Mahfouz Hassan, Mahfouz Hamza, Al Farii Humaid
King's College London, London, UK.
Queen Mary University of London, London, UK.
Eur Spine J. 2025 Jun 12. doi: 10.1007/s00586-025-08993-9.
Pyogenic spondylodiscitis and vertebral osteomyelitis remain challenging clinical entities, particularly when surgical intervention is required. While recombinant human bone morphogenetic protein-2 (rhBMP-2) is well established in degenerative spinal fusion, its role in the context of active or previously treated spinal infection remains controversial. This focused review evaluates the clinical outcomes, safety profile, and cost considerations of rhBMP-2 in the surgical management of pyogenic spondylodiscitis and vertebral osteomyelitis.
A focused literature review was conducted to identify studies reporting on the use of rhBMP-2 in patients undergoing spinal fusion for pyogenic spondylodiscitis and vertebral osteomyelitis. Data were extracted on patient demographics, rhBMP-2 dose, fusion rates, complication profiles, infection recurrence, neurological outcomes, and cost-related metrics.
Six retrospective studies encompassing 346 patients treated with rhBMP-2 were included. Fusion rates ranged from 95 to 100%, with a weighted average of 97.84% across reported studies. Infection recurrence was low at 1.54%, and no study attributed reinfection to rhBMP-2 use. The complication rate averaged 18.49%, with only one transient rhBMP-2 related event (radiculitis) reported. Neurological improvement was observed in 68.0% of patients. Cost data, though limited, suggest reduced long-term healthcare utilisation in rhBMP-2 treated patients, potentially offsetting initial implant costs.
Based on currently available retrospective data, rhBMP-2 appears to be a potentially safe adjunct in the surgical management of pyogenic spondylodiscitis and vertebral osteomyelitis. When used selectively, it has been associated with high fusion rates and an acceptable safety profile. These findings support the need for prospective, controlled trials to further define its optimal role, dosing strategies, and cost-effectiveness in the surgical management of pyogenic spondylodiscitis and vertebral osteomyelitis.
化脓性椎间盘炎和椎体骨髓炎仍然是具有挑战性的临床病症，尤其是在需要手术干预时。虽然重组人骨形态发生蛋白-2（rhBMP-2）在退行性脊柱融合中已得到充分确立，但其在活动性或既往治疗过的脊柱感染中的作用仍存在争议。本综述评估了rhBMP-2在化脓性椎间盘炎和椎体骨髓炎手术治疗中的临床疗效、安全性和成本考量。
进行了一项重点文献综述，以确定报告rhBMP-2在因化脓性椎间盘炎和椎体骨髓炎接受脊柱融合手术患者中应用情况的研究。提取了患者人口统计学数据、rhBMP-2剂量、融合率、并发症情况、感染复发情况、神经功能结果以及成本相关指标。
纳入了6项回顾性研究，共346例接受rhBMP-2治疗的患者。融合率在95%至100%之间，各报告研究的加权平均融合率为97.84%。感染复发率较低，为1.54%，且没有研究将再次感染归因于rhBMP-2的使用。并发症发生率平均为18.49%，仅报告了1例与rhBMP-2相关的短暂性事件（神经根炎）。68.0%的患者神经功能得到改善。成本数据虽然有限，但表明rhBMP-2治疗的患者长期医疗利用率降低，可能抵消了初始植入成本。
基于目前可得的回顾性数据，rhBMP-2似乎是化脓性椎间盘炎和椎体骨髓炎手术治疗中一种潜在安全的辅助手段。选择性使用时，它与高融合率和可接受的安全性相关。这些发现支持进行前瞻性对照试验，以进一步明确其在化脓性椎间盘炎和椎体骨髓炎手术治疗中的最佳作用、给药策略和成本效益。
