Research In Brief

Executive Summary

BMP adds cost to spinal fusion: Application of bone-morphogenetic protein (BMP) in anterior cervical spinal fusions increases the likelihood of complications and increases the cost of all types of spinal fusions, according to results of a retrospective cohort study of 328,468 patients in the Nationwide Inpatient Sample database appearing in the July 1 Journal of the American Medical Association. The study found that BMP was used in about 25% of all spinal fusions in the United States in 2006, including 56% of the procedures in women and 30% of procedures in Medicare patients, but in only about 9% of non-white patients. In the study, BMP in anterior cervical fusion increased the risk of complications, including wound complications, from about 4.7% to 7%, while adding 11% to 41% to total hospital charges for all types of spinal fusion. Study authors Kevin S. Cahill, M.D./Ph.D., Brigham and Women's Hospital, Boston, et al. write that the results "illustrate the need to continue to develop refined guidelines for [BMP] and to further study the long-term risks and benefits of [BMP]." This is the first nationwide survey of on-label and off-label BMP applications in spinal fusion, according to the authors. FDA first approved BMP in 2002 when it approved Medtronic's Infuse bone graft to be used with the LT-Cage lumbar tapered fusion device. Stryker's OP-1 BMP putty is approved as a humanitarian use device for revision of inter-transverse lumbar fusion in compromised patients