Introduction: Several recently published case series report the development of vertebral body osteolysis following the insertion of bone morphogenetic proteins (BMP) in the interbody space.

The aim of this case report was to highlight the development of severe vertebral body osteolysis following posterior lumbar interbody fusion with recombinant human bone morphogenetic protein (rhBMP-2).

Methods: A 62 year old male who developed adjacent segment disease 13 years after an L4/5 and L5/S1 posterolateral fusion underwent what appeared to be a successful instrumented L3/4 posterior lumbar interbody fusion using morselised posterior elements and scavenged drilled particulate interbody autograft together with a single large sized sponge of rhBMP-2.

Results: He continued to experience intermittent episodes of severe low back pain following that procedure, and a CT scan performed three months post-operatively revealed severe osteolysis of the L3 and L4 vertebral bodies. Although he was a type 2 diabetic, extensive investigations did not reveal any evidence of infection

Discussion: Vertebral body osteolysis has previously been reported following the use of BMP in the interbody space. The mechanism for this is unclear, but may be due to osteoclast activation. The prevalence of this complication following the use of BMP is not known. It is recommended that a process of independent post-marketing surveillance be established to further investigate this possible complication of the use of BMP in posterior interbody fusion.