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World J Orthop. Jul 18, 2015; 6(6): 449-456
Published online Jul 18, 2015. doi: 10.5312/wjo.v6.i6.449
Bone graft substitutes for spine fusion: A brief review
Ashim Gupta, Nitin Kukkar, Kevin Sharif, Benjamin J Main, Christine E Albers, Saadiq F El-Amin III
Ashim Gupta, Benjamin J Main, Saadiq F El-Amin III, Department of Medical Microbiology, Immunology and Cell Biology, Southern Illinois University School of Medicine, Springfield, IL 62794, United States
Ashim Gupta, Institute for Plastic Surgery, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL 62794, United States
Nitin Kukkar, Kevin Sharif, Benjamin J Main, Christine E Albers, Saadiq F El-Amin III, Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL 62794, United States
Benjamin J Main, Department of Surgery, Kansas City University of Medicine and Biosciences, Kansas City, MO 64106, United States
Author contributions: Gupta A, Kukkar N, Sharif K, Main BJ, Albers CE, and El-Amin III SF contributed to the writing, editing, and updating of this review article.
Conflict-of-interest statement: Authors have no conflicts of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Saadiq F El-Amin III, MD, PhD, Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62794, United States. sel-amin@siumed.edu
Telephone: +1-212-5457700 Fax: +1-212-5457901
Received: March 9, 2015
Peer-review started: March 12, 2015
First decision: March 20, 2015
Revised: April 17, 2015
Accepted: May 16, 2015
Article in press: May 18, 2015
Published online: July 18, 2015
Processing time: 126 Days and 18.6 Hours
Abstract

Bone graft substitutes are widely used in the field of orthopedics and are extensively used to promote vertebral fusion. Fusion is the most common technique in spine surgery and is used to treat morbidities and relieve discomfort. Allograft and autograft bone substitutes are currently the most commonly used bone grafts to promote fusion. These approaches pose limitations and present complications to the patient. Numerous alternative bone graft substitutes are on the market or have been developed and proposed for application. These options have attempted to promote spine fusion by enhancing osteogenic properties. In this review, we reviewed biology of spine fusion and the current advances in biomedical materials and biological strategies for application in surgical spine fusion. Our findings illustrate that, while many bone graft substitutes perform well as bone graft extenders, only osteoinductive proteins (recombinant bone morphogenetic proteins-2 and osteogenic protein-1) provide evidence for use as both bone enhancers and bone substitutes for specific types of spinal fusion. Tissue engineered hydrogels, synthetic polymer composites and viral based gene therapy also holds the potential to be used for spine fusion in future, though warrants further investigation to be used in clinical practice.

Keywords: Bone enhancers; Bone graft substitutes; Spine fusion; Autograft; Allograft

Core tip: In this review, we discussed the biology of spine fusion and the current advances in biomedical materials and biological strategies for application in surgical spine fusion. Our findings illustrate that, while many bone graft substitutes perform well as bone graft extenders, only osteoinductive proteins (recombinant bone morphogenetic proteins-2 and osteogenic protein-1) provide evidence for use as both bone enhancers and bone substitutes for specific types of spinal fusion. Tissue engineered hydrogels, synthetic polymer composites and viral based gene therapy also holds the potential to be used for spine fusion in the future, though further investigation is needed before being used in clinical practice.