Home Clean Living Bone morphogenetic protein increases risk of symptomatic pseudarthrosis after ALIF

Bone morphogenetic protein increases risk of symptomatic pseudarthrosis after ALIF


August 22, 2022

1 min read


The authors report no relevant financial disclosures.

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Published results showed patients who received bone morphogenetic protein during single-level anterior lumbar interbody fusion had increased risk for symptomatic pseudarthrosis with no improvement in revision rates.

In a retrospective, propensity-matched analysis, Syed I. Khalid, MD, and colleagues analyzed a population of 22,380 Medicare Part A and Medicare Part B patients who underwent single-level anterior lumbar interbody fusion (ALIF) from January 2004 to December 2014. According to the study, 8,971 patients underwent the procedure with bone morphogenetic protein (BMP), while 13,139 patients underwent the procedure without BMP. Outcome measures included symptomatic pseudarthrosis and need for revision with a maximum follow-up of 2 years.

Overall, the rate of symptomatic pseudarthrosis was 1.9% in the BMP group and 1.4% in the control group. The researchers noted BMP use during the procedure was associated with a 44% increased risk of developing pseudarthrosis (OR = 1.44). With a 3.7% revision rate in the BMP group and a 3.5% revision rate in the control group, the researchers found no statistically significant differences in need for revision.

“Initial data demonstrating the safety and efficacy of the use of BMP in ALIF procedures have spurred its increased use in many off-label indications,” Khalid and colleagues wrote.

“Taking the recently mounting evidence of lower than previously demonstrated efficacy, significant side effect profile and significant costs associated with the use of BMP, its use should be more thoroughly evaluated not only in off-label uses in spine surgery but also in its approved use in ALIF surgeries,” they concluded.

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