Spinal fusion protein associated with complications, higher costs

In the United States, back pain continues to be a leading cause of disability and one of the most common reasons to see a physician for evaluation. Among various treatment options is spinal fusion surgery, which may use a biological agent known as bone-morphogenetic protein (BMP).

Researchers at Brigham and Women’s Hospital (BWH) found that BMP is used in 25 percent of spinal fusion surgeries and is associated with a higher rate of complications in certain types of fusions, as well as greater hospital charges, compared with fusions that do not use BMP. The research appears in the June 30 issue of the Journal of the American Medical Association.

Researchers looked at the outcomes of more than 300,000 patients who underwent spinal fusion surgery. “The use of BMP in these surgeries jumped from less than 1 percent in 2002 to 25 percent in 2006,” said Kevin Cahill of the Neurosurgery Department at BWH, a clinical fellow in surgery, and lead author of the study. “With the use of BMP on the rise, this study illustrates the need to determine the cost-effectiveness of the product in different procedures.”

The researchers found that immediate postoperative, in-hospital rates of complications among patients undergoing spinal fusion by BMP were no higher for lumbar, thoracic, or posterior cervical procedures.

However, the use of BMP in anterior cervical (front of the neck) fusion procedures was associated with a 50 percent higher complication rate, with the primary increases seen in wound-related complications, difficulty in swallowing, or hoarseness.

BMP use was associated with a longer length of stay in the hospital and greater inpatient hospital charges across all categories of fusion, with an 11 percent to 41 percent increase in total hospital charges.

“This study has highlighted the need to continue to develop refined guidelines for BMP usage and to further study its long-term risks and benefits,” Cahill said. Other investigators on the study include John H. Chi, Arthur Day, and Elizabeth B. Claus, all of the Neurosurgery Department at BWH.

The Brain Science Foundation funded the study.