European Spine Journal

, Volume 18, Issue 6, pp 783–799 | Cite as

An update on bone substitutes for spinal fusion

  • Masashi Miyazaki
  • Hiroshi Tsumura
  • Jeffrey C. Wang
  • Ahmet AlanayEmail author
Review Article


With the current advances in spinal surgery, an understanding of the precise biological mechanism of each bone substitute is necessary for inducing successful spinal fusion. In this review, the categories of bone substitutes include allografts, ceramics, demineralized bone matrix, osteoinductive factors, autogenous platelet concentrate, mesenchymal stem cells, and gene therapy. Further, clinical studies have been evaluated by their levels of evidence in order to elucidate the precise effect of the bone substitute employed and to establish clinical guidance. This article will review both clinical studies based on evidence and basic research in current advances in order to avoid as far as possible any chances of failure in the future and to understand cellular biology in novel technologies.


Bone substitutes Spinal fusion Demineralized bone matrix Bone morphogenic protein Gene therapy 


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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Masashi Miyazaki
    • 1
  • Hiroshi Tsumura
    • 1
  • Jeffrey C. Wang
    • 2
  • Ahmet Alanay
    • 3
    Email author
  1. 1.Department of Orthopaedic SurgeryOita UniversityOitaJapan
  2. 2.Department of Orthopaedic SurgeryUniversity of California at Los AngelesLos AngelesUSA
  3. 3.Department of Orthopaedics and Traumatology, Faculty of MedicineHacettepe UniversityAnkaraTurkey

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