Biological Approaches to Spinal Fusion

Abstract

Bone grafting procedures are frequently performed for spinal applications in an attempt to promote successful arthrodesis. Autograft remains the gold standard grafting material. However, due to relatively limited supply and the morbidity associated with procurement of autograft, there has been a great deal of interest in developing alternative bone graft materials. Allograft and ceramic preparations are osteoconductive matrices that support bone formation, but these materials exhibit minimal osteoinductive potential. Recent research efforts have focused specifi cally on osteoinductive substances such as demineralized bone matrices, recombinant human bone morphogenetic proteins and autologous bone marrow aspirates. Since none of these materials deliver all of the elements required for bone formation when implanted alone, composite grafts, consisting of osteoinductive factors combined with an osteoconductive carrier, may prove to be more effective in stimulating spinal fusion than any single graft substitute.