How do we interpret national inpatient sample data about complications? Commentary on an article by Amit Jain, MD, et al.: "rhBMP Use in Cervical Spine Surgery: Associated Factors and In-hospital Complications".

Abstract

Achieving solid osseous fusion remains a challenge in spine surgery. Autologous iliac crest bone graft remains the gold-standard graft material. In most cases, the fusion rates achievable with modern surgical techniques and autologous iliac crest bone graft are >90%. In specific scenarios, including long-segment fusion surgery and in patients with comorbidities, the fusion rates are substantially lower than this benchmark. Commercially available recombinant human bone morphogenetic protein (rhBMP) has rapidly been adopted as an alternative that can avoid the morbidity of iliac crest harvest and yet achieve similar, or possibly better, fusion rates than autograft bone. A number of recent publications have questioned the potential risks associated with the use of rhBMP1. A series of papers showing conflicting results has followed: some describing serious complications associated with rhBMP, and some reporting minimal or no effect on complication rates. In fact, two independent groups analyzed individual patient-level data supplied by the manufacturer of rhBMP-2 (Medtronic Sofamor Danek) and reached similar, but not identical, conclusions2,3. This controversy is the context for the paper by Jain et al., which describes the use of rhBMP in cervical spine surgery …