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Application of rhBMP in spinal fusion surgery: any correlation of cancer incidence? A systematic review and meta-analysis

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Abstract

Purpose

Safety concerns regarding the application of bone morphogenetic proteins (BMPs) have been highlighted in recent years. It is noted that both BMP and their receptors being identified as a trigger for cancer growth. Here, we aimed to determine the safety and efficacy of BMP for spinal fusion surgery.

Methods

We conducted this systematic review on topics of spinal fusion surgery with rhBMP application from three database (PubMed, EuropePMC, and Clinicaltrials.gov) with MeSH phrases such as “rh-BMP,” ”rhBMP,” “spine surgery,” “spinal arthrodesis,” and “spinal fusion” were searched (using the Boolean operators “and” and “or”). Our research includes all articles, as long as published in English language. In the face of disagreement between the two reviewers, we discussed it together until all authors reached a consensus. The primary key outcome of our study is the incidence of cancer following rhBMP implantation.

Results

Our study included a total of 8 unique studies (n = 37,682). The mean follow-up varies among all studies, with the longest follow-up is 66 months. Our meta-analysis showed that exposure to rhBMP in spinal surgery did increase the risk of cancers (RR 1.85, 95%CI [1.05, 3.24], p = 0.03).

Conclusions

Our study found that rhBMP was not associated with the increased risk of cancer incidence within the rhBMP cohort. Still, we did face several limitations, in which further studies are needed to confirm the result of our meta-analysis.

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Data availability

All data will be given upon reasonable requests by contacting the corresponding author of the current study.

Abbreviations

rhBMP:

Recombinant human bone morphogenetic protein

OP-1:

Osteogenic protein 1

FDA:

US food and drug administration

PRISMA:

Preferred reporting items for systematic review and meta-analysis

NOS:

Newcastle–Ottawa Scale

RoB:

Risk of bias

RR:

Risk ratio

CI:

Confidence interval

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Authors and Affiliations

  1. Department of Neurosurgery, Universitas Pelita Harapan, MH Thamrin Boulevard 1100, Karawaci, Tangerang, 15811, Banten, Indonesia

    Jeremiah Hilkiah Wijaya, Alexander Erick Purnomo, Yang Yang Endro Arjuna & Yesaya Yunus

  2. Department of Medicine, Tarumanagara University, Jakarta, Indonesia

    Teddy Tjahyanto

  3. Department of Medicine, Santo Vincentius Hospital, Singkawang, West Kalimantan, Indonesia

    Roberto Alexi

  4. Department of Orthopedics, Universitas Pelita Harapan, Karawaci, Tangerang, Banten, Indonesia

    Louis Rianto & Jephtah Furano Lumban Tobing

  5. Department of Neurosurgery, Universitas Padjajaran, Bandung, West Java, Indonesia

    Ahmad Faried

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  1. Jeremiah Hilkiah Wijaya
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Wijaya, J.H., Tjahyanto, T., Alexi, R. et al. Application of rhBMP in spinal fusion surgery: any correlation of cancer incidence? A systematic review and meta-analysis. Eur Spine J 32, 2020–2028 (2023). https://doi.org/10.1007/s00586-023-07730-4

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