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Related Experiment Video

Updated: May 12, 2026

Polyelectrolyte Complex for Heparin Binding Domain Osteogenic Growth Factor Delivery
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Published on: August 22, 2016

Bone morphogenetic protein in complex cervical spine surgery: A safe biologic adjunct?

Darren R Lebl1

  • 1Darren R Lebl, Hospital for Special Surgery, New York, NY 10021, United States.

World Journal of Orthopedics
|April 24, 2013
PubMed
Summary

Off-label use of bone morphogenetic proteins (BMP) in cervical spine surgery shows mixed results. While BMP-2 has a high complication rate, BMP-7 data is limited, and posterior use may benefit select patients.

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Area of Science:

  • Spine Surgery
  • Biologics
  • Recombinant DNA Technology

Background:

  • Bone morphogenetic proteins (BMP) are increasingly used in spine surgery following FDA approval.
  • The off-label use of BMP in the cervical spine is less understood.
  • Recombinant DNA technology has advanced biologic augmentation in spinal procedures.

Purpose of the Study:

  • To review and discuss the literature on off-label BMP use in the cervical spine.
  • To evaluate the benefits and risks of BMP implantation in anterior and posterior cervical spine surgery.
  • To assess the current evidence regarding BMP efficacy and safety in cervical spine fusion.

Main Methods:

  • Literature review of studies on BMP implantation in the cervical spine.
  • Analysis of prospective and retrospective studies on BMP-2 and BMP-7.
Keywords:
Bone morphogenetic proteinCervical spine

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  • Examination of reported outcomes, fusion rates, and complications.

    • Main Results:

    • BMP-2 in anterior cervical spine surgery showed early promise but later retrospective studies reported life-threatening complications, leading to an FDA advisory.
    • Limited data on BMP-7 in anterior cervical surgery indicated a 2.4% early complication rate.
    • BMP use in posterior cervical spine surgery may pose risks but can increase fusion rates in select complex and pediatric cases.
    • No cases of de novo neoplasia were associated with BMP implantation in the cervical spine.

    Conclusions:

    • BMP-2 use in anterior cervical spine surgery is linked to a high early complication rate.
    • Insufficient clinical data currently prevents definitive recommendations for BMP-7 in anterior cervical spine surgery.
    • Off-label BMP use may be considered for select high-risk patients undergoing posterior cervical or occipitocervical fusion, and for pediatric cases, with informed consent.
    • High-level clinical studies on cervical spine BMP outcomes and complications are lacking.