Sir,
Thank you for the opportunity to respond to the “letter to the editor” on the above journal article that we submitted which was graciously accepted and published. We agree with several points indicated in the letter as far as it being “good supportive evidence”. We also agree on the comment on small sample size. Since publication, we have doubled the number of patients without any complications pending a minimum 2-year follow-up. We do indeed share the concerns of cost, limiting its use. For most “hard to fuse” patients (rheumatoid disease, severe osteoarthritis) and also for patients undergoing revision surgery, the possibility of maximizing fusion postfixation may need to be considered with regard to cost as mentioned in the above letter. In all, for the carefully selected patient, rhBMP-2 has been safe and efficacious in the promoting posterior occipital cervical region fusion with instrumentation.