BMP 2 usage in posterior lumbar fusion in degenerative conditions

rhBMP-2 is approved for use in single-level anterior lumbar interbody fusion (ALIF) within an LT-CAGE. Following impressive reports regarding the safety and efficacy of rhBMP-2 in ALIF, many surgeons have started using rhBMP-2 as a graft substitute for posterior lumbar fusion in an off-label manner. A number of studies have been published documenting the outcomes and complications seen following the off-label use of rhBMP-2 in the lumbar spine. In the setting of PLF, PLIF, and TLIF, fusion rates following the administration of rhBMP-2 are comparable, and at times, higher than the fusion rates seen with ICBG. rhBMP-2 is frequently associated with decreased blood loss and faster operative times as compared to ICBG. Radiculitis, osteolysis, and ectopic bone formation are adverse events seen related to the use of rhBMP-2 in PLIF and TLIF.