Nwachukwu BU, et al. – This study assessed bone morphogenetic protein (BMP) utilization, factors associated with its use and its long–term prognostic impact in pediatric spinal arthrodesis. As per documented data, off–label use of BMP for pediatric spinal arthrodesis increased until 2008 and now appears to be decreasing. BMP was less likely to be utilized by racial/ethnic minorities and lower socioeconomic status patients. In addition, the rate of revision after spinal arthrodesis did not vary between those treated with and without BMP.