Bone Morphogenetic Protein in Anterior Cervical Discectomy and Fusion: A Meta-Analysis of Randomized Controlled Trials and Prospective studies

Background Recombinant human bone morphogenetic protein-2 (rhBMP-2) is increasingly used to augment fusion in anterior cervical discectomy and fusion (ACDF), but reported benefits and complications remain inconsistent. No meta-analysis has isolated the effect of BMP in ACDF using only randomized controlled trials (RCTs) and prospective comparative studies or stratified outcomes by control graft type. We therefore compared fusion, safety, and clinical outcomes of ACDF with versus without BMP, with subgroup analysis by allograft or iliac crest bone autograft (ICBG). Methods PubMed, Cochrane, and Google Scholar were searched through July 2026. RCTs and prospective studies comparing ACDF with and without BMP were included. Outcomes included fusion, adverse events, surgery-related outcomes, and patient-reported outcome measures (PROMs). Subgroup analysis was performed according to control graft type. Results Two RCTs and four prospective studies from three cohorts met the criteria, including 821 BMP and 1,067 control patients. BMP was associated with higher fusion rates than controls (OR 16.19; 95% CI 4.36–60.11; p < .001). This benefit persisted versus allograft but was not observed versus ICBG. BMP was also associated with higher heterotopic ossification (OR 2.50; 95% CI 1.66–3.78; p < .001) and lower estimated blood loss (MD −7.43 mL; 95% CI −12.40 to −2.47; p = .003). No significant differences were found in dysphagia, subsidence, reoperation, operative time, or PROM improvement. Conclusion BMP increases fusion rates in ACDF compared with allograft but offers no significant fusion advantage over ICBG. Its use is associated with increased heterotopic ossification without meaningful differences in dysphagia, reoperation, or functional outcomes.