Fusion biologics and adjuvants in minimally invasive spine surgery

Gurmit Singh, Wellington K. Hsu*

*Corresponding author for this work

Research output: Chapter in Book/Report/Conference proceedingChapter

2 Scopus citations


The utilization of minimally invasive spine fusion is increasing due to several benefits associated with it including shorter hospital stays, lower blood loss, and improved functional outcomes. The selection of a proper biologic based on its properties of osteoconductivity, osteoinductivity, and osteogenecity determines the success of spinal arthrodesis. Autologous bone graft, specifically iliac crest bone graft (ICBG), remains the historic gold standard due to its inherent osteoconductive, osteogenic, and osteoinductive nature without the risk of immunogenic reaction or disease transmission. However, there has been a significant interest in the development of bone graft substitutes and enhancers to relieve the shortcomings, including donor site morbidity, postoperative complications, and limited graft availability, of iliac crest bone graft. As a result, there has been an expansion of graft options such as allografts, demineralized bone matrix, ceramics, and growth factors. Bone morphogenetic proteins have been increasingly utilized in the last decade due to their efficacious osteoinductive properties. However, since their approval, the bone morphogenetic protein (BMP) use has been scrutinized due to its associations with a number of complications. There is an increased focus to alleviate these complications by lowering the dose of growth factor required through improved delivery and localization systems. Lastly, more data are required to establish the clinical efficacy of newer technologies such as cell and synthetic peptide-based therapy that may serve as viable options in the future.

Original languageEnglish (US)
Title of host publicationMinimally Invasive Spine Surgery
Subtitle of host publicationSurgical Techniques and Disease Management
PublisherSpringer International Publishing
Number of pages16
ISBN (Electronic)9783030190071
ISBN (Print)9783030190064
StatePublished - Jan 1 2020


  • Allograft
  • Autograft
  • Biologics
  • Bone graft
  • Bone morphogenetic protein (BMP)
  • Ceramics
  • Demineralized bone
  • Growth factors
  • Minimally invasive
  • Polyetheretherketone (PEEK) cage

ASJC Scopus subject areas

  • Medicine(all)


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