If Not BMP, Then What?

Ivan Cheng, MD; Stuart B. Goodman, MD, PhD; and Philipp Leucht, MD, PhD

The safety of recombinant human bone morphogenetic protein-2 (rhBMP-2) has recently been called into question due to concerns regarding postoperative soft-tissue swelling, the potential increased risk of retrograde ejaculation with its use in the anterior lumbar spine, and possibly an increased cancer risk.

In response to these concerns, the Yale University Open Data Access (YODA) Project recently published two independent systematic reviews on rhBMP-2. Neither group found a clinically significant difference in outcomes or complication rates between rhBMP-2 and iliac crest bone graft (ICBG) in the spine with the exception of increased immediate postoperative pain in patients receiving rhBMP-2. Cancer risk was slightly increased in patients receiving rhBMP-2 at 2 years, but the difference seemed to disappear at 4 years.

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