{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T20:22:30Z","timestamp":1790194950796,"version":"4.1.0"},"reference-count":44,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,8,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Use of bone morphogenetic protein (BMP)\u2014an osteoinductive agent commonly used in lumbar arthrodesis\u2014is off-label for cervical arthrodesis. This study aimed to identify the effect of BMP use on clinical and radiological outcomes in instrumented cervical arthrodesis.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>A comprehensive systematic review of the literature was performed to identify studies directly comparing outcomes between cervical arthrodeses with and without using BMP. Outcomes were analyzed separately for cases of anterior cervical discectomy and fusion (ACDF) and posterior cervical fusion (PCF).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>A total of 20 studies with 5828 patients (1948 with BMP and 3880 without BMP) were included. In the ACDF cases, BMP use was associated with higher fusion rates (98.9% vs 93.6%, risk difference [RD] 8%; risk ratio [RR] 1.12, p = 0.02), lower reoperation rates (2.2% vs 3.1%, RD 3%; RR 0.48, p = 0.04), and higher risk of dysphagia (24.7% vs 8.1%, RD 11%; RR 1.93, p = 0.02). No significant differences in the Neck Disability Index, neck pain, or arm pain scores were associated with the use of BMP. On subgroup meta-analysis of ACDF cases, older age (\u2265 50 years) and higher BMP dose (\u2265 0.9 mg\/level) were associated with significantly higher fusion rates and relatively lower risk for dysphagia, whereas arthrodesis of fewer segments (&lt; 2 levels) showed significantly higher dysphagia rates without a significant increase in fusion rates. In the PCF cases, the use of BMP was not associated with significant differences in fusion (p = 0.38) or reoperation (p = 0.61) rates but was associated with significantly higher blood loss during surgery (mean difference 146.7 ml, p \u2264 0.01).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Use of BMP in ACDF offers higher rates of augmented fusion and lower rates of all-cause reoperation but with an increased risk of dysphagia. The benefit of fusion outweighs the risk of dysphagia with a higher BMP dose in older patients being operated on for &lt; 2 levels. The use of BMP in PCF seems to have a less important effect on clinical and radiological outcomes.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2024.2.spine23941","type":"journal-article","created":{"date-parts":[[2024,5,4]],"date-time":"2024-05-04T01:48:39Z","timestamp":1714787319000},"page":"174-187","source":"Crossref","is-referenced-by-count":3,"title":["Bone morphogenetic protein in subaxial cervical arthrodesis: a meta-analysis of 5828 patients"],"prefix":"10.3171","volume":"41","author":[{"given":"Sufyan","family":"Ibrahim","sequence":"first","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester; and"},{"name":"Departments of Neurologic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgos D.","family":"Michalopoulos","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester; and"},{"name":"Departments of Neurologic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Flanigan","sequence":"additional","affiliation":[{"name":"Departments of Neurologic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah E.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester; and"},{"name":"Departments of Neurologic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Katsos","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester; and"},{"name":"Departments of Neurologic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arjun S.","family":"Sebastian","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brett A.","family":"Freedman","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad","family":"Bydon","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester; and"},{"name":"Departments of Neurologic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"5-6","key":"b1","series-title":"Cytokine Growth Factor Rev","first-page":"341","article-title":"Bone morphogenetic proteins (BMPs): from morphogens to metabologens","volume":"20","author":"Reddi AH","year":"2009","unstructured":"Reddi AH, Reddi A. Bone morphogenetic proteins (BMPs): from morphogens to metabologens. Cytokine Growth Factor Rev. 2009;20(5-6):341\u2013342."},{"issue":"13","key":"b2","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):874-881."},{"key":"b3","series-title":"Food and Drug Administration;","article-title":"FDA Public Health Notification: Life-threatening Complications Associated with Recombinant Human Bone Morphogenetic Protein in Cervical Spine Fusion","year":"2008","unstructured":"FDA Public Health Notification: Life-threatening Complications Associated with Recombinant Human Bone Morphogenetic Protein in Cervical Spine Fusion. 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Multilevel anterior cervical discectomy and fusion with and without rhBMP\u20132: a comparison of dysphagia rates and outcomes in 150 patients: Clinical article. J Neurosurg Spine. 2013;18(1):43\u201349."},{"issue":"2","key":"b33","series-title":"Spine J","first-page":"256","article-title":"Prospective comparison of dysphagia following anterior cervical discectomy and fusion (ACDF) with and without rhBMP-2","volume":"22","author":"Bellamy JT","year":"2022","unstructured":"Bellamy JT, Dilbone E, Schell A,  Prospective comparison of dysphagia following anterior cervical discectomy and fusion (ACDF) with and without rhBMP-2. Spine J. 2022;22(2):256\u2013264."},{"issue":"8","key":"b34","series-title":"Eur Spine J","first-page":"1257","article-title":"Complications of anterior cervical discectomy and fusion using recombinant human bone morphogenetic protein\u20132","volume":"16","author":"Vaidya R","year":"2007","unstructured":"Vaidya R, Carp J, Sethi A, Bartol S, Craig J, Les CM. 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J Neurosurg Spine. 2013;18(3):269\u2013273."},{"issue":"3","key":"b36","series-title":"J Bone Joint Surg Br","first-page":"342","article-title":"Interbody fusion with allograft and rhBMP\u20132 leads to consistent fusion but early subsidence","volume":"89","author":"Vaidya R","year":"2007","unstructured":"Vaidya R, Weir R, Sethi A, Meisterling S, Hakeos W, Wybo CD. Interbody fusion with allograft and rhBMP\u20132 leads to consistent fusion but early subsidence. J Bone Joint Surg Br. 2007;89(3):342\u2013345."},{"issue":"10","key":"b37","series-title":"Laryngoscope","first-page":"1954","article-title":"Acute airway obstruction in cervical spinal procedures with bone morphogenetic proteins","volume":"120","author":"Yaremchuk KL","year":"2010","unstructured":"Yaremchuk KL, Toma MS, Somers ML, Peterson E. Acute airway obstruction in cervical spinal procedures with bone morphogenetic proteins. Laryngoscope. 2010;120(10):1954\u20131957."},{"issue":"3_suppl","key":"b38","series-title":"Global Spine J","first-page":"150S","article-title":"A262: Allograft cellular bone matrix versus ultra low dose BMP-2 as an augment in 3-level ACDF","volume":"12","author":"Coban D","year":"2022","unstructured":"Coban D, Saela S, Changoor S,  A262: Allograft cellular bone matrix versus ultra low dose BMP-2 as an augment in 3-level ACDF. Global Spine J. 2022;12(3_suppl):150S\u2013151S."},{"issue":"4","key":"b39","series-title":"J Neurosurg Spine","first-page":"556","article-title":"Reoperation rates for symptomatic nonunions in posterior cervical (subaxial) fusions with and without bone morphogenetic protein in a cohort of 1158 patients","volume":"24","author":"Guppy KH","year":"2016","unstructured":"Guppy KH, Harris J, Chen J, Paxton EW, Alvarez J, Bernbeck J. Reoperation rates for symptomatic nonunions in posterior cervical (subaxial) fusions with and without bone morphogenetic protein in a cohort of 1158 patients. J Neurosurg Spine. 2016;24(4):556\u2013564."},{"issue":"3","key":"b40","series-title":"J Neurosurg Spine","first-page":"309","article-title":"Reoperation rates for symptomatic nonunions in posterior cervicothoracic fusions with and without bone morphogenetic protein in a cohort of 450 patients","volume":"25","author":"Guppy KH","year":"2016","unstructured":"Guppy KH, Harris J, Chen J, Paxton EW, Bernbeck JA. Reoperation rates for symptomatic nonunions in posterior cervicothoracic fusions with and without bone morphogenetic protein in a cohort of 450 patients. J Neurosurg Spine. 2016;25(3):309\u2013317."},{"issue":"7","key":"b41","series-title":"Spine J","first-page":"1079","article-title":"Off\u2013label usage of RhBMP\u20132 in posterior cervical fusion is not associated with early increased complication rate and has similar clinical outcomes","volume":"22","author":"Weinberg DS","year":"2022","unstructured":"Weinberg DS, Eoh JH, Manz WJ,  Off\u2013label usage of RhBMP\u20132 in posterior cervical fusion is not associated with early increased complication rate and has similar clinical outcomes. Spine J. 2022;22(7):1079\u20131088."},{"issue":"1","key":"b42","series-title":"Surg Neurol Int","first-page":"109","article-title":"Safety and efficacy of rhBMP2 in posterior cervical spinal fusion for subaxial degenerative spine disease: analysis of outcomes in 204 patients","volume":"2","author":"Xu R","year":"2011","unstructured":"Xu R, Bydon M, Sciubba DM,  Safety and efficacy of rhBMP2 in posterior cervical spinal fusion for subaxial degenerative spine disease: analysis of outcomes in 204 patients. Surg Neurol Int. 2011;2(1):109."},{"issue":"9","key":"b43","series-title":"Spine (Phila Pa 1976)","first-page":"885","article-title":"Is it safe to use recombinant human bone morphogenetic protein in posterior cervical fusion?","volume":"34","author":"Hiremath GK","year":"2009","unstructured":"Hiremath GK, Steinmetz MP, Krishnaney AA. Is it safe to use recombinant human bone morphogenetic protein in posterior cervical fusion? Spine (Phila Pa 1976). 2009;34(9):885\u2013889."},{"issue":"6","key":"b44","series-title":"Global Spine J","first-page":"622","article-title":"The posterior use of BMP\u20132 in cervical deformity surgery does not result in increased early complications: a prospective multicenter study","volume":"8","author":"Iyer S","year":"2018","unstructured":"Iyer S, Kim HJ, Bao H,  The posterior use of BMP\u20132 in cervical deformity surgery does not result in increased early complications: a prospective multicenter study. 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