The Use of Recombinant Bone Morphogenetic Protein-2 in the Treatment of Spondylodiscitis

Study DesignRetrospective observational cohort.ObjectiveAlthough recombinant human bone morphogenetic protein-2 (rhBMP-2) has been shown to enhance fusion rates in spinal fusion surgery, its use in patients with spondylodiscitis remains controversial. This study evaluated the surgical outcomes and complication rates associated with rhBMP-2 use in the treatment of spondylodiscitis.MethodsWe retrospectively reviewed a consecutive series of patients who underwent surgical treatment for spondylodiscitis, including anterior column debridement and reconstruction with cage placement, with at least 12-month follow-up. Outcomes and complications were compared between patients who received rhBMP-2 and those who did not.ResultsA total of 133 patients (mean follow-up, 32.4 ± 27.4 months) were included; 114 (86%) received rhBMP-2 (mean dose, 14.4 ± 6.4 mg), anteriorly in 97 (73%), posteriorly in 92 (69%), and in both locations in 75 patients (56%). . The fusion rate was significantly higher in BMP_Posterior vs non-BMP_Posterior (95% vs 80%, P = 0.023, but not significantly different in other subgroup comparisons. There were no significant differences in implant-related complications, revision surgery, recurrence, or major medical complications between patients who received rhBMP-2 and those who did not. The multivariable analysis demonstrated that rhBMP-2 use in both the anterior and posterior columns (OR = 9.93, 95% CI: 1.90 - 77.7, P = 0.012) and age (OR = 0.93, 95% CI: 0.85-0.99, P = 0.042) were independently associated with fusion at the infected level.ConclusionThe use of rhBMP-2 was not associated with increased complications and may support fusion, even in the setting of active spondylodiscitis.