TY - JOUR
T1 - Bone morphogenetic protein and cancer in spinal fusion
T2 - a propensity score–matched analysis
AU - Mazur-Hart, David J.
AU - Yamamoto, Erin A.
AU - Yoo, Jung
AU - Orina, Josiah N.
N1 - Publisher Copyright:
© AANS 2023, except where prohibited by US copyright law.
PY - 2023
Y1 - 2023
N2 - OBJECTIVE Bone morphogenetic protein (BMP) has been increasingly used in spinal surgery to promote arthrodesis. Because BMP stimulates cellular proliferation, its association with tumorigenesis is a concern. Previous research has generated conflicting conclusions on the risk of cancer in patients receiving BMP. The authors aimed to compare the incidence of solid organ and hematopoietic malignancies in patients undergoing spinal arthrodesis with or without BMP. METHODS The PearlDiver Mariner Patient Claims Database was queried for patients undergoing thoracolumbar fusion between 2015 and 2021. Patients with preexisting malignancy were excluded. Data were analyzed for incidence of solid organ malignancy and hematopoietic malignancy diagnosed after spinal surgery. Propensity score matching using age, sex, tobacco usage, and year of surgery was performed between patients who did and those who did not receive BMP. RESULTS Among patients without prior solid organ malignancy, BMP was used in 22,139 patients and not used in 306,249. In the propensity score–matched group, 3.1% of the BMP group developed solid organ malignancy following surgery compared with 3.5% in the non-BMP group. The relative risk (RR) of developing solid organ malignancy after BMP exposure was 0.89 (95% CI 0.81–0.98, p = 0.02). Among patients without prior hematopoietic malignancy, BMP was used in 23,505 patients and not used in 328,796 patients. In the propensity score–matched group, 0.4% of the BMP group developed hematopoietic malignancy compared with 0.6% of the non-BMP group. The RR of developing hematopoietic malignancy after BMP exposure was 0.71 (95% CI 0.55–0.93, p = 0.015). CONCLUSIONS BMP use in thoracolumbar fusion was not associated with an increased risk of new malignancy, which further supports emerging data on the lack of an association between BMP use and increased malignancy.
AB - OBJECTIVE Bone morphogenetic protein (BMP) has been increasingly used in spinal surgery to promote arthrodesis. Because BMP stimulates cellular proliferation, its association with tumorigenesis is a concern. Previous research has generated conflicting conclusions on the risk of cancer in patients receiving BMP. The authors aimed to compare the incidence of solid organ and hematopoietic malignancies in patients undergoing spinal arthrodesis with or without BMP. METHODS The PearlDiver Mariner Patient Claims Database was queried for patients undergoing thoracolumbar fusion between 2015 and 2021. Patients with preexisting malignancy were excluded. Data were analyzed for incidence of solid organ malignancy and hematopoietic malignancy diagnosed after spinal surgery. Propensity score matching using age, sex, tobacco usage, and year of surgery was performed between patients who did and those who did not receive BMP. RESULTS Among patients without prior solid organ malignancy, BMP was used in 22,139 patients and not used in 306,249. In the propensity score–matched group, 3.1% of the BMP group developed solid organ malignancy following surgery compared with 3.5% in the non-BMP group. The relative risk (RR) of developing solid organ malignancy after BMP exposure was 0.89 (95% CI 0.81–0.98, p = 0.02). Among patients without prior hematopoietic malignancy, BMP was used in 23,505 patients and not used in 328,796 patients. In the propensity score–matched group, 0.4% of the BMP group developed hematopoietic malignancy compared with 0.6% of the non-BMP group. The RR of developing hematopoietic malignancy after BMP exposure was 0.71 (95% CI 0.55–0.93, p = 0.015). CONCLUSIONS BMP use in thoracolumbar fusion was not associated with an increased risk of new malignancy, which further supports emerging data on the lack of an association between BMP use and increased malignancy.
KW - allograft
KW - bone morphogenetic protein
KW - fusion
KW - malignancy
KW - oncology
KW - spine
KW - thoracolumbar
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U2 - 10.3171/2023.4.SPINE22584
DO - 10.3171/2023.4.SPINE22584
M3 - Article
C2 - 37657115
AN - SCOPUS:85178649303
SN - 1547-5654
VL - 39
SP - 722
EP - 728
JO - Journal of Neurosurgery: Spine
JF - Journal of Neurosurgery: Spine
ER -