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Neurosurgery:
doi: 10.1227/NEU.0000000000000018
Research-Human-Clinical Studies: Editor's Choice

Cancer After Spinal Fusion: The Role of Bone Morphogenetic Protein

Lad, Shivanand P. MD, PhD*,‡; Bagley, Jacob H. BS*,‡; Karikari, Isaac O. MD; Babu, Ranjith MS; Ugiliweneza, Beatrice PhD, MSPH§; Kong, Maiying PhD§; Isaacs, Robert E. MD; Bagley, Carlos A. MD; Gottfried, Oren N. MD; Patil, Chirag G. MD; Boakye, Maxwell MD

Editor's Choice
Press Release
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Abstract

BACKGROUND: Bone morphogenetic protein (BMP) is used in tens of thousands of spinal fusions each year. A trial evaluating a high-dose BMP formulation demonstrated that its use may be associated with an increased risk of cancer.

OBJECTIVE: To evaluate whether BMP, as commonly used today, is associated with an increased risk of cancer or benign tumors.

METHODS: We performed a retrospective study using the Thomson Reuter MarketScan database. We retained all patients who had no previous diagnosis of cancer or benign tumor and had at least 2 years of uninterrupted enrollment in the database before and after their operations. A propensity score--matched cohort was created to ensure greater covariate balance between treatment groups.

RESULTS: Within the propensity score--matched cohort (n = 4698), BMP-exposed patients had a nonsignificant increase in the rate of cancer diagnosis (9.37% vs 7.92%; P = .08). After adjustment for covariates, BMP exposure was associated with a 31% increased risk of benign tumor diagnosis (odds ratio, 1.31; 95% confidence interval, 1.02-1.68; P < .05). When the benign tumor diagnoses were stratified by organ type, BMP patients had significantly more diagnoses of benign nervous system tumors (0.81% vs 0.34%; P = .03), and within this group, benign tumors of the spinal meninges were much more common in the BMP-treated group (0.13% vs 0.02%; P = .002).

CONCLUSION: The results of this large, independent, propensity-matched study suggest that the use of BMP in lumbar fusions is associated with a significantly higher rate of benign neoplasms but not malignancies.

ABBREVIATIONS: aOR, adjusted odds ratio

BMP, bone morphogenetic protein

CI, confidence interval

CPT-4, Current Procedural Terminology, Fourth Edition

ICD-9-CM, International Classification of Disease, Ninth Revision, Clinical Modification

Copyright © by the Congress of Neurological Surgeons

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