A Narrative Review on Recombinant Human Bone Morphogenetic Protein 2: Where Are We Now?

Area of Science:

• Orthopedics
• Biomaterials Science
• Regenerative Medicine

Background:

• Spinal fusion is a common surgery for degenerative spinal diseases, increasingly complex due to patient multimorbidity.
• Advanced bone grafts are vital for successful spinal fusion, driving demand for effective bone graft substitutes.
• Recombinant human bone morphogenetic protein-2 (rhBMP-2) is a key biomaterial used in spinal fusion.

Purpose of the Study:

• To review the development, clinical application, and controversies of rhBMP-2 in spinal fusion.
• To analyze the efficacy, side effects, and evolving usage patterns of rhBMP-2.
• To identify areas for future research to improve rhBMP-2 delivery and patient outcomes.

Main Methods:

• Comprehensive narrative review of literature from January 1980 to January 2024.
• Searches conducted on PubMed and Google Scholar.
• Included studies focused on rhBMP-2 in spinal fusion, excluding other BMPs and non-spinal applications.

Main Results:

• rhBMP-2 demonstrates comparable radiographic fusion and clinical outcomes to autologous bone grafts.
• Clinical practice has evolved to adjust rhBMP-2 usage and dosages to mitigate adverse effects.
• Unique risks associated with rhBMP-2 necessitate safer delivery mechanisms and further research.

Conclusions:

• rhBMP-2 is a potent osteoinductive agent for spinal fusion but requires careful risk management.
• Optimizing rhBMP-2 delivery systems is crucial for reducing side effects and enhancing patient outcomes.
• Further research into spatio-temporal delivery could significantly improve spinal fusion surgery success.