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. 2022 Jun 14;16(4):706-713.
doi: 10.14444/8301. Online ahead of print.

Bone Morphogenetic Protein in Anterior Lumbar Interbody Fusions: A Propensity-Matched Medicare Outcome Analysis

Syed I Khalid  1   2 , Ravi S Nunna  3 , Rachyl M Shanker  4 , Kyle B Thomson  4 , Rown Parola  3 , Owoicho Adogwa  5 , Ankit I Mehta  3
Affiliations

Bone Morphogenetic Protein in Anterior Lumbar Interbody Fusions: A Propensity-Matched Medicare Outcome Analysis

Syed I Khalid et al. Int J Spine Surg. .

Abstract

Background: Bone morphogenetic protein (BMP) is a costly agent commonly used in spine surgery. Its effectiveness and complication profile have never been studied in a large, propensity-matched population following its approval by the Food and Drug Administration for use in single-level anterior lumbar interbody fusion (ALIF) surgeries.

Objective: To investigate the rate of symptomatic pseudarthrosis or need for revision surgery after single-level stand-alone ALIFs with and without the use of BMP.

Methods: Medicare Standard Analytic files derived from Medicare parts A and B were used to identify adult patients who underwent single-level ALIF procedures with and without use of BMP between 2004 and 2014. Patients were propensity matched based on their age, gender, and history of diabetes mellitus, hypertension, chronic kidney disease, body mass index greater than 30 kg/m2, smoking, rheumatoid arthritis, and osteoporosis. Sensitivity analysis using adjusted multivariate logistic regression models was also performed. The primary outcomes were the rates of symptomatic pseudarthrosis or need for revision surgery.

Results: The propensity-matched population analyzed in this study contained 22,380 patients undergoing single-level ALIF (8971 [40.6%] with BMP and 13,139 [59.4%] without BMP). Both patient groups were balanced at baseline. The rate of symptomatic pseudarthrosis in the propensity-matched analysis was higher in the BMP group (1.9% vs 1.4%, P < 0.05). BMP use during single-level ALIFs was associated with 44% increased odds of developing pseudarthrosis (OR 1.44, 95% CI 1.16-1.76). However, there was no statistically significant difference in the rate of revision surgery between groups (3.7% vs 3.5%, P = 0.49).

Conclusions: BMP use in single-level ALIFs may be associated with increased risk of symptomatic pseudarthrosis. Large prospective pragmatic trials are needed to corroborate our findings.

Keywords: bone morphogenetic protein; complication, postoperative; fusion; lumbar; pseudarthrosis.

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Conflict of interest statement

Declaration of Conflicting Interests: The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Patient selection flow chart. ALIF, anterior lumbar interbody fusion; BMP, bone morphogenetic protein.
Figure 2
Figure 2
Kaplan-Meier plot for pseudarthrosis and revision surgery occurring within 2 y postoperatively. BMP, bone morphogenetic protein.
See this image and copyright information in PMC

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