Has the Promise Been Kept?
Thomas A. Einhorn, MD

In November 1965, a landmark article in Science1 demonstrated that the demineralized extracellular matrix of bone possesses a property that allows it to induce the formation of new bone when implanted into a nonskeletal site, an effect that initially was known as “bone autoinduction.” Certain members of a family of proteins, later known as bone morphogenetic proteins (BMPs), were shown to be responsible for this effect. Twenty-three years later, scientists cloned recombinant human BMP-2 (rhBMP-2) and touted its potential ability to change skeletal surgery. Clinicians and scientists waited with bated breath for the U.S. Food and Drug Administration (FDA) to grant regulatory approval to this protein.

In this issue of JBJS Reviews, Hsu reviews the role of rhBMP-2 in spine surgery. The article provides the historical perspective on the development of this recombinant protein and the results of different preclinical and clinical studies that led to its approval and widespread use. However, despite the many clinical success stories that have accompanied the use of …