{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T22:03:37Z","timestamp":1789077817817,"version":"build-2803163510"},"reference-count":21,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2013,6]]},"abstract":"<jats:p>Recombinant human bone morphogenetic protein\u20132 (rhBMP-2) promotes the induction of bone growth and is widely used in spine surgery to enhance arthrodesis. Recombinant human BMP-2 has been associated with a variety of complications including ectopic bone formation, adjacent-level fusion, local bone resorption, osteolysis, and radiculitis. Some of the complications associated with rhBMP-2 may be the result of rhBMP-2 induction of the inflammatory host response. In this paper the authors report on a patient with prior transforaminal lumbar interbody fusion (TLIF) using an interbody cage packed with rhBMP-2, in which rhBMP-2 possibly contributed to vascular injury during an attempted anterior lumbar interbody fusion. This 63-year-old man presented with a 1-year history of worsening refractory low-back pain and radiculopathy caused by a Grade 1 spondylolisthesis at L4\u20135. He underwent an uncomplicated L4\u20135 TLIF using an rhBMP-2\u2013packed interbody cage. Postoperatively, he experienced marginal improvement of his symptoms. Within the next year and a half the patient returned with unremitting low-back pain and neurogenic claudication that failed to respond to conservative measures. Radiological imaging of the patient revealed screw loosening and pseudarthrosis. He underwent an anterior retroperitoneal approach with a plan for removal of the previous cage, complete discectomy, and placement of a femoral ring. During the retroperitoneal approach the iliac vein was adhered with scarring and fibrosis to the underlying previously operated L4\u20135 interbody space. During mobilization the left iliac vein was torn, resulting in significant blood loss and cardiac arrest requiring chest compression, defibrillator shocks, and blood transfusion. The patient was stabilized, the operation was terminated, and he was transferred to the intensive care unit. He recovered over the next several days and was discharged at his neurological baseline. The authors propose that the rhBMP-2\u2013induced host inflammatory response partially contributed to vessel fibrosis and scarring, resulting in the life-threatening vascular injury during the reoperation. Spine surgeons should be aware of this potential inflammatory fibrosis in addition to other reported complications related to rhBMP-2.<\/jats:p>","DOI":"10.3171\/2013.3.spine12377","type":"journal-article","created":{"date-parts":[[2013,4,5]],"date-time":"2013-04-05T16:12:38Z","timestamp":1365178358000},"page":"582-587","source":"Crossref","is-referenced-by-count":14,"title":["Revision surgery after interbody fusion with rhBMP-2: a cautionary tale for spine surgeons"],"prefix":"10.3171","volume":"18","author":[{"given":"Shaun D.","family":"Rodgers","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan J.","family":"Marascalchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bartosz T.","family":"Grobelny","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael L.","family":"Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uzma","family":"Samadani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"5 Suppl 2","key":"b1-spine12377","series-title":"Neurosurgery","first-page":"ONS423","article-title":"A comprehensive review of the safety profile of bone morphogenetic protein in spine surgery","volume":"62","author":"Benglis","year":"2008"},{"key":"b2-spine12377","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"1350","DOI":"10.1056\/NEJM200005043421807","article-title":"Role of transforming growth factor \u03b2 in human disease","volume":"342","author":"Blobe","year":"2000"},{"key":"b3-spine12377","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1097\/00007632-200002010-00020","article-title":"The use of rhBMP-2 in interbody fusion cages. Definitive evidence of osteoinduction in humans: a preliminary report","volume":"25","author":"Boden","year":"2000"},{"key":"b4-spine12377","series-title":"J Spinal Disord Tech","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1097\/00024720-200210000-00001","article-title":"Anterior lumbar interbody fusion using rhBMP-2 with tapered interbody cages","volume":"15","author":"Burkus","year":"2002"},{"key":"b5-spine12377","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"296","DOI":"10.3171\/2011.11.SPINE11629","article-title":"Bone morphogenetic protein-induced inflammatory cyst formation after lumbar fusion causing nerve root compression. Case report","volume":"16","author":"Choudhry","year":"2012"},{"key":"b6-spine12377","series-title":"J Vasc Surg","doi-asserted-by":"publisher","first-page":"946","DOI":"10.1016\/j.jvs.2009.11.039","article-title":"Vascular complications of exposure for anterior lumbar interbody fusion","volume":"51","author":"Garg","year":"2010"},{"key":"b7-spine12377","series-title":"Blood","doi-asserted-by":"publisher","first-page":"5040","DOI":"10.1182\/blood-2011-03-339762","article-title":"BMP activity controlled by BMPER regulates the proinflammatory phenotype of endothelium","volume":"118","author":"Helbing","year":"2011"},{"key":"b8-spine12377","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1007\/s00701-005-0669-1","article-title":"Vascular injury and complication in neurosurgical spine surgery","volume":"148","author":"Inamasu","year":"2006"},{"key":"b9-spine12377","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1007\/s00586-002-0460-4","article-title":"Arterial complications following anterior lumbar interbody fusion: report of eight cases","volume":"12","author":"Kulkarni","year":"2003"},{"key":"b10-spine12377","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"E149","DOI":"10.1097\/BRS.0b013e3181f2d1ec","article-title":"Inflammatory characteristics of rhBMP-2 in vitro and in an in vivo rodent model","volume":"36","author":"Lee","year":"2011"},{"key":"b11-spine12377","series-title":"Lab Invest","doi-asserted-by":"publisher","first-page":"1761","DOI":"10.1038\/labinvest.3780186","article-title":"Role of B lymphocytes in new bone formation","volume":"80","author":"Marusic","year":"2000"},{"key":"b12-spine12377","series-title":"Bone","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/S8756-3282(99)00095-2","article-title":"Genetic variability of new bone induction in mice","volume":"25","author":"Marusi\u0107","year":"1999"},{"issue":"16 Suppl 1","key":"b13-spine12377","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"S66","DOI":"10.1097\/00007632-200208151-00014","article-title":"Use of recombinant human bone morphogenetic protein-2 in spinal fusion applications","volume":"27","author":"McKay","year":"2002"},{"key":"b14-spine12377","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1480","DOI":"10.1097\/BRS.0b013e3181a396a1","article-title":"Recombinant human bone morphogenetic protein-2-induced radiculitis in elective minimally invasive transforaminal lumbar interbody fusions: a series review","volume":"34","author":"Mindea","year":"2009"},{"issue":"9 Suppl","key":"b15-spine12377","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"S86","DOI":"10.1097\/BRS.0b013e3181d81ef2","article-title":"Complications related to osteobiologics use in spine surgery: a systematic review","volume":"35","author":"Mroz","year":"2010"},{"key":"b16-spine12377","series-title":"Spine J","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1016\/j.spinee.2010.06.020","article-title":"Histopathologic inflammatory response induced by recombinant bone morphogenetic protein-2 causing radiculopathy after transforaminal lumbar interbody fusion","volume":"10","author":"Muchow","year":"2010"},{"key":"b17-spine12377","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"612","DOI":"10.1007\/s00586-010-1494-7","article-title":"Perioperative complications with rhBMP-2 in transforaminal lumbar interbody fusion","volume":"20","author":"Owens","year":"2011"},{"issue":"1 Suppl","key":"b18-spine12377","series-title":"J Neurosurg","first-page":"60","article-title":"Visceral and vascular complications resulting from anterior lumbar interbody fusion","volume":"91","author":"Rajaraman","year":"1999"},{"key":"b19-spine12377","series-title":"Nat Rev Mol Cell Biol","doi-asserted-by":"publisher","first-page":"857","DOI":"10.1038\/nrm2262","article-title":"Extracellular control of TGFbeta signalling in vascular development and disease","volume":"8","author":"ten Dijke","year":"2007"},{"key":"b20-spine12377","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"529","DOI":"10.3171\/SPI\/2008\/8\/6\/529","article-title":"The safety and efficacy of anterior cervical discectomy and fusion with polyetheretherketone spacer and recombinant human bone morphogenetic protein-2: a review of 200 patients","volume":"8","author":"Tumial\u00e1n","year":"2008"},{"key":"b21-spine12377","series-title":"Ann Vasc Surg","first-page":"277.e15","article-title":"Alternative management of iliac vein injury during anterior lumbar spine exposure","volume":"26","author":"Zahradnik","year":"2012"}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/18\/6\/article-p582.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/18\/6\/article-p582.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/18\/6\/article-p582.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,16]],"date-time":"2023-04-16T00:28:43Z","timestamp":1681604923000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/18\/6\/article-p582.xml"}},"subtitle":["Case report"],"short-title":[],"issued":{"date-parts":[[2013,6]]},"references-count":21,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2013.3.spine12377","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2013,6]]}}}