Is there any advantage to using the new BMP bone graft substitute other than personal comfort? It costs at least $5,000 more. I’m inclined to take my chances with donating my own bone graft and saving the money. What do you think?

The product you mentioned (bone morphogenetic protein or BMP) is more expensive, but product has two major advantages over bone taken from the patient: 1) patients no longer suffer pain and discomfort at the pelvic crest where donor bone has been taken from and 2) patients with poor bone growth due to diabetes or tobacco use can have a spinal fusion when necessary.

But there are some new complications and post-operative problems that have been reported that could be quite serious. So surgeons are taking a second look at the safety of this bone substitute product. BMPs were first discovered in 1965 with more than 20 types now being studied. Only one (BMP-2) has been approved for use by the Food and Drug Administration (FDA) in spinal fusion surgeries.

When used as it was approved and intended, BMP stimulates safe and effective bone growth to aid in the fusion process. And that primary use for which it was intended is only anterior lumbar (low back) interbody fusion. Troubles begin when this product is used off-label such as for cervical (neck) fusion, especially anterior (from the front of the spine) procedures and posterior (from the back) lumbar fusion.

Massive soft tissue swelling, extra bone formation, seromas (fluid-filled pockets), and even cancer have been reported as emerging concerns with BMP-use. Surgeons at the University of Pittsburgh suggest BMP should only be used as indicated until further studies expand its use. In other words, it should not be used as an off-label product. They advise surgeons to select patients carefully for spinal fusion. Not everyone is appropriate for the primary surgical procedure. Surgical success is more likely when used for the right patients.

They also note that until perfected through studies, BMP should NOT be used in anterior cervical spine patients and certainly not for anyone who has a past (or current) history of cancer of any kind. Using BMP for the ease and convenience of the surgeon is not considered acceptable when there are added costs, safety concerns, and risks of serious harm to the patient.