Bioceramics and biocomposites in spine surgery

Abstract

Spinal arthrodesis is an essential procedure in spine surgery which is performed to fuse two or more vertebrae. Success rates and outcomes strictly depend on substrates used to achieve a solid bony fusion of the vertebral segments. Autologous bone graft, usually harvested from the iliac crest or even locally, is traditionally considered the gold standard for its potential to lead to bone formation and integrate within surrounding tissues, although donor-site morbidity cannot be disregarded. This has led to develop alternative strategies for spinal arthrodesis, such as allogenic bone graft (both human and animal, also known as xenograft), demineralized bone matrix (DMB), synthetic and biodegradable bioceramics, local administration of bone morphogenetic proteins (BMPs), and products derived from peripheral blood (platelet-rich plasma, PRP) and bone marrow (bone marrow aspirate, BMA). While autograft exhibits ideal osteoconductive, osteoinductive, and osteogenic properties, other options must be combined to obtain constructs that own all the features. The design of an ideal bioscaffold that emulates the natural bone structure and function is still challenging. New biofabrication technologies of hybrid organic/inorganic materials with controlled architecture associated with osteoinductive growth factors can overcome the limitations of the current alternates.