Complications following use of rhBMP-2 in anterior lumbar interbody fusion: an institutional cohort controlled study

Daniel Lubelski1, Kalil Abdullah1, Amy Nowacki, PhD1, Matthew Alvin1, Michael Steinmetz1, Edward C. Benzel, MD1

1University Heights, OH United States

Keywords: complications, spinal stenosis, interbody fusion, spinal fusion, spine surgery

Interactive Manuscript

Ask Questions of this Manuscript:



     rhBMP-2 has been increasingly used in spinal fusions.
     While initial studies extolled the product’s improvement of patients’ outcomes, recent investigations have revealed increased rates of urological complications, as well as wound infection, pseudoarthrosis, and reoperation, relative to the standard ALIF procedure.
     Of the 267 ALIF patients that fit our inclusion criteria, 144 included the use of rhBMP-2 and 123 did not and served as the control cohort
     Using the institutional electronic medical records, we retrospectively reviewed all patients who underwent ALIF with and without rhBMP-2 between January 2002 and August 2010. Patient demographic, operative, and outcome/complication information was collected.
     . The mean follow-up was 20.2 months for the rhBMP-2 group and 32.5 months for the control group. No difference was found regarding the number of urological complications in the rhBMP-2 group versus the control group (8% versus 7%, respectively). Only one case of retrograde ejaculation was identified in the rhBMP-2 group; none were found in the control group. The rates of pseudoarthrosis, radicultis, and reoperation were significantly higher in the rhBMP-2 group relative to the control (17% vs. 5%, 23% vs. 2%, and 22% vs. 5%, respectively).
     This is a retrospective study.
     Urological complications and retrograde ejaculation may not be as prevalent as previously reported following ALIF procedures with rhBMP-2.
     The higher rate of pseudoarthrosis, radiculitis, and reoperation confirm previous reports and should be considered by patient and surgeon before proceeding to operations with rhBMP-2.


Project Roles:

D. Lubelski (), K. Abdullah (), A. Nowacki (), M. Alvin (), M. Steinmetz (), E. Benzel ()