The Efficacy and Safety of Bone Morphogenetic Protein in Posterior Cervical Fusion: A Systematic Review and Meta-Analysis

Introduction: The use of bone morphogenetic protein (BMP) to enhance spinal fusion has increased exponentially despite limited data on efficacy and safety. BMP utilization in posterior cervical fusion procedures is off label with unclear impacts on outcomes.

Methods: PubMed, Embase, and Cochrane databases were searched for studies comparing BMP versus no BMP in posterior cervical fusion. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for outcomes of fusion rate, reoperation rate, overall complications, using a random effects model.

Results: Eighteen studies including 3622 patients were analyzed. BMP was associated with higher fusion rates versus no BMP controls (OR 3.99, 95% CI 2.60-6.13, p< 0.0001). No differences were found in reoperation rates (OR 4.93, 95% CI 0.82-29.47, p=0.08) or overall complications (OR 0.99, 95% CI 0.41-2.40, p=0.98).

Conclusion : BMP increases fusion rates in posterior cervical fusion procedures without increasing postoperative complications or reoperations. Further studies are needed to determine optimal BMP dosing and surgical techniques.