title: Cancer after spinal fusion: the role of bone morphogenetic protein.
abstract: BACKGROUND
  Bone morphogenetic protein (BMP) is used in tens of thousands of spinal fusions each year. A trial evaluating a high-dose BMP formulation demonstrated that its use may be associated with an increased risk of cancer.
  
  
  OBJECTIVE
  To evaluate whether BMP, as commonly used today, is associated with an increased risk of cancer or benign tumors.
  
  
  METHODS
  We performed a retrospective study using the Thomson Reuter MarketScan database. We retained all patients who had no previous diagnosis of cancer or benign tumor and had at least 2 years of uninterrupted enrollment in the database before and after their operations. A propensity score--matched cohort was created to ensure greater covariate balance between treatment groups.
  
  
  RESULTS
  Within the propensity score--matched cohort (n = 4698), BMP-exposed patients had a nonsignificant increase in the rate of cancer diagnosis (9.37% vs 7.92%; P = .08). After adjustment for covariates, BMP exposure was associated with a 31% increased risk of benign tumor diagnosis (odds ratio, 1.31; 95% confidence interval, 1.02-1.68; P < .05). When the benign tumor diagnoses were stratified by organ type, BMP patients had significantly more diagnoses of benign nervous system tumors (0.81% vs 0.34%; P = .03), and within this group, benign tumors of the spinal meninges were much more common in the BMP-treated group (0.13% vs 0.02%; P = .002).
  
  
  CONCLUSIONS
  The results of this large, independent, propensity-matched study suggest that the use of BMP in lumbar fusions is associated with a significantly higher rate of benign neoplasms but not malignancies.
authors.affiliation: Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA. Nandan.Lad@duke.edu
authors.forename: Shivanand P
authors.initials: SP
authors.lastname: Lad
authors.forename: Jacob H
authors.initials: JH
authors.lastname: Bagley
authors.forename: Isaac O
authors.initials: IO
authors.lastname: Karikari
authors.forename: Ranjith
authors.initials: R
authors.lastname: Babu
authors.forename: Beatrice
authors.initials: B
authors.lastname: Ugiliweneza
authors.forename: Maiying
authors.initials: M
authors.lastname: Kong
authors.forename: Robert E
authors.initials: RE
authors.lastname: Isaacs
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Bagley
authors.forename: Oren N
authors.initials: ON
authors.lastname: Gottfried
authors.forename: Chirag G
authors.initials: CG
authors.lastname: Patil
authors.forename: Maxwell
authors.initials: M
authors.lastname: Boakye
mesh_terms: D000328:Adult; D000368:Aged; D019485:Bone Morphogenetic Proteins / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000139:chemically induced*; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects*
chemical_list: D019485:Bone Morphogenetic Proteins