Use of Bone Morphogenetic Protein-2 in Vertebral Column Tumor Surgery: A National Investigation

Abstract

To report the rate of bone morphogenetic protein-2 (BMP-2) use in vertebral column tumor surgery. The Nationwide Inpatient Sample database (2012-2014) was queried to identify patients who underwent spinal fusion for vertebral column tumors (primary benign, primary malignant, or metastatic). The rate of BMP-2 use was calculated, and patient and operative factors associated with its use were also investigated. We identified 9375 patients who underwent fusion surgery for spinal tumors between 2012 and 2014, with 540 cases using BMP-2 (5.8%). Preoperative diagnosis revealed that the rate of BMP-2 use in primary benign tumor surgery was 4.9%, 7.6% for primary malignant tumors, and 5.7% for metastatic lesions (P= 0.607). The overall complication rate was 13.2% (13.4% in the NO-BMP-2 group vs. 11.1% in the BMP-2 group; P= 0.504). Patients who received this growth factor were less likely to have epidural spinal cord compression at presentation (37.0% vs. 49.2%; P= 0.014), and more likely to have elective surgery (53.7% vs. 37.7%; P < 0.001). Analysis of hospital location indicated that the highest use of BMP-2 was in the South (7.4% rate; P= 0.002). There was no statistical difference between age, sex, insurance status, comorbidities, the presence of a pathologic fracture, or the use of inpatient radiotherapy or chemotherapy between patients who received BMP-2 and controls. BMP-2 has been used off-label to promote arthrodesis; however, its use in patients with spinal tumors is controversial. In this national study, BMP-2 use was highest in the South, in patients without epidural cord compression at presentation, and in elective cases.