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August 20, 2025

Current use and Complications Associated with Bone Morphogenetic Protein in Spine Fusion Surgery

MKMaximilian KorsunHospital for Special Surgery TATomoyuki AsadaHospital for Special Surgery THTakashi HiraseHospital for Special Surgery

Key Points

Patients undergoing spinal fusion with rhBMP-2 showed higher rates of osteoporosis and associated complications, especially in certain surgery types.
In a cohort of 9809 patients, rhBMP-2 was frequently utilized in AL/TF and LLIF procedures, indicating targeted use based on surgery type.
Retrospective analysis relied on electronic health records, assessing complications through ICD-10 codes over six years.
The findings underscore the need for careful consideration of rhBMP-2 use in patients with risk factors, as no clear trend in complications was observed.

Abstract

Study Design. Retrospective review of electronic health records system. Objective. To compare the indications and complication rates between rhBMP-2 and non-rhBMP-2 use in spine fusion at a high-volume tertiary orthopedic institution. Summary of Background Data. Bone morphogenetic proteins are growth factors that play a critical role in bone development and proliferation. rhBMP-2 is a biologic approved for select spinal fusion procedures to improve fusion rates. It is used in off-label indications. There are limited studies describing the use of rhBMP-2 in current practice. Methods. Patients who underwent spinal fusion from February 2016 to January 2022 were included. Surgery types were categorized by the approach listed as the primary procedure. A subgroup analysis was performed to assess differences in rhBMP-2 use for short and long fusions. Complications present within one year as ICD-10 codes were assessed. Results. A total of 9809 patients were assessed. rhBMP-2 was used in 0.3% of ACF and 64.5% of PCF surgeries. Patients who underwent PCF with rhBMP-2 had higher rates of osteoporosis. rhBMP-2 was used in 96.1% of AL/TF, 69.2% of PL/TF, 97.4% of LLIF, and 24.1% of TLIF. Patients who underwent PL/TF with rhBMP-2 had higher rates of osteoporosis, mean age, former smoking status, and ASA class. There were increased rates of wound dehiscence in PL/TF with rhBMP-2. Patients who underwent long fusions with rhBMP-2 were more likely to have osteoporosis than those who underwent short fusions without rhBMP-2. Conclusions. We found that rhBMP-2 was used extensively in AL/TF and LLIF, frequently in PCF and PL/TF, occasionally in TLIF, and sparingly in ACF. While patterns of use differed in the cervical spine, mostly selecting for patients with risk factors for pseudarthrosis, this pattern of usage was only found in posterior lumbar and thoracic fusion. There was no obvious trend in complications associated with rhBMP-2 use.

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