Bone morphogenetic proteins and spinal surgery.

Abstract

A review of the literature concerning the use of recombinant human bone morphogenetic proteins 2 (rhBMP-2) and 7 (rhBMP-7) in spinal fusion. To summarize the pertinent preclinical experiments that enabled regulated human clinical trials of recombinant bone morphogenetic proteins for spinal fusion and to update clinicians on the results of those trials. More than three decades of research involving thousands of scientists and academicians throughout the world have led to the clinical use of recombinant bone morphogenetic proteins for the treatment of spinal disease. The published and presented scientific literature and the author's personal experience were examined. Recent clinical data support the assertion that recombinant bone morphogenetic proteins can be used as complete bone graft substitutes in spinal fusion surgery. In some circumstances, the efficacy of these factors for inducing successful fusion is superior to that of autogenous bone graft. RhBMP-2 is shown to be efficacious in several fusion applications, including intervertebral and lumbar posterolateral. Similar efficacy for rhBMP-7 has not yet been demonstrated, although relevant clinical studies are currently under way. The availability of these biologic agents will improve our ability to predictably treat spinal disease and may facilitate the further development of less invasive surgical innovations.