2005, pp 225-239

Biology of Spine Fusion

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Spinal fusion was first reported in the United States in 1911 by Hibbs and Albee for the treatment of scoliosis and tuberculosis (1,2). Since that time, the indications for spinal arthrodesis have continued to increase, and, in the late 1990s, approx 250,000 spinal fusions were performed each year in the United States (3,4). The rate of nonunion after spinal arthrodesis is reported to range from 5% to 35% (5). Better biomechanical control of the fusion environment with instrumentation and the use of autologous bone grafting techniques have failed to eliminate the problem of pseudoarthrosis in spine surgery (612). As spinal surgery enters the new millennium, attention is focused on the biology of spine fusion to further enhance the rate of successful arthrodesis (13).