Abstract
Spinal fusion is the most widely performed procedure in spine surgery. It is the preferred treatment for a wide variety of pathologies including degenerative disc disease, spondylolisthesis, segmental instability, and deformity. Surgeons have the choice of fusing vertebrae by utilizing cages containing autografts, allografts, demineralized bone matrices (DBMs), or graft substitutes such as ceramic scaffolds. Autografts from the iliac spine are the most commonly used as they offer osteogenic, osteoinductive, and osteoconductive capabilities, all while avoiding immune system rejection. Allografts obtained from cadavers and living donors can also be advantageous as they lack the need for graft extraction from the patient. DBMs are acid-extracted organic allografts with osteoinductive properties. Ceramic grafts containing hydroxyapatite can be readily manufactured and are able to provide osteoinductive support while having a long shelf life. Further, bone-morphogenetic proteins (BMPs), mesenchymal stem cells (MSCs), synthetic peptides, and autologous growth factors are currently being optimized to assist in improving vertebral fusion. Genetic therapies utilizing viral transduction are also currently being devised. This review provides an overview of the advantages, disadvantages, and future directions of currently available graft materials. The current literature on growth factors, stem cells, and genetic therapy is also discussed.
Highlights
Interbody fusion is an established treatment option for a wide range of spinal pathologies including degenerative disc disease, herniated discs, spondylolisthesis, infections, deformity, and neoplasia with the primary goal of providing spinal stabilization [1]
This review provides a succinct overview of each bone graft material including their advantages, disadvantages, and future directions for innovation
Other disadvantages of allografts include the limited risk of HBV or HCV infection from the donor and the potential of adverse changing of the bone matrix composition during the process of sterilization with chemicals and radiation [22,26]
Summary
Interbody fusion is an established treatment option for a wide range of spinal pathologies including degenerative disc disease, herniated discs, spondylolisthesis, infections, deformity, and neoplasia with the primary goal of providing spinal stabilization [1]. There are numerous methods by which fusions can be performed These approaches include anterior and posterior approaches to the cervical spine, transpedicular, costotransversectomy, lateral extracavitary, and intrathoracic approaches to the thoracic spine, anterior (ALIF), posterior (PLIF), transforaminal (TLIF), and lateral (XLIF, DLIF, OLIF) interbody approaches to the lumbar spine. Spinal fusion surgeries involve the placement of an interbody device in a disc space or corpectomy cavity such as a cage, spacer, or structural graft to promote bony fusion [3]. There are several different types of grafts that can be chosen for placement These options include autografts, allografts, demineralized bone matrices (DBM) and/or graft substitutes such as ceramic scaffolding products. We discuss the current literature of growth factors, stem cells, and genetic therapy [4,5,6,7,8]
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