Rethinking Bone Morphogenetic Protein
The Recommendation: Do not use recombinant human bone morphogenetic protein (rhBMP) in routine anterior cervical spine fusion surgery.
The Rationale: rhBMPs are a group of growth factors that control tissue architecture throughout the body, including stimulating formation and healing. Although these compounds, particularly rhBMP type 2, have been used in numerous orthopedic applications, life-threatening complications have been reported with routine use of recombinant human rhBMP in anterior cervical spine fusion surgery, owing to swelling of the soft tissues. This may lead to difficulty swallowing or pressure on the airway.
Dr. Wei's Bottom Line: BMP initially showed promise as an adjunct to help with healing. It was also explored as a possible disease-modifying therapy for osteoarthritis. Unfortunately, the formation of ectopic bone, with its attendant risks and complications, has dampened the enthusiasm for this protein. Until further studies demonstrate that BMP can be used without incurring complications, it will rest on the back burner.
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