Usage and Complication Rates of Bone Morphogenetic Protein-2 for Spine Fusion

Introduction: Bone Morphogenetic Protein-2 (BMP-2) is a popular adjunct for spine fusion. Although it has only been FDA-approved for select uses, it has been commonly used in off-label indications. This study assessed BMP-2 usage and complication rates at a high-volume tertiary orthopedic institute.

Methods: This retrospective study utilized a database generated through ICD-10 codes within our electronic medical records system. All fusion surgeries from 2/1/2016 - 1/31/22 were included. Surgeries defined by primary procedure name include anterior and posterior cervical fusion (ACF, PCF), anterior and posterior lumbar and/or thoracic fusion (AL/TF, PL/TF), lateral lumbar interbody fusion (LLIF), and transforaminal lumbar interbody fusion (TLIF).
Chi-square for categorical variables and one-way ANOVA tests for continuous variables were used. We assessed complications within one year, including cancer, venous thromboembolism, cardiopulmonary, hematoma, dysphagia, wound dehiscence, infection, and pulmonary embolism. Radiculitis was assessed as novel or non-resolved.

Results: The number of non-BMP-2 and BMP-2 cases was 2865 and 33 ACF, 168 and 273 PCF, 43 and 1089 AL/TF, 928 and 1597 PL/TF, 37 and 1381 LLIF, 154 and 40 TLIF.
Patients who underwent ACF with BMP-2 had higher mean ASA class, (2.1 vs 2.3) rates of osteoporosis, (24.2% vs 4.5%) hypertension, (12.1% vs 3.1%) diabetes, (15.2% vs 5.1%) age, (65.8 vs 56.4) dysphagia, (3.0% vs 0.2%) seroma, (3.0% vs 0.1%) wound dehiscence, (3% vs 0.2%) and infection. (6.1% vs 0.8%)
PCF with BMP-2 had greater rates of osteoporosis, (16.5% vs 8.9%) lower mean age (62.2 vs 65.0) and BMI. (27.6 vs 29.1)
TLIF with BMP-2 had greater rates of novel (18.4% vs 15.6%) and non-resolved (20.4% vs 7.1%) radiculitis. PL/TF patients with BMP-2 had lower rates of novel (10.2% vs 14.3%) but higher rates of non-resolved (9.5% vs 4.7%) radiculitis. AL/TF patients with BMP-2 had lower rates of both novel (13.3% vs 16.3%) and non-resolved (12.8% vs 25.6%) radiculitis.

Conclusion : BMP-2 use was associated with greater rates of dysphagia in ACF, greater rates of postoperative radiculitis in TLIF, and lower rates of radiculitis in ATF and ALIF.