{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T16:18:23Z","timestamp":1765383503238,"version":"3.46.0"},"reference-count":41,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T00:00:00Z","timestamp":1765324800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: To evaluate the safety, efficacy, and predictors of rhBMP-2 use in atlantoaxial (C1\u20132) fusion through institutional outcomes and a pooled analysis from the literature. Methods: We retrospectively analyzed adult patients who underwent C1\u20132 fusion at a tertiary care center between 2015 and 2020. Primary outcomes included radiographic fusion and postoperative complications. Univariate logistic regression was used to identify predictors of intraoperative rhBMP-2 use. A subset of eight patients who underwent isolated C1\u20132 fusion using rhBMP-2 were analyzed and evaluated against 260 cases from a PRISMA-compliant systematic review of the literature. Results: Among our 49 patients (mean age, 61.8 \u00b1 22.8 years; 57% female), 24 (49%) received rhBMP-2. Radiographic fusion or early signs were observed in 89.8% of patients, with no significant difference between rhBMP-2 and non-rhBMP-2 groups (p = 0.678). Complications were similar (12.5% vs. 25.0%, p = 0.702). All postoperative instabilities occurred in non-rhBMP-2 patients (p = 0.043). Degenerative pathology was associated with increased use of rhBMP-2 (OR of 7.96, p = 0.051), while trauma was associated with decreased use (OR of 0.21, p = 0.019). Among the eight local isolated cases, seven achieved fusion and none required revision. Our literature review yielded a group of 260 patients, 241 of which achieved successful fusion with a complication rate of 10.8% and a revision surgery rate of 3.8%. Conclusions: rhBMP-2 appears to be a safe and effective adjunct in C1\u20132 fusion, with outcomes comparable to alternative techniques. Although off-label, its selective use may benefit patients at risk of nonunion. Interpretation should be tempered by the retrospective design and heterogeneity across cohorts; pooled rates are descriptive. Further prospective studies are needed to establish standardized protocols, optimal dosing, and long-term efficacy.<\/jats:p>","DOI":"10.3390\/jcm14248731","type":"journal-article","created":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T16:11:18Z","timestamp":1765383078000},"page":"8731","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Role of Recombinant Human Bone Morphogenetic Protein\u20132 in Atlantoaxial Arthrodesis: Institutional Predictors and Systematic Review of Outcomes"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-8133-6929","authenticated-orcid":false,"given":"Mazen","family":"Taman","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8761-3612","authenticated-orcid":false,"given":"Abigail A.","family":"Teshome","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arjun","family":"Ganga","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elijah M.","family":"Persad","sequence":"additional","affiliation":[{"name":"Stanford Health Care, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6282-828X","authenticated-orcid":false,"given":"Owen P.","family":"Leary","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Senay","family":"Gokcebel","sequence":"additional","affiliation":[{"name":"School of Public Health, Brown University, Providence, RI 02903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rahul","family":"Sastry","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia Zadnik","family":"Sullivan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ki-Eun","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adetokunbo A.","family":"Oyelese","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ziya L.","family":"Gokaslan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jared S.","family":"Fridley","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tianyi","family":"Niu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1007\/s00381-008-0606-8","article-title":"Anatomy and biomechanics of normal craniovertebral junction (a) and biomechanics of stabilization (b)","volume":"24","author":"Menezes","year":"2008","journal-title":"Child\u2019s Nerv. 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