BMP-2 with anterior lumbar interbody fusion: Clinical usage and recent controversies

BMP-2 in the spine was first introduced as an adjunct to anterior lumbar interbody fusion (ALIF). The best available evidence suggests increased fusion rates with BMP-2, which has led many to view it as a replacement for iliac crest autograft. It may also be beneficial in patients who are at higher risk for pseudarthrosis. In either case, only a few studies have shown a favorable cost-benefit ratio. The complication profile of BMP-2 has come under recent scrutiny, dependent not only on its biologic properties but also the dosage, carrier properties, surgical approach, and graft containment technique. Recently highlighted issues such as retrograde ejaculation, heterotopic ossification, and radiculitis have been associated with its use in the lumbar spine. An understanding of the benefits, risks, and costs of BMP-2 use in ALIF can help identify patients who are most likely to benefit from it and promote informed decision-making.