The use of bone morphogenic protein in spinal deformity surgery

Bone morphogenic protein (BMP) as an adjunct to standard grafting techniques has become more and more common in spinal deformity surgery. There are several issues specific to deformity surgery that make these cases suitable for the use of BMP: the relatively high non-union rate due to the multiple fusion levels, the limited amount of iliac crest available for harvest, and the need for 360° fusions at the lumbosacral junction. However, there are concerns about using BMP for these surgeries, particularly as there are no set guidelines with regards to dosage as well as the method of utilization. In addition, the use of BMP posteriorly is technically off-label with regards to FDA approval, leaving compensation for its use in this scenario somewhat up in the air.