The use of bone morphogenic protein in cervical spine fusions: A literature review

Bone morphogenic proteins (BMPs) are signaling proteins which promote osteogenesis and facilitate fusion of bone in lumbar spinal procedures. Research is targeted towards the benefits of use in lumbar fusions and the use of BMPs in anterior lumbar interbody fusions (ALIFs) is FDA approved. However, fewer studies have detailed adverse effects and use in cervical fusion procedures, which is currently considered “off-label”. BMP use in cervical fusion procedures may improve radiographic outcomes and functionality of patients in the long term, though overall rates of serious medical complications from use are increased in the early postoperative period. Complications of BMP use include: ectopic bone formation, inflammation, swelling and seroma. These adverse outcomes can be much more fatal in the cervical spine as compared to their occurrence in the lumbar spine. Because of the adverse effects, low doses of BMPs have been recommended, reducing risks of complications while still aiding in the fusion process. Additionally, BMPs have not been approved for use in pediatric populations, though off-label use in fusion patients with paucity of autologous bone may prove advantageous. Patients who are considered high risk for pseudoarthrosis may also be candidates for the use of BMPs in cervical procedures. Physicians and patients should be aware of the potential adverse outcomes of using BMPs in cervical fusion procedures and weigh the risks and benefits before deciding on use.