Neurosurgery · IF 3.9 · July 21, 2026 · LoE III
Is rhBMP-2 Worth the Risk? A Data-Driven Look at Fusion Outcomes and rhBMP-2–Related Complication Burden in High-Risk Adult Spinal Deformity Patients
Duby Okonkwo, Harsh Jain, Nick De Oliveira, Sam Kavarana, Advith Sarikonda, Bayard Wilson, Amir M. Abtahi, Byron F. Stephens, Scott L. Zuckerman — Vanderbilt University
This single-center retrospective cohort study looked at 288 adults undergoing complex adult spinal deformity surgery (≥5-level fusion), comparing the 118 patients whose surgeon used rhBMP-2 intraoperatively against the 170 who did not. Pseudarthrosis/rod fracture occurred far less often in the BMP group (16.1% vs 38.2%, adjusted OR 0.14), and this benefit was strongest in patients with obesity or osteoporosis/osteopenia, while diabetic patients showed no significant benefit and BMP did not increase radiculitis, wound problems, or seroma after adjustment.
AI summary · from the full text · reviewed by Pukhraj Gaheer, Medical Student, Queen's University before publishing
Why it mattersBMP-2 use in spinal deformity surgery remains controversial due to cost and complication concerns, so evidence suggesting it may selectively benefit high-risk fusion patients (obese, osteoporotic) without added harm could influence surgeon decision-making about which patients merit the biologic.
Conclusion strengthConfirms prior evidence
The effect exceeds a 25% relative reduction, though the 95% CI 0.02 to 0.78 reaches below it.
Presenting this at rounds? Start here
- ?Given that BMP allocation was left entirely to surgeon discretion in this retrospective cohort, how might confounding by indication (BMP preferentially used in higher-risk revision cases) have been imperfectly controlled by the multivariable model?
- ?If you were counseling an obese or osteoporotic patient before deformity surgery, would this single-center, underpowered, hypothesis-generating study be enough to change your intraoperative biologic choice, or would you wait for prospective confirmation?