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Online ISSN 1827-1707
White A. P. 1, Brothers J. G. 2, Brown Z. B. 2, Vaccaro A. R. 3
1 Carl J. Shapiro Department of Orthopaedics Beth Israel Deaconess Medical Center Boston, MA, USA
2 Department of Orthopaedic and Neurological Surgery Thomas Jefferson University Hospital Philadelphia, PA, USA
3 Spine Division Department of Orthopaedic Surgery and Neurosurgery Rothman Institute at Jefferson University Hospital Thomas Jefferson University Philadelphia, PA, USA
Modern techniques in cervical spinal surgery have evolved, in part, as a result of technological advancements. The interest in developing an alternative to iliac crest autograft has been motivated by its shortcomings including the risk of pseudarthrosis as well as graft harvest complications. To this end, bone morphogenetic protein (BMP) has been studied with considerable interest for many decades. Well-performed, prospective clinical studies have demonstrated the efficacy of BMP in the long bones and lumbar spine. It has only recently, however, been applied to cervical procedures on a large scale. Over the past two years, reports in the literature have confirmed the robust ability of BMP to promote bony union in the cervical spine but have also attributed complications to its use. Difficulties associated with BMP in the cervical spine include those related to exuberant soft tissue swelling, inappropriate formation of bone, and accelerated resorption of structural interbody grafts. Akin to other surgical advancements, the use of BMP in the cervical spine may be optimized by careful attention to details of appropriate surgical technique. These techniques reduce the risk of complications and improve the efficacy of BMP application in the cervical spine.