For a study, the researchers sought to assess early postoperative problems linked with bone morphogenic protein (BMP) in posterior cervical fusion (PCF) and determine if BMP caused adverse early clinical outcomes. A secondary goal was to discover the best location for BMP sponge placement, whether it was within the facet joint (IF) or elsewhere, and the best dosage and amount. A retrospective, case-control research was conducted. PCF was performed on 765 patients. PROs (patient-reported outcomes), complications, arthrodesis, and the best BMP dose/level. Preoperative diagnosis, fused levels, kind of bone transplant, BMP dose (if utilized), and fusion technique were all noted in the surgery. Complications were determined by evaluating the medical record for the first 6 weeks after surgery. Medical, neurological, and wound-related problems and reoperation were among them. Any new weakness, radicular discomfort, or numbness were considered neurological problems. SF36, VAS, EQ-5D, and NDI scores were gathered as PROs. A sub-analysis was carried out to find the best dosage and location for BMP placement. In terms of wound complications, neurological issues, or reoperation, there were no significant differences between the BMP and non-BMP groups. Between BMP and no BMP, there were no variations in PROs. Wound-related problems were reduced by using BMP for IF and at a 0.87 mg/level dose. When comparing the BMP group with the non-BMP group 1 year after surgery, the BMP group had a greater fusion rate (96% vs 91%, P=0.02). When the dose of BMP was reduced, it was not linked to a higher rate of early problems after PCF. Compressive seroma, radiculitis, and wound-related problems, which were associated with BMP, were not determined at a greater rate. Early follow-up PROs were similar. BMP injections for IF at lower doses than previously reported could reduce problems.