title: Complications with the use of bone morphogenetic protein 2 (BMP-2) in spine surgery.
abstract: BACKGROUND
  Recombinant human bone morphogenetic protein 2 (rhBMP-2) is a very potent osteogenic growth factor that has been used successfully in various spine fusions, obviating the need for autologous iliac crest bone graft harvest and therefore avoiding the associated morbidities.
  
  
  OBJECTIVE
  In the past few years, a tremendous increase in rhBMP-2 usage was noted, and concerns regarding costs, benefits, and safety issues were raised by many. The goal of this work was to provide a comprehensive review of the adverse events and complications associated with use of rhBMP-2.
  
  
  METHODS
  Literature review.
  
  
  METHODS
  This is a review of the current literature on the reported adverse events, complications, and concerns associated with rhBMP-2 use.
  
  
  RESULTS
  This article discusses the wide spectrum of adverse outcomes related to rhBMP-2 use in the lumbar and the cervical spine; retrograde ejaculation, antibodies formation, postoperative radiculitis, postoperative nerve root injury, ectopic bone formation, vertebral osteolysis/edema, dysphagia and neck swelling, hematoma formation, interbody graft lucency, and wound healing complications are reviewed. Cost-related concerns, dosage considerations, carrier types, and theoretical carcinogenesis concerns were also presented.
  
  
  CONCLUSIONS
  Despite the excellent spinal fusion rates promoted by this powerful molecule, the increasingly reported adverse outcomes associated with bone morphogenetic protein usage have created real concerns. This article will provide the reader with a good understanding of the reported complications associated with rhBMP-2 use and ultimately help recognize its safety spectrum and limits for better clinical application.
authors.affiliation: Boston University Medical Center, 720 Harrison Ave., D2N, Boston, MA 02118, USA.
authors.forename: Chadi A
authors.initials: CA
authors.lastname: Tannoury
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, 1611 West Harrison St. Suite 300, Chicago, IL 60612, USA. Electronic address: han@rushortho.com.
authors.forename: Howard S
authors.initials: HS
authors.lastname: An
mesh_terms: D055396:Bone Morphogenetic Protein 2 / Q000009:adverse effects* / Q000627:therapeutic use; D002574:Cervical Vertebrae / Q000601:surgery*; D004305:Dose-Response Relationship, Drug; D006406:Hematoma / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D009999:Ossification, Heterotopic / Q000453:epidemiology / Q000209:etiology; D011843:Radiculopathy / Q000453:epidemiology / Q000209:etiology; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D016212:Transforming Growth Factor beta / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D055396:Bone Morphogenetic Protein 2; D011994:Recombinant Proteins; D016212:Transforming Growth Factor beta; C499469:recombinant human bone morphogenetic protein-2
keywords: Bone morphogenetic protein; Complications; Ectopic bone; Fusion; Osteolysis; Radiculitis; Retrograde ejaculation; Spine; rhBMP-2