The Role of Biologic Agents in Spinal Fusion Surgery
What is the role of biologic agents in spinal fusion surgery?
What is spinal fusion?
Spinal fusion is the most widely performed procedure in spine surgery. In spinal fusion surgeries, metal is commonly used to provide stabilization. However, metal does not have any cellular stimulating properties to produce bone, so the use of a biologic material or agent is often incorporated during the surgical procedure. The addition of a biologic material is to attract and stimulate cells to produce bone and promote fusion. Biologics may be used in conjunction with the patient’s own bone (autograft) or with donated bone (allograft).
Why would a surgeon choose a biologic agent?
Biologics and graft technology continues to evolve giving the surgeon a number of options that best meets the needs of the individual patient. The option of an allograft and biologic is often done to avoid complications that may occur at the donor site with autografts. There is evidence that using biologic agents in conjunction with grafts may improve the successful fusion outcome in many patients.
What are some biologics used in spinal surgery?
An example of a common biologic used in spinal surgery are proteins used to stimulate bone growth and spinal fusion known as bone morphogenetic proteins, or “BMP’s”. Using BMP’s have been reported to reduce the pain and side effects that may be associated when harvesting the patient’s own bone.
Another biologic product that can be used is stem cells from the patient’s own bone marrow. Bone marrow cells are removed from the patient and by concentrating these cells and placing them on donors’ bone (allograft), this can replace the patient’s own bone in trying to achieve spinal fusion.
Synthetic biologics products are also available and are generally composed of ceramic or bioactive glass. Synthetic biologics may also be used in combination with an autograft as a bone graft extender, and research suggests that synthetic and biologic composites could potentially yield adequate bone healing without the need for autograft or high-dose growth factors.An example of a common biologic used in spinal surgery are proteins used to stimulate bone growth and spinal fusion known as bone morphogenetic proteins, or “BMP’s”. Using BMP’s have been reported to reduce the pain and side effects that may be associated when harvesting the patient’s own bone.
What is the future of biologics ?
The future of biologics in spinal fusion surgery continues to evolve. The use of gene therapy techniques, both to assist in spinal fusion and also potentially to repair damaged discs, thus avoiding performing a fusion and thereby the loss of motion is an example. Research and ongoing scientific understanding of the biological process involved in spinal disease are ongoing as are the development of new applications for treatment.
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D’Souza, M., Macdonald, N. A., Gendreau, J. L., Duddleston, P. J., Feng, A. Y., & Ho, A. L. (2019). Graft Materials and Biologics for Spinal Interbody Fusion. Biomedicines, 7(4), 75. https://doi.org/10.3390/biomedicines7040075