Spine
Volume 36(20), 15 September 2011, p 1685–1691

Does Bone Morphogenetic Protein Increasethe Incidence of Perioperative Complicationsin Spinal Fusion?: A Comparison of 55,862 Cases of Spinal Fusion With and Without Bone Morphogenetic Protein?

Williams, Brian J. MD*; Smith, Justin S. MD, PhD*; Fu, Kai-Ming G. MD, PhD*; Hamilton, D. Kojo MD†; Polly, David W. Jr. MD‡; Ames, Christopher P. MD§; Berven, Sigurd H. MD; Perra, Joseph H. MD[//]; Knapp, Dennis R. Jr. MD**; McCarthy, Richard E. MD††; Shaffrey, Christopher I. MD*; Scoliosis Research Society Morbidity and Mortality Committee. © 2011 Lippincott Williams & Wilkins, Inc. Author Information: *Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA; †Department of Neurosurgery, University of Maryland, Baltimore, MD; ‡Departments of Orthopedic Surgery and Neurosurgery, University of Minnesota, Minneapolis, MN; §Department of Neurosurgery, University of California, San Francisco, CA; Department of Orthopedic Surgery, University of California, San Francisco, CA; [//]Department of Orthopedic Surgery, Twin Cities Spine Center, Minneapolis, MN; **Department of Orthopedic Surgery, Arnold Palmer Children's Hospital, Orlando, FL; ††Department of Orthopedic Surgery, Arkansas Spine Center, Little Rock, AR.

Study Design. Retrospective review of a multi-institutional, multisurgeon database.

Objective. Assess for associations between bone morphogenetic protein (BMP) use and rate of complications in spinal fusion.

Summary of Background Data. BMP is commonly used in spinal surgery to augment fusion; however, there is limited evidence demonstrating its associated complications.

Methods. We performed a retrospective analysis of all fusion cases submitted by members of the Scoliosis Research Society from 2004 to 2007. We stratified on the basis of the use of BMP and evaluated for complications and associated characteristics.

Results. A total of 55,862 cases of spinal fusion were identified with BMP used in 21% (11,933) of the cases. Excluding anterior cervical fusions, there were no significant differences between fusions with and without BMP with regard to overall complications (8.4% vs. 8.5%; P = 0.5), wound infections (2.4% vs. 2.4%; P = 0.8), or epidural hematomas/seromas (0.2% vs. 0.2%; P = 0.3). Anterior cervical fusions with BMP were associated with more overall complications (5.8% vs. 2.4%; P < 0.001) and more wound infections (2.1% vs. 0.4%; P < 0.001) than fusions without BMP.

On multivariate analysis for thoracolumbar and posterior cervical fusions, BMP use was not a significant predictor of complications (P = 0.334; odds ratio = 1.039; 95% confidence interval = 0.961–1.124; covariates were BMP use, patient age, revision vs. primary surgery). Multivariate analysis for anterior cervical spinal fusion demonstrated that BMP use remained a significant predictor of complications (P < 0.001, odds ratio = 1.6; 95% confidence interval = 1.516–1.721), after adjusting for the effects of patient age and whether the surgery was a revision procedure.

Conclusion. BMP use with anterior cervical fusion was associated with an increased incidence of complications. Use of BMP was not associated with more complications in thoracolumbar and posterior cervical fusions.