Comparison of fusion outcomes of bone morphogenetics proteins-7 and bone autograft in posterolateral lumbar fusion: A systematic review

The aim of the study is to evaluate the parameter of fusion success of Bone Morphogenetic Protein-7 (BMP-7 or osteogenic pro- tein-1) versus autograft (autogenous iliac crest bone graft (ICBG) or cancellous bone) in posterolateral fusion (PLF) of the spine. A systematic search of all articles published through January 1, 2000 to January 2022 was conducted in databases such as PubMed, Cochrane Collaboration Library, and Cross Reference. Randomized controlled trials (RCTs) that compared BMP-7 with autograft for the treatment of degenerative spondylolisthesis, provided the clinical success rate and fusion rate were assessed using Medical Subject Headings terms ‘‘bone morphogenetic protein,“ and ‘‘spinal fusion.” Two independent investigators screened eligible studies, assessed the bias of original articles, extracted data including radiological fusion success, Oswestry disability index improvement. Inclusion criteria were randomized controlled trial studies published in Indonesian or English. Initial selection yielded 246 studies, and 8 studies were selected for the systematic review. Posterolateral fusion had been used as therapy for spondylolisthesis and symptomatic canal stenosis. Based on the systematic review to date, there are several studies that provide complete information of fusion success. There is no significant difference between BMP-7 and autograft. There are several factors that affects successful radiological fusion success and Oswestry Disability Index such as composite carrier, instruments use, decompression factor, and the definition for radiological fusion success. Further research is needed to compare the benefit of BMP-7 as effective substitute for autograft.