Bone morphogenetic protein in adult spinal deformity surgery: a meta-analysis.

Abstract

Since its introduction BMP has been utilized in populations with higher rates of malunion, such as adult spinal deformity (ASD) patients. Contradictory conclusions exist in spinal literature regarding the safety and efficacy of the use of BMP in this setting. Previous studies, however, did not distinguish deformity cases from spondylolisthesis or stenosis. The purpose of this study is to evaluate the safety and efficacy of BMP use in spinal fusion surgery for ASD. 166 papers were screened after database search. 40 full texts were assessed for eligibility. Five studies were included for meta-analysis. Three were comparative studies between a BMP and non-BMP group, and the other was used to supplement dose-effect analysis. The current meta-analysis found increased odds of developing radiculitis or neurological complications (OR=2.18, 95% CI, p=0.02, i 2=0), but no other significant relationship between complications commonly attributed to BMP use (tumorigenesis, infections, seroma formation, or osteolysis) and BMP use. BMP patients had decreased rates of pseudarthrosis (OR=0.23, 95% CI, p=0.002, i 2=0). There was an average dose of 8.75mg/level in the 417 patients studied, lower than the advised dosage of 12mg/level. The current literature shows BMP to be a safe and effective grafting technique in the treatment of ASD. Spine surgeons may currently be using sub-optimal doses of BMP. The benefit of increasing the rate of fusion must be weighed against the increased risk of radiculitis and neurologic complications in this patient population.