Biologic Options in Interbody Fusion

A successful spine fusion is a multifactorial process dependent on a number of local and systemic factors that affect the healing response. Surgeons should assess the host biologic environment and ensure that all necessary elements are present to promote bone healing. The ideal bone graft substitute possesses three distinct properties: osteogenesis, osteoconduction, and osteoinduction. Autograft iliac crest is considered the gold standard, however, morbidity associated with graft harvest have led to the development of a number of alternatives. The field of spine biologics continues to expand and now not only includes autogenous bone graft but also allograft, demineralized bone matrix, ceramic carriers, recombinant growth factors, and tissue engineering therapies. The efficacy of these materials varies widely in the literature and should be critically evaluated prior to implantation.