Resurgence in BMP Use in Spine Surgery: An Analysis From 2010 to 2022

Study DesignRetrospective Cohort.ObjectivesTo evaluate trends in bone morphogenetic protein (BMP) utilization across spinal fusion procedures.MethodsPatients undergoing anterior cervical discectomy and fusion (ACDF), posterior cervical decompression and fusion (PCDF), anterior lumbar interbody fusion (ALIF), or posterior/transforaminal lumbar interbody fusion (PLIF/TLIF) between January 1, 2010 and April 30, 2023 were identified in the PearlDiver Mariner Database. BMP utilization was identified using ICD-9/10 codes and assessed annually as a percentage of total cases, with 2023 omitted due to incomplete data. Subgroup analysis stratified annual trends by number of levels fused. Temporal trends in patient demographics were compared between early (2010-2016) and late (2017-2023) cohorts using Welch's t-test and Pearson chi-squared test of independence.ResultsA total of 596,453 ACDF, 104,287 PCDF, 159,575 ALIF, and 622,252 PLIF/TLIF cases were identified, respectively. Across all procedures, BMP utilization declined to a nadir in 2017, followed by marked increase. From 2017 to 2022, BMP utilization increased by 667% in ACDF, 1138% in PCDF, 441% in ALIF, and 900% in PLIF/TLIF. BMP use was higher in multi-level PCDF and PLIF/TLIF compared to single-level, whereas ALIF demonstrated slightly higher utilization in single-level cases. In the later cohort, patients receiving BMP were older, had greater comorbidity burden, and longer hospital stays across all procedures (p<0.001).ConclusionsBMP utilization in spine surgery declined steadily until 2017, followed by marked increase through 2022, particularly in multi-level posterior cervical and lumbar fusions and among high-risk patients. This likely reflects evolving evidence supporting optimized dosing and improved safety profiles.