Recombinant human bone morphogenetic protein-2 in spine surgery: recommendations for use and alternative bone substitutes-a narrative review

i) Recommend clear informed consent regarding current evidence of using rhBMP-2 and alternative bone graft substitutes.
ii) Consideration of rhBMP-2 for spinal fusion surgery especially adult spinal deformity (ASD) surgery, lumbar surgery for multilevel degenerative disease, revision surgery for pseudoarthrosis, and surgery in patients with a low-quantity or low-quality autograft.
iii) Regulatory oversight of the type, volume, and dose of bone graft substitute (both per level and per procedure) to ensure appropriate indications and enhance cost containment.

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