JBJS Reviews
Recombinant Human Bone Morphogenetic Protein-2 in Spine Surgery
Wellington K. Hsu, MD
  • The use of recombinant human bone morphogenetic protein-2 (rhBMP-2) during spine surgery is controversial, requiring surgeons to be intimately familiar with the available data.

  • The use of rhBMP-2 during spine surgery has been associated with a number of complications, many of which can be mitigated with proper usage, including the application of an appropriate dose, use of associated carriers that help confine the extravasation protein, and timely recognition and treatment of any complications.

  • The Yale Open Data Access Project provides an unbiased, comprehensive review of the available patient data from U.S. Food and Drug Administration investigational device exemption clinical trials and adds to our understanding of rhBMP-2 and its clinical effects.

The era of using bone morphogenetic protein (BMP) to augment spinal arthrodesis has been noteworthy in a number of ways. Since the U.S. Food and Drug Administration (FDA) approved the use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in a titanium cage for anterior lumbar interbody arthrodesis in 2002, the widespread effects of its use have been well publicized, both in the evidence-based literature and in the lay press, with a variety of connotations. Initially perceived as a revolutionary, fail-safe bone-graft substitute that obviated the need for iliac crest bone graft, rhBMP-2 is now perceived as a potentially high-risk material and has been vilified in academic circles, the media, and conversations between surgeons and patients. This review will highlight the important historical milestones in the clinical and basic-science research on BMP and will assess the current state of its use in spine surgery.

The Use of Autograft

The use of iliac crest bone graft has long been the so-called gold standard for the augmentation of spinal arthrodesis. With the ability to obtain large amounts of graft through either an anterior or a posterior approach, the technique has evolved greatly to …