Clinical outcomes, safety, and cost considerations of rhBMP-2 in the surgical management of pyogenic spinal infections: a focused review.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.