The September issue of The Spine Journal is devoted to the casualties of war and reveals facts about the psychological and physical effects of war.

Craig Rabb, MD, is a professor in the department of neurosurgery at the University of Oklahoma's College of Medicine. He is also the director of the neurotrauma program.

Paul Slosar, MD, is a spine surgeon and president of SpineCare Medical Group at the San Francisco Spine Institute.

In July, the official journal of the North American Spine Society, The Spine Journal, released an issue dedicated to the use of recombinant bone morphogenic protein. The only BMP product on the market currently approved by the FDA for promoting spinal fusion is Medtronic's Infuse, which has been the gold standard in BMP use since it was approved in 2003. Now, surgeons and researchers are raising questions about its efficacy in off-label use because additional studies have linked it to complications, including retrograde ejaculation in male patients.

The use of Infuse even among on-label applications has recently come into question as well because some feel the field is lacking evidence-based literature proving BMP creates better outcomes. Without solid backing from strong studies, hospitals and insurance companies are hard-pressed to approve the use of Infuse, since it is considerably more expensive than the alternatives.

The Spine Journal, the journal of the North American Spine Society, has announced editorial changes aimed at becoming more transparent and protecting scientific integrity, according to a NASS news release.

In June, Eugene Carragee, MD, editor-in-chief for the North American Spine Society's The Spine Journal and a spine surgeon at Stanford University School of Medicine, co-authored an article showing that the use for recombinant bone morphogenic protein was associated with retrograde ejaculation among male patients, which could cause infertility. The study, published in The Spine Journal, was surprising for many spine surgeons who had been using Medtronic's Infuse, an rhBMP-2 product, with patients for spinal fusions over several years because they weren't aware of the complication risks. At the same time, the articles' authors revealed that while Medtronic reported complications of RE to the FDA for clearance, the data about these complications was not made available for the public in peer review articles sponsored by Medtronics.