The use of bone morphogenetic protein in spine fusion

BACKGROUND CONTEXT: Because pseudarthrosis remains a clinically significant complication after spinal arthrodesis, the role of recombinant bone morphogenetic proteins (BMPs) is continually evaluated in spine surgery. PURPOSE: This article reviews the important literature in clinical research involving the use of BMPs in the augmentation of spinal fusion. STUDY DESIGN/SETTING: Review article. METHODS: A literature search was performed via MEDLINE through PubMed with the dates January 1960 to July 2007 using the keywords "bone morphogenetic protein, BMP, spinal arthrodesis, and/or bone healing." Pertinent preclinical and clinical publications were chosen based on relevance and quality for inclusion in this study. RESULTS: Publications focused on the historical context and potential clinical applications using BMP were selected to delineate the risks, benefits, and current indications for the augmentation of spinal arthrodesis. CONCLUSIONS: Although multiple commercially available recombinant BMPs have demonstrated clinical success in interbody and posterolateral fusions, the associated costs preclude its routine use in spinal arthrodesis. The spine surgeon must assess each patient individually based on age, bone quality, diagnosis, comorbidifies, and risks of nonunion to determine the cost effectiveness of the use of BMP to augment spinal fusion. (C) 2008 Elsevier Inc. All rights reserved.