Is rhBMP-2 Worth the Risk? A Data-Driven Look at Fusion Outcomes and rhBMP-2–Related Complication Burden in High-Risk Adult Spinal Deformity Patients
Neurosurgery · 21 Jul 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
rhBMP-2 use in adult spinal deformity surgery remains controversial and often surgeon-dependent, so data suggesting it may reduce nonunion risk in high-risk bone-quality patients without added complications could influence how residents and attendings think about biologic augmentation in complex fusions.
The evidence
This single-centre retrospective cohort followed 288 adults with adult spinal deformity who underwent ≥5-level fusion, comparing those who received rhBMP-2 (41%) versus those who did not. Patients given rhBMP-2 had a much lower rate of pseudarthrosis/rod fracture than those without it (16.1% vs 38.2%), and this held up after adjustment (OR 0.14, 95% CI 0.02-0.78). The benefit was clearest in patients with osteoporosis/osteopenia and, for mechanical complications specifically, in obese patients, while diabetic patients showed no statistically significant benefit, and rhBMP-2 was not independently linked to its classically feared complications (radiculitis, wound problems, seroma).
Pseudarthrosis/rod fracture: Odds ratio 0.14 (95% CI 0.02 to 0.78; units not reported). The interval favours the first group; the size of the benefit needs clinical interpretation.
Why this rigour score?
Retrospective cohort
Methods at a glance
Recorded assessment- Confounding adjustmentMultivariable regression
- Covariate balance confirmedNot reported
- Outcome assessors blindedNot reported
- Comparable start of follow-upNot reported
- Adequate statistical powerUnderpowered
- Prospective registrationNot met
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
How to read this assessment
The recorded methods are shown alongside the published score. A verified point-by-point calculation is not available for this version of the appraisal.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.Given that rhBMP-2 use was not randomised and was more common in revision cases and longer constructs, how much of the observed pseudarthrosis benefit could reflect unmeasured surgeon selection (confounding by indication) rather than a true biologic effect?
2.If you were counselling a patient with osteoporosis undergoing a long deformity fusion, would this single-centre, retrospective, explicitly 'hypothesis-generating' study be enough to justify off-label rhBMP-2 use given its cost and regulatory status?
Original publication title
Is rhBMP-2 Worth the Risk? A Data-Driven Look at Fusion Outcomes and rhBMP-2–Related Complication Burden in High-Risk Adult Spinal Deformity Patients