Heterotopic ossification associated with recombinant human bone morphogenetic protein-2 (infuse) in posterolateral lumbar spine fusion: a case report

A case of heterotopic ossification in the lumbar spine associated with the off-label use of recombinant human bone morphogenetic protein-2 (rhBMP-2) is reported. To highlight a previously unreported complication of rhBMP-2 use and to review the literature pertinent to the topic. There is no report in the literature regarding a large mass of rhBMP-2-associated heterotopic ossification surrounding the paraspinal musculature. The clinical and radiographical features of this complication and treatment course are presented. The surgical excision of heterotopic ossification and removal of symptomatic instrumentation have resulted in the patient remaining asymptomatic at 1 year of follow-up examination. The reported case adds to the literature of off-label use of rhBMP-2 and the potential for the formation of heterotopic ossification with its use.