Autologous bone grafts and allografts are the most accepted procedures for achieving spinal fusion. Recently, breakthroughs in understanding bone biology have led to the development of novel approaches to address the clinical problem of bone regeneration in an unfavorable environment, while bypassing the drawbacks of traditional treatments, including limited availability, donor site morbidity, risk of disease transmission and reduced osteogenicity. These approaches have also been studied for their effectiveness in reaching successful spinal fusion. This review focuses on the cellular and molecular mechanisms explaining the rationale behind these methods, including bone marrow aspirate and mesenchymal stem cells, platelet-rich plasma, bone morphogenetic proteins and gene therapy, which have opened a promising perspective in the field of bone formation in spinal surgery.
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