant predictors of rhBMP use. Use of rhBMP was a significant predictor of complications on univariate analysis and on multivariate analysis adjusted for patient age and sex, Charlson comorbidity score, insurance status, surgical approach, autograft bone use, and hospital teaching status, size, and region. Use of rhBMP was significantly associated with the development of dysphagia (prevalence, 2.0%; adjusted odds ratio [OR], 1.53), dysphonia (prevalence, 0.28%; adjusted OR, 1.48), hematoma/seroma formation (prevalence, 0.7%; adjusted OR, 1.24), and neurological complications (prevalence, 0.84%; adjusted OR, 2.0). These complications were most commonly found after anterior cervical fusion surgery. Wound infections and neurological complications were most commonly found after posterior cervical fusion surgery. Dysphagia was most commonly found after circumferential fusion surgery. Indications for rhBMP use for cervical spinal fusion are multifactorial. Its use is associated with a significantly higher likelihood of cervical-spine-specific complications.