Spine - 2026-03-15 - Journal Article
Current Use and Complications Associated With Bone Morphogenetic Protein in Spine Fusion Surgery: A Review of 9809 Patients.
Korsun MK, Asada T, Hirase T, Zhang B, Kwas CT, Zhang J, Kim ET, Morse KW, Sandhu HS, Kim HJ, Cunningham ME, Albert TJ, Huang RC, Dowdell JE, Farmer JC, Lovecchio FC, Sheha E, Iyer S, Qureshi SA
Topics
Key Takeaway
rhBMP-2 was used in 96.1% of anterior lumbar/thoracic fusions and 97.4% of LLIF cases but only 0.3% of anterior cervical fusions, with wound dehiscence as the sole significantly elevated complication in posterior lumbar/thoracic fusion with rhBMP-2.
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Summary
This study examined rhBMP-2 utilization patterns and 1-year complication rates across all spine fusion approaches at a single high-volume tertiary center from 2016–2022. rhBMP-2 use varied dramatically by approach: 96.1% AL/TF, 97.4% LLIF, 64.5% PCF, 69.2% PL/TF, 24.1% TLIF, and 0.3% ACF; patients selected for rhBMP-2 in posterior approaches had higher rates of osteoporosis, older age, and higher ASA class. The only statistically notable complication difference was increased wound dehiscence in PL/TF with rhBMP-2; no other complication signal emerged across approaches.
Key Limitation
ICD-10 code-based complication detection at a single institution introduces both undercoding bias and limits generalizability, as institutional rhBMP-2 protocols and surgeon selection criteria may not reflect broader practice patterns.
Original 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 biological 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.
MATERIALS AND 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.