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Fusion Biologics

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Abstract

The biology of spinal fusion is a complex process that requires perfect coordination of multiple molecular, cellular, and structural events for a successful outcome. Although spinal fusion surgery has been performed for decades, the understanding of this process is still in a state of evolution. Current focus has been on elucidating the mechanism of fusion and finding alternatives or adjuncts to the traditionally viewed gold standard of iliac crest bone autograft. Studies of the process of bone healing and formation have described some of the critical components and, therefore, targets to harvest or replicate. The identification and successful application of growth factors found during bone healing has led to increasing interest in the molecular mechanisms of spinal fusion. These topics serve as current and future areas for investigation. Vast arrays of clinically available spinal biologics exist or are planned. It is vital that surgeons have an understanding of the basic science of spinal fusion to facilitate critical decision making when choosing, or forgoing, a bone graft alternative.

Spinal fusion is the bony union of two or more contiguous vertebrae causing elimination of motion at the respective segment(s). The biologic principles of spinal fusion are complex and multifactorial. Although it shares some fundamental attributes of long bone fracture healing, spinal fusion has its own unique considerations that are not as well understood. The steady increase in spinal fusion surgery in recent decades and the potential morbidity associated with pseudoarthrosis have brought with it an increasing interest in the biology of spinal fusion. The advent of improved animal models has helped further our knowledge and provided important agents to assist in promoting fusion. As the array of available bone graft options and alternatives increases, it is important to understand the underlying basic science to facilitate decision making and provide optimal outcome.

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Authors and Affiliations

  1. Seaview Orthopaedic and Medical Associates, Ocean, NJ, USA

    Praveen K. Yalamanchili MD

  2. Department of Orthopaedic Surgery, Emory School of Medicine, The Emory Spine Center, Atlanta, GA, USA

    Scott D. Boden MD

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  1. Praveen K. Yalamanchili MD
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  2. Scott D. Boden MD
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Correspondence to Scott D. Boden MD .

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Editors and Affiliations

  1. Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA

    Frank Phillips

  2. Scoliosis and Spine Tumor Center, Texas Back Institutes, Texas Health Presbyterian Hospital Plano, Plano, Texas, USA

    Isador Lieberman

  3. Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA

    David Polly

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Yalamanchili, P.K., Boden, S.D. (2014). Fusion Biologics. In: Phillips, F., Lieberman, I., Polly, D. (eds) Minimally Invasive Spine Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5674-2_8

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  • DOI: https://doi.org/10.1007/978-1-4614-5674-2_8

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