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

This single-center 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).

AI summary · from the full text · reviewed by Pukhraj Gaheer, Medical Student, Queen's University before publishing

Why it mattersrhBMP-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.

Presenting this at rounds? Start here

• ?Given that rhBMP-2 use was not randomized 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?
• ?If you were counseling a patient with osteoporosis undergoing a long deformity fusion, would this single-center, retrospective, explicitly 'hypothesis-generating' study be enough to justify off-label rhBMP-2 use given its cost and regulatory status?