Related Experiment Video
Updated: May 5, 2026
Uniportal Full Endoscopic Posterolateral Transforaminal Lumbar Interbody Fusion
Published on: June 6, 2025
rhBMP-2 for posterolateral instrumented lumbar fusion: a multicenter prospective randomized controlled trial
R John Hurlbert1, David Alexander, Stewart Bailey
1*University of Calgary Spine Program and Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta †Division of Orthopedic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada ‡Division of Orthopedic Surgery, University of Western Ontario, London, Ontario, Canada §Division of Orthopedic Surgery, University of Alberta, Edmonton, Alberta, Canada ¶Division of Orthopedic Surgery, Dalhousie University, St. John, New Brunswick, Canada ‖Division of Orthopedic Surgery, Trillium Health Centre, Mississauga, Ontario, Canada; **Division of Orthopedic Surgery, University of Montreal, Montreal, Quebec, Canada; and ††Division of Orthopedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
Study Design:
Multicenter randomized controlled trial.
Objective:
To evaluate the effect of recombinant human bone morphogenetic protein (rhBMP-2) on radiographical fusion rate and clinical outcome for surgical lumbar arthrodesis compared with iliac crest autograft.
Summary Of Background Data:
In many types of spinal surgery, radiographical fusion is a primary outcome equally important to clinical improvement, ensuring long-term stability and axial support. Biologic induction of bone growth has become a commonly used adjunct in obtaining this objective. We undertook this study to objectify the efficacy of rhBMP-2 compared with traditional iliac crest autograft in instrumented posterolateral lumbar fusion.
Methods:
Patients undergoing 1- or 2-level instrumented posterolateral lumbar fusion were randomized to receive either autograft or rhBMP-2 for their fusion construct. Clinical and radiographical outcome measures were followed for 2 to 4 years postoperatively.
Results:
One hundred ninety seven patients were successfully randomized among the 8 participating institutions. Adverse events attributable to the study drug were not significantly different compared with controls. However, the control group experienced significantly more graft-site complications as might be expected. 36-Item Short Form Health Survey, Oswestry Disability Index, and leg/back pain scores were comparable between the 2 groups. After 4 years of follow-up, radiographical fusion rates remained significantly higher in patients treated with rhBMP-2 (94%) than those who received autograft (69%) (P = 0.007).
Conclusion:
The use of rhBMP-2 for instrumented posterolateral lumbar surgery significantly improves the chances of radiographical fusion compared with the use of autograft. However, there is no associated improvement in clinical outcome within a 4-year follow-up period. These results suggest that use of rhBMP-2 should be considered in cases where lumbar arthrodesis is of primary concern.
