An update on bone substitutes for spinal fusion

Eur Spine J. 2009 Jun;18(6):783-99. doi: 10.1007/s00586-009-0924-x. Epub 2009 Mar 12.


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.

Publication types

  • Review

MeSH terms

  • Bone Matrix / transplantation
  • Bone Substitutes / therapeutic use*
  • Ceramics / therapeutic use
  • Genetic Therapy / methods
  • Genetic Therapy / trends
  • Humans
  • Mesenchymal Stem Cell Transplantation / methods
  • Mesenchymal Stem Cell Transplantation / trends
  • Platelet-Derived Growth Factor / therapeutic use
  • Spinal Diseases / pathology
  • Spinal Diseases / surgery*
  • Spinal Fusion / instrumentation*
  • Spinal Fusion / methods*
  • Transplantation, Homologous / methods
  • Transplantation, Homologous / trends


  • Bone Substitutes
  • Platelet-Derived Growth Factor