Comparative Complications Associated With BMP Use In Patients Undergoing ACDF for Degenerative Spinal Conditions: Systematic Review and Meta-Analysis

Christopher T. Martin, Kenneth Holton, Samuel E. Broida, Anne Katrin Hickmann, Caitlin Bakker, Paul A. Lender, Kota Watanabe, Hans Jörg Meisel, Zorica Buser, Steven M. Presciutti, Sangwook Tim Yoon

Research output: Contribution to journalArticlepeer-review


Study Design: Systematic Review and Meta-Analysis. Objectives: To compare complication incidence in patients with or without the use of recombinant human Bone Morphogenic Protein-2 (BMP2) undergoing anterior cervical discectomy and fusion (ACDF) for degenerative conditions. Methods: A systematic search of eight online databases was conducted using PRISMA guidelines. Inclusion criteria included English language studies with a minimum of 10 adult patients undergoing instrumented ACDF surgery for a degenerative spinal condition in which BMP2 was used in all patients or one of the treatment arms. Studies with patients undergoing circumferential fusions, with non-degenerative indications, or which did not report post-operative complication data were excluded. Patients with and without BMP2 were compared in terms of the incidence of dysphagia/dysphonia, anterior soft tissue complications (hematoma, seroma, infection, dysphagia/dysphonia), nonunion, medical complications, and new neurologic deficits. Results: Of 1832 preliminary search results, 27 manuscripts were included. Meta-analysis revealed the relative risk of dysphagia or dysphonia (RR = 1.39, CI 95% 1.18 – 1.64, P = <.001), anterior soft tissue complications (RR = 1.43, CI 95% 1.25-1.64, P = <.001), and medical complications (RR = 1.32, CI 95% 1.06-1.66, P =.013) were statistically significant in the BMP2 group while the relative risk of non-union (RR =.5, CI 95%.23 - 1.13, P =.09) trended lower in the BMP2 group. Neurological deficit (RR = 1.06, CI 95%.82-1.37, P =.66), and additional medical complications (RR = 1.53, CI 95%.98-2.38, P =.06) were not found to be statistically different between the groups. Conclusions: This meta-analysis identified a high rate of arthrodesis when BMP2 was used in ACDF, but confirmed increased rates of dysphagia and anterior soft tissue complications. Surgeons may consider reserving BMP2 implementation for cases with a high risk of non-union, and should be aware of the risk of airway compromise.

Original languageEnglish (US)
Pages (from-to)94S-109S
JournalGlobal Spine Journal
Issue number2_suppl
StatePublished - Feb 2024

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© The Author(s) 2023.


  • ACDF
  • BMP
  • degenerative

PubMed: MeSH publication types

  • Journal Article


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