• Jeremiah Hilkiah Wijaya, Teddy Tjahyanto, Roberto Alexi, Alexander Erick Purnomo, Louis Rianto, Yang Yang Endro Arjuna, Jephtah Furano Lumban Tobing, Yesaya Yunus, and Ahmad Faried.
• Department of Neurosurgery, Universitas Pelita Harapan, MH Thamrin Boulevard 1100, Karawaci, Tangerang, 15811, Banten, Indonesia. jeremiah.hansum6@gmail.com.
• Eur Spine J. 2023 Jun 1; 32 (6): 202020282020-2028.

PurposeSafety 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.MethodsWe 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.ResultsOur 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).ConclusionsOur 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.© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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