Increased swelling complications associated with off-label usage of rhBMP-2 in the anterior cervical spine

Spine (Phila Pa 1976). 2006 Nov 15;31(24):2813-9. doi: 10.1097/01.brs.0000245863.52371.c2.


Study design/setting: Independent, retrospective clinical record review with a concurrent control.

Objective: To identify whether rhBMP-2 is associated with an increased incidence of clinically relevant postoperative prevertebral swelling problems in patients undergoing anterior cervical fusions.

Summary of background data: Bone Morphogenetic Protein-2 (rhBMP-2) is FDA approved as a bone graft substitute in anterior lumbar interbody fusions. rhBMP-2 has also been used "off-label" in anterior cervical fusions. We suspected that rhBMP-2 might increase the incidence of adverse swelling events.

Methods: A total of 234 consecutive patients (ages 12-82 years) undergoing anterior cervical fusion with and without rhBMP-2 over a 2-year period at one institution comprised the study population. The incidence of clinically relevant prevertebral swelling was calculated. The populations were compared and statistical significance was determined.

Results: A total of 234 patients met the study criteria, 69 of whom underwent anterior cervical spine fusions using rhBMP-2; 27.5% of those patients in the rhBMP-2 group had a clinically significant swelling event versus only 3.6% of patients in the non-rhBMP-2 group. This difference was statistically significant (P < 0.0001) and remained so after controlling for other significant predictors of swelling.

Conclusions: Off-label use of rhBMP-2 in the anterior cervical spine is associated with an increased rate of clinically relevant swelling events.

Publication types

  • Clinical Trial
  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Bone Morphogenetic Protein 2
  • Bone Morphogenetic Proteins / adverse effects*
  • Bone Morphogenetic Proteins / therapeutic use
  • Cervical Vertebrae / surgery*
  • Child
  • Deglutition Disorders / epidemiology
  • Deglutition Disorders / etiology
  • Edema / chemically induced*
  • Edema / epidemiology
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Neck
  • Postoperative Complications / chemically induced*
  • Postoperative Complications / epidemiology
  • Recombinant Proteins / administration & dosage
  • Recombinant Proteins / therapeutic use
  • Spinal Fusion*
  • Transforming Growth Factor beta / adverse effects*
  • Transforming Growth Factor beta / therapeutic use


  • BMP2 protein, human
  • Bone Morphogenetic Protein 2
  • Bone Morphogenetic Proteins
  • Recombinant Proteins
  • Transforming Growth Factor beta