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Updated: Jun 1, 2026
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Uniportal Full Endoscopic Posterolateral Transforaminal Lumbar Interbody Fusion
Published on: June 6, 2025
Retrograde ejaculation after anterior lumbar interbody fusion using rhBMP-2: a cohort controlled study
Eugene J Carragee1, Kyle A Mitsunaga, Eric L Hurwitz
1Stanford University School of Medicine, 450 Broadway St, Redwood City, CA 94063, USA. carragee@stanford.edu
Summary
Recombinant bone morphogenic protein-2 (rhBMP-2) use in anterior lumbar interbody fusion (ALIF) is associated with a higher incidence of retrograde ejaculation (RE). This finding is crucial for patients considering fertility after spinal fusion surgery.
Area of Science:
- Spinal surgery
- Orthopedic research
- Urological outcomes
Background:
- Recombinant bone morphogenic protein-2 (rhBMP-2) is used in spinal fusion but linked to adverse effects.
- Previous studies suggest a potential link between rhBMP-2 and retrograde ejaculation (RE) after anterior lumbar interbody fusion (ALIF).
Purpose of the Study:
- To compare the incidence of RE in patients undergoing ALIF with and without rhBMP-2.
- To evaluate the association between rhBMP-2 use and post-operative RE.
Main Methods:
- Retrospective analysis of prospectively collected data from male patients undergoing ALIF.
- Comparison of RE incidence between ALIF with rhBMP-2 and ALIF without rhBMP-2.
- Inclusion criteria: lumbar spondylosis or spondylolisthesis requiring one- or two-level ALIF.
Main Results:
- A higher rate of RE was observed in the rhBMP-2 group (7.2%) compared to the control group (0.6%).
- For single-level L5/S1 ALIF, RE rates were 6.7% with rhBMP-2 versus 0% without.
- Some resolution of RE was reported within one year post-surgery.
Conclusions:
- This study confirms a higher incidence of RE following ALIF when rhBMP-2 is used.
- The findings highlight a significant consideration for male patients regarding fertility preservation after ALIF with rhBMP-2.
