432 Evaluating the Impact of Low-Dose Bone Morphogenetic Protein on Dysphagia Incidence Following Anterior Cervical Fusion and Corpectomy: A Multi-Institutional Propensity-Matched Analysis

INTRODUCTION: Dysphagia is a notable complication following anterior cervical spine fusion (ACF). The use of Bone Morphogenetic Protein (BMP) is controversial due to associated risks including exacerbated postoperative swelling. METHODS: A retrospective cohort study design of prospectively collected data was employed at three institutions including 1776 ACFs. Exploratory bivariate analysis was performed for feature selection in a 3:1 propensity matching including patient demographics, surgical characteristics, baseline dysphagia, and baseline patient-reported outcome measures. Primary outcome measure: incidence of dysphagia (Eating Assessment Tool or EAT-10 > 3) within 12 months. Secondary outcome measures: NG-tube placement, LOS, complications, and revision/reoperation rate. Three- and 12-month patient satisfaction, VAS-neck, VAS-arm, mJOA, NDI, and EQ-5D were compared to baseline. RESULTS: Thirty-eight patients with use of BMP were matched to 117 patients without BMP. Doses ranged from 0.21–0.50mg/level. All variables were well-matched (p > 0.06) including age (BMP: 58 ± 10.8, no-BMP: 56.2 ± 11.8; p = 0.446), baseline dysphagia (10.5% vs 9.4%; p = 0.762), number of levels (2.5 ± 1.0 vs 2.2 ± 1.0; p = 0.300), highest level (C4 ± 1 vs C4 ± 1, p = 0.609), or corpectomy (10.5% vs 17.1%, p = 0.475). The incidence of any postoperative dysphagia was no different with or without BMP (32% vs 38%; p = 0.633). EAT-10 scores were also similar at baseline (2.3 ± 6.1 vs 1.7 ± 4.7; p = 0.931), 1-month (8.3±8.9 vs 10.2 ± 9.5; p = 0.346), 3-month (4.4 ± 7.1 vs 3.4 ± 6.1; p = 0.464), and 12-month (2.8 ± 4.5 vs 3.3 ± 6.0; p = 0.346). No significant difference in secondary measures was observed. CONCLUSIONS: The use of low-dose BMP in ACF did not increase the incidence of dysphagia or affect other postoperative outcomes compared to surgeries without BMP. While BMP may increase swelling, it does not exacerbate dysphagia, affect perioperative outcomes, or affect 12-month patient-reported outcomes in this population.