Is Bone Morphogenetic Protein the new Gold Standard? A Meta-Analysis and Systematic Review of Bone Morphogenetic Protein vs Autologous Iliac Crest Bone Graft Use in Spinal Fusion

OBJECTIVE: To evaluate the safety and efficacy of BMP across different spinal procedures and anatomical sites to inform decision-making in spinal fusion. MATERIALS AND METHODS: A systematic search of PubMed and the Cochrane Central Register of Controlled Trials was performed, focusing on randomized controlled trials (RCTs) published between 2003 and 2023. The search utilized the Medical Subject Headings (MeSH) terms "bone morphogenetic protein," "iliac crest bone graft," and "spinal fusion." RESULTS: Seventeen RCTs encompassing 1,788 patients compared BMP with ICBG in terms of efficacy, quality of life, morbidity, and safety outcomes. BMP consistently achieved higher spinal fusion success rates than ICBG, particularly at 6 and 24 months, and in lumbar procedures. BMP-2 outperformed ICBG, while OP-1 showed no significant benefit. BMP also reduced operative time and showed slightly better clinical outcomes in pain, disability, and return to work. Complication rates were 15% lower with BMP, notably fewer non-unions and revision surgeries with BMP-2. CONCLUSIONS: BMP, particularly BMP-2, demonstrates superior fusion success rates, improved clinical outcomes, and lower complication rates compared to ICBG, especially in lumbar spine procedures.