{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T20:23:26Z","timestamp":1790195006977,"version":"4.1.0"},"reference-count":29,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,12,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Bone morphogenetic protein (BMP) has been increasingly used in spinal surgery to promote arthrodesis. Because BMP stimulates cellular proliferation, its association with tumorigenesis is a concern. Previous research has generated conflicting conclusions on the risk of cancer in patients receiving BMP. The authors aimed to compare the incidence of solid organ and hematopoietic malignancies in patients undergoing spinal arthrodesis with or without BMP.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The PearlDiver Mariner Patient Claims Database was queried for patients undergoing thoracolumbar fusion between 2015 and 2021. Patients with preexisting malignancy were excluded. Data were analyzed for incidence of solid organ malignancy and hematopoietic malignancy diagnosed after spinal surgery. Propensity score matching using age, sex, tobacco usage, and year of surgery was performed between patients who did and those who did not receive BMP.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Among patients without prior solid organ malignancy, BMP was used in 22,139 patients and not used in 306,249. In the propensity score\u2013matched group, 3.1% of the BMP group developed solid organ malignancy following surgery compared with 3.5% in the non-BMP group. The relative risk (RR) of developing solid organ malignancy after BMP exposure was 0.89 (95% CI 0.81\u20130.98, p = 0.02). Among patients without prior hematopoietic malignancy, BMP was used in 23,505 patients and not used in 328,796 patients. In the propensity score\u2013matched group, 0.4% of the BMP group developed hematopoietic malignancy compared with 0.6% of the non-BMP group. The RR of developing hematopoietic malignancy after BMP exposure was 0.71 (95% CI 0.55\u20130.93, p = 0.015).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>BMP use in thoracolumbar fusion was not associated with an increased risk of new malignancy, which further supports emerging data on the lack of an association between BMP use and increased malignancy.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.4.spine22584","type":"journal-article","created":{"date-parts":[[2023,9,2]],"date-time":"2023-09-02T04:10:37Z","timestamp":1693627837000},"page":"722-728","source":"Crossref","is-referenced-by-count":7,"title":["Bone morphogenetic protein and cancer in spinal fusion: a propensity score\u2013matched analysis"],"prefix":"10.3171","volume":"39","author":[{"given":"David J.","family":"Mazur-Hart","sequence":"first","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin A.","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jung","family":"Yoo","sequence":"additional","affiliation":[{"name":"Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josiah N.","family":"Orina","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"Cell Res","first-page":"71","article-title":"Signaling cross-talk between TGF-beta\/BMP and other pathways","volume":"19","author":"Guo X","year":"2009","unstructured":"Guo X, Wang XF. Signaling cross-talk between TGF-beta\/BMP and other pathways. Cell Res. 2009;19(1):71\u201388."},{"issue":"2","key":"b2","series-title":"Int J Biol Sci","first-page":"272","article-title":"TGF-\u03b2 and BMP signaling in osteoblast differentiation and bone formation","volume":"8","author":"Chen G","year":"2012","unstructured":"Chen G, Deng C, Li YP. TGF-\u03b2 and BMP signaling in osteoblast differentiation and bone formation. Int J Biol Sci. 2012;8(2):272\u2013288."},{"issue":"1","key":"b3","series-title":"Spine Surg Relat Res","first-page":"1","article-title":"BMP and beyond: a 25-year historical review of translational spine research at Emory University","volume":"2","author":"Presciutti S","year":"2018","unstructured":"Presciutti S, Boden S. BMP and beyond: a 25-year historical review of translational spine research at Emory University. Spine Surg Relat Res. 2018;2(1):1\u201310."},{"issue":"23","key":"b4","series-title":"Spine (Phila Pa 1976)","first-page":"2585","article-title":"Effect of recombinant human bone morphogenetic protein-2 in an experimental model of spinal fusion in a radiated area","volume":"30","author":"Ames CP","year":"2005","unstructured":"Ames CP, Smith JS, Preul MC,  Effect of recombinant human bone morphogenetic protein-2 in an experimental model of spinal fusion in a radiated area. Spine (Phila Pa 1976). 2005;30(23):2585\u20132592."},{"issue":"26","key":"b5","series-title":"Spine (Phila Pa 1976)","first-page":"2843","article-title":"RhBMP-2 versus iliac crest bone graft for lumbar spine fusion: a randomized, controlled trial in patients over sixty years of age","volume":"33","author":"Glassman SD","year":"2008","unstructured":"Glassman SD, Carreon LY, Djurasovic M,  RhBMP-2 versus iliac crest bone graft for lumbar spine fusion: a randomized, controlled trial in patients over sixty years of age. Spine (Phila Pa 1976). 2008;33(26):2843\u20132849."},{"issue":"9","key":"b6","series-title":"J Clin Neurosci","first-page":"1184","article-title":"Patient satisfaction and radiographic outcomes after lumbar spinal fusion without iliac crest bone graft or transverse process fusion","volume":"16","author":"Acosta FL","year":"2009","unstructured":"Acosta FL, Cloyd JM, Aryan HE, Ames CP. Patient satisfaction and radiographic outcomes after lumbar spinal fusion without iliac crest bone graft or transverse process fusion. J Clin Neurosci. 2009;16(9):1184\u20131187."},{"issue":"12","key":"b7","series-title":"Spine (Phila Pa 1976)","first-page":"E738","article-title":"Use of recombinant human bone morphogenetic protein-2 with local bone graft instead of iliac crest bone graft in posterolateral lumbar spine arthrodesis","volume":"38","author":"Park DK","year":"2013","unstructured":"Park DK, Kim SS, Thakur N, Boden SD. Use of recombinant human bone morphogenetic protein-2 with local bone graft instead of iliac crest bone graft in posterolateral lumbar spine arthrodesis. Spine (Phila Pa 1976). 2013;38(12):E738\u2013E747."},{"issue":"13","key":"b8","series-title":"Spine (Phila Pa 1976)","first-page":"874","article-title":"Utilization trends of recombinant human bone morphogenetic protein in the United States","volume":"46","author":"Kerezoudis P","year":"2021","unstructured":"Kerezoudis P, Alvi MA, Freedman BA, Nassr A, Bydon M. Utilization trends of recombinant human bone morphogenetic protein in the United States. Spine (Phila Pa 1976). 2021;46(13):874\u2013881."},{"issue":"19","key":"b9","series-title":"Spine (Phila Pa 1976)","first-page":"1794","article-title":"Off-label use of bone morphogenetic proteins in the United States using administrative data","volume":"35","author":"Ong KL","year":"2010","unstructured":"Ong KL, Villarraga ML, Lau E, Carreon LY, Kurtz SM, Glassman SD. Off-label use of bone morphogenetic proteins in the United States using administrative data. Spine (Phila Pa 1976). 2010;35(19):1794\u20131800."},{"key":"b10","series-title":"Mol Ther Oncolytics","first-page":"1","article-title":"The dual role of bone morphogenetic proteins in cancer","volume":"8","author":"Bach DH","year":"2017","unstructured":"Bach DH, Park HJ, Lee SK. The dual role of bone morphogenetic proteins in cancer. Mol Ther Oncolytics. 2017;8:1\u201313."},{"issue":"6","key":"b11","series-title":"J Bone Joint Surg Am","first-page":"1377","article-title":"Clinical and radiographic analysis of an optimized rhBMP-2 formulation as an autograft replacement in posterolateral lumbar spine arthrodesis","volume":"91","author":"Dimar JR II","year":"2009","unstructured":"Dimar JR II, Glassman SD, Burkus JK, Pryor PW, Hardacker JW, Carreon LY. Clinical and radiographic analysis of an optimized rhBMP-2 formulation as an autograft replacement in posterolateral lumbar spine arthrodesis. J Bone Joint Surg Am. 2009;91(6):1377\u20131386."},{"issue":"12","key":"b12","series-title":"Ann Intern Med","first-page":"877","article-title":"Safety and effectiveness of recombinant human bone morphogenetic protein-2 for spinal fusion: a meta-analysis of individual-participant data","volume":"158","author":"Simmonds MC","year":"2013","unstructured":"Simmonds MC, Brown JV, Heirs MK,  Safety and effectiveness of recombinant human bone morphogenetic protein-2 for spinal fusion: a meta-analysis of individual-participant data. Ann Intern Med. 2013;158(12):877\u2013889."},{"issue":"12","key":"b13","series-title":"Ann Intern Med","first-page":"890","article-title":"Effectiveness and harms of recombinant human bone morphogenetic protein-2 in spine fusion: a systematic review and meta-analysis","volume":"158","author":"Fu R","year":"2013","unstructured":"Fu R, Selph S, McDonagh M,  Effectiveness and harms of recombinant human bone morphogenetic protein-2 in spine fusion: a systematic review and meta-analysis. Ann Intern Med. 2013;158(12):890\u2013902."},{"issue":"1","key":"b14","series-title":"J Neurosurg Spine","first-page":"86","article-title":"A comprehensive assessment of the risk of bone morphogenetic protein use in spinal fusion surgery and postoperative cancer diagnosis","volume":"23","author":"Cahill KS","year":"2015","unstructured":"Cahill KS, McCormick PC, Levi AD. A comprehensive assessment of the risk of bone morphogenetic protein use in spinal fusion surgery and postoperative cancer diagnosis. J Neurosurg Spine. 2015;23(1):86\u201393."},{"issue":"23","key":"b15","series-title":"Spine (Phila Pa 1976)","first-page":"1785","article-title":"Incidence of cancer in spinal deformity patients receiving high-dose (\u226540 mg) bone morphogenetic protein (rhBMP-2)","volume":"42","author":"Baldus C","year":"2017","unstructured":"Baldus C, Kelly MP, Yanik EL,  Incidence of cancer in spinal deformity patients receiving high-dose (\u226540 mg) bone morphogenetic protein (rhBMP-2). Spine (Phila Pa 1976). 2017;42(23):1785\u20131791."},{"issue":"13","key":"b16","series-title":"J Bone Joint Surg Am","first-page":"1064","article-title":"Bone morphogenetic protein use and cancer risk among patients undergoing lumbar arthrodesis: a case-cohort study using the SEER-Medicare database","volume":"98","author":"Beachler DC","year":"2016","unstructured":"Beachler DC, Yanik EL, Martin BI,  Bone morphogenetic protein use and cancer risk among patients undergoing lumbar arthrodesis: a case-cohort study using the SEER-Medicare database. J Bone Joint Surg Am. 2016;98(13):1064\u20131072."},{"issue":"2","key":"b17","series-title":"Int J Spine Surg","first-page":"260","article-title":"Risk of cancer following lumbar fusion surgery with recombinant human bone morphogenic protein-2 (rhBMP-2): an analysis using a commercially insured patient population","volume":"12","author":"Cooper GS","year":"2018","unstructured":"Cooper GS, Kou TD. Risk of cancer following lumbar fusion surgery with recombinant human bone morphogenic protein-2 (rhBMP-2): an analysis using a commercially insured patient population. Int J Spine Surg. 2018;12(2):260\u2013268."},{"issue":"12","key":"b18","series-title":"Spine J","first-page":"2929","article-title":"The use of bone morphogenetic protein in thoracolumbar spine procedures: analysis of the MarketScan longitudinal database","volume":"14","author":"Veeravagu A","year":"2014","unstructured":"Veeravagu A, Cole TS, Jiang B, Ratliff JK, Gidwani RA. The use of bone morphogenetic protein in thoracolumbar spine procedures: analysis of the MarketScan longitudinal database. Spine J. 2014;14(12):2929\u20132937."},{"issue":"2","key":"b19","series-title":"Pharmacoepidemiol Drug Saf","first-page":"111","article-title":"Recombinant human bone morphogenetic protein-2 and pancreatic cancer: a retrospective cohort study","volume":"20","author":"Mines D","year":"2011","unstructured":"Mines D, Gu Y, Kou TD, Cooper GS. Recombinant human bone morphogenetic protein-2 and pancreatic cancer: a retrospective cohort study. Pharmacoepidemiol Drug Saf. 2011;20(2):111\u2013118."},{"issue":"2","key":"b20","series-title":"Neurosurgery","first-page":"233","article-title":"Bone morphogenetic proteins and cancer: review of the literature","volume":"66","author":"Thawani JP","year":"2010","unstructured":"Thawani JP, Wang AC, Than KD, Lin CY, La Marca F, Park P. Bone morphogenetic proteins and cancer: review of the literature. Neurosurgery. 2010;66(2):233\u2013246."},{"issue":"11","key":"b21","series-title":"J Cancer Res Clin Oncol","first-page":"741","article-title":"Bone morphogenetic protein 2 (BMP-2) and induction of tumor angiogenesis","volume":"131","author":"Raida M","year":"2005","unstructured":"Raida M, Clement JH, Leek RD,  Bone morphogenetic protein 2 (BMP-2) and induction of tumor angiogenesis. J Cancer Res Clin Oncol. 2005;131(11):741\u2013750."},{"issue":"4","key":"b22","series-title":"Cytokine Growth Factor Rev","first-page":"299","article-title":"The Yin and Yang of bone morphogenetic proteins in cancer","volume":"21","author":"Singh A","year":"2010","unstructured":"Singh A, Morris RJ. The Yin and Yang of bone morphogenetic proteins in cancer. Cytokine Growth Factor Rev. 2010;21(4):299\u2013313."},{"issue":"4","key":"b23","series-title":"Stem Cells","first-page":"939","article-title":"Bone morphogenetic protein-mediated modulation of lineage diversification during neural differentiation of embryonic stem cells","volume":"25","author":"Gossrau G","year":"2007","unstructured":"Gossrau G, Thiele J, Konang R, Schmandt T, Br\u00fcstle O. Bone morphogenetic protein-mediated modulation of lineage diversification during neural differentiation of embryonic stem cells. Stem Cells. 2007;25(4):939\u2013949."},{"issue":"6","key":"b24","series-title":"Cold Spring Harb Perspect Biol","first-page":"a021899","article-title":"Bone morphogenetic proteins","volume":"8","author":"Katagiri T","year":"2016","unstructured":"Katagiri T, Watabe T. Bone morphogenetic proteins. Cold Spring Harb Perspect Biol. 2016;8(6):a021899."},{"issue":"8","key":"b25","series-title":"Int J Cancer","first-page":"1941","article-title":"BMP-2 inhibits tumor growth of human renal cell carcinoma and induces bone formation","volume":"131","author":"Wang L","year":"2012","unstructured":"Wang L, Park P, Zhang H,  BMP-2 inhibits tumor growth of human renal cell carcinoma and induces bone formation. Int J Cancer. 2012;131(8):1941\u20131950."},{"issue":"6","key":"b26","series-title":"J Cancer Res Clin Oncol","first-page":"1013","article-title":"BMP-2 inhibits tumor-initiating ability in human renal cancer stem cells and induces bone formation","volume":"141","author":"Wang L","year":"2015","unstructured":"Wang L, Park P, La Marca F, Than KD, Lin CY. BMP-2 inhibits tumor-initiating ability in human renal cancer stem cells and induces bone formation. J Cancer Res Clin Oncol. 2015;141(6):1013\u20131024."},{"key":"b27","series-title":"OncoTargets Ther","first-page":"7543","article-title":"BMP-2 inhibits lung metastasis of osteosarcoma: an early investigation using an orthotopic model","volume":"11","author":"Xiong Q","year":"2018","unstructured":"Xiong Q, Wang X, Wang L,  BMP-2 inhibits lung metastasis of osteosarcoma: an early investigation using an orthotopic model. OncoTargets Ther. 2018;11:7543\u20137553."},{"issue":"2","key":"b28","series-title":"Evid Based Spine Care J","first-page":"35","article-title":"The use of rhBMP in spine surgery: is there a cancer risk?","volume":"3","author":"Devine JG","year":"2012","unstructured":"Devine JG, Dettori JR, France JC, Brodt E, McGuire RA. The use of rhBMP in spine surgery: is there a cancer risk? Evid Based Spine Care J. 2012;3(2):35\u201341."},{"issue":"17","key":"b29","series-title":"J Bone Joint Surg Am","first-page":"1537","article-title":"Cancer risk after use of recombinant bone morphogenetic protein-2 for spinal arthrodesis","volume":"95","author":"Carragee EJ","year":"2013","unstructured":"Carragee EJ, Chu G, Rohatgi R,  Cancer risk after use of recombinant bone morphogenetic protein-2 for spinal arthrodesis. J Bone Joint Surg Am. 2013;95(17):1537\u20131545."}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/39\/6\/article-p722.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/39\/6\/article-p722.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/39\/6\/article-p722.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,6]],"date-time":"2024-12-06T13:14:11Z","timestamp":1733490851000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/39\/6\/article-p722.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,1]]},"references-count":29,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2023.4.spine22584","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2023,12,1]]}}}