Delayed Pleural Effusion After Anterior Thoracic Spinal Fusion Using Bone Morphogenetic Protein-2

作者：Kepler Christopher K; Huang Russel C^*; Meredith Dennis; Cunningham Matthew; Boachie Adjei Oheneba

来源：Spine, 2011, 36(5): E365-E369.

DOI：10.1097/BRS.0b013e3181f55057

• BMP-2
• complication
• pleural effusion
• thoracic spinal fusion
• thoracotomy

Study Design: Case report.
Objective: To report four cases of delayed pleural effusion after minimally invasive thoracotomy and interbody thoracic fusion with or without corpectomy using cages filled with bone morphogenetic protein-2.
Summary of Background Data: Multiple human studies have documented the efficacy of bone morphogenetic protein-2 in achieving fusion in the cervical, thoracic, and lumbosacral spine. However, unintended adverse effects of bone morphogenetic protein use in spine surgery have been reported and include cervical soft tissue swelling, ectopic bone formation, sterile seroma formation, vertebral body resorption and neuritis.
Methods: Two case histories are reviewed in detail in which patients developed clinically significant dyspnea and other clinical symptoms associated with the large pleural effusions. Both surgeries were performed with the patient in the lateral decubitus position. An expandable tubular retractor system was used through a 3- to 4-cm incision to maintain exposure of the lateral aspect of the thoracic spine and to retract the lung anteriorly during surgery.
Results: One patient required diuresis using furosemide and his discharge from the hospital was delayed because of the effusion. The effusion and associated subjective chest fullness resolved by 3 months after surgery. The second patient required reinsertion of a chest tube and diuresis, which also delayed discharge. Her effusion resolved by 1 month after surgery. Two additional patients who developed symptomatic pleural effusions are presented in tabular format. Effusions resolved by 5 months in all cases.
Conclusion: The case histories described in this report are similar with respect to the development of a large delayed onset effusion significant enough to cause symptoms, possibly due to an inflammatory reaction in the pleural cavity. Surgeons should consider the possibility of effusion formation when using bone morphogenetic proteinss in anterior thoracic surgery.

• 出版日期2011-3-1