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The review addresses why autologous bone graft, despite being the gold standard, is limited by donor-site pain and morbidity, restricted graft volume, and diminished osteoinductive capacity after mineralization. It summarizes available orthobiologic options used in practice, including allografts such as demineralized bone matrix, and fusion adjuvants like recombinant human bone morphogenetic proteins, alongside newer biomimetic peptide-based and cellular-augmented approaches. It also outlines benefits, drawbacks, and the need for ongoing work on safety, efficacy, and cost-effectiveness.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/orthobiologics-in-spine-surgery-a-narrative-review/450958/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/orthobiologics-in-spine-surgery-a-narrative-review/450958.png","ImageObject",300,407,{"name":92,"@type":93},"Aditya","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why are orthobiologics important in spine surgery?","Question",{"text":112,"@type":113},"They augment spinal fusion by improving osseous union locally and helping address limitations of autologous graft harvest. The review emphasizes their role in enhancing fusion success while minimizing associated drawbacks.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What are the main limitations of autologous bone graft?",{"text":117,"@type":113},"Autologous graft use is constrained by donor-site pain and morbidity, limited available graft volume, and reduced osteoinductive capacity in the mineralized state.",{"name":119,"@type":110,"acceptedAnswer":120},"How do different orthobiologic materials differ in function?",{"text":121,"@type":113},"Graft materials are described by three properties: osteoconductivity (scaffold), osteoinductivity (molecular signals stimulating osteogenesis), and osteogenicity (viable bone-forming cells). The review relates allografts, growth factors such as rhBMPs, and newer biomimetic options to these principles.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},450958,1790762985,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":39,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":46,"preview_page_count":4},962085564549,"https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","Orthobiologics in spine surgery: a narrative review  \nJanice M. Bonsu1, Vivek A. Pisharody2, Scott D. Boden1, Brian C. Goh1  \n1Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA; 2Emory University School of Medicine, Atlanta, GA, USA  \nContributions: (I) Conception and design: JM Bonsu, BC Goh, SD Boden; (II) Administrative support: BC Goh, SD Boden; (III) Provision of study materials or patients: All authors; (IV) Collection and assembly of data: JM Bonsu, VA Pisharody; (V) Data analysis and interpretation: All authors; (VI)  \nManuscript writing: All authors; (VII) Final approval of manuscript: All authors.  \nCorrespondence to: Brian C. Goh, MD, PhD. Department of Orthopaedic Surgery, Emory University School of Medicine, 21 Ortho Lane, Atlanta, GA  \n30329, [USA. Email: brian.goh@emory.edu](USA. Email: brian.goh@emory.edu).  \nBackground and Objective: Orthobiologics play a critical role in contemporary spine surgery. While autologous bone graft remains the gold standard for spinal fusion, its use is limited by donor site pain and morbidity, finite graft volume, and reduced osteoinductive capacity in the mineralized state. A range of orthobiologic materials has been developed to address these limitations. The objective of this narrative review is to summarize the orthobiologic options currently used in spine surgery and outline their key  \nfeatures, advantages, and limitations.  \nMethods: A nonsystematic review of the literature was performed using electronic databases to identify peer-reviewed articles relevant to the use of orthobiologics in spine surgery. Articles were reviewed in full by the authors. Orthobiologic materials were categorized, and their principal benefits and drawbacks were  \nsynthesized for inclusion in this review.  \nKey Content and Findings: Allografts, including demineralized bone matrix (DBM), provide anosteoconductive scaffold without donor site morbidity, thought heir osteoinductive capacity is variable and they lack intrinsic osteogenic potential. Growth factors, such as recombinant human bone morphogenic proteins (rhBMPs), act as potent fusion adjuvants by stimulating osteogenesis; however, concerns remain regarding their safety profile and off-label applications. Newer options, such as synthetic peptide-based compounds (e.g., P-15) and cellular-augmented allografts, represent a biomimetic approach designed to  \nreplicate natural bone matrix components and enhance fusion rates.  \nConclusions: Orthobiologics are a rapidly evolving field of bone graft substitutes and extenders that can augment spinal fusion rates while minimizing the drawbacks of autologous graft harvest. Ongoing research  \ninto safety, efficacy, and cost-effectiveness will be critical to optimize their role in spine surgery.  \nKeywords: Orthobiologics; spine fusion; osteoinductive; allograft; bone morphogenetic protein  \nSubmitted May 03, 2025. Accepted for publication Aug 29, 2025. Published online Dec 11, 2025.  \ndoi: 10.21037/jss-25-69  \nView this article at: [https://dx.doi.org/10.21037/jss-25-69](https://dx.doi.org/10.21037/jss-25-69)  \nIntroduction  \nIn orthopaedic surgery, one of the principal challenges in achieving successful bony fusion is optimizing a patient’s modifiable risk factors to enhance healing. In the management of many spinal pathologies, surgical goals often include decompression of neural elements, and when indicated, stabilization of the vertebral column through  \nbony fusion (1) . Nonunion, the failure to achieve solid fusion within one year of surgery, is a relatively common complication of spine surgery (2) . Although the exact incidence remains unknown, reported rates reach up to 56% in the lumbar spine and 26% in the cervical spine (2) . The term ‘orthobiologic’ refers to biologically active materials used in orthopaedic surgery that provide not only structural support but also enhance musculoskeletal healing.  \n© AME Publishing Company. J Spine Surg 2025;11(4):1065-1","cbCaihATKrFKgCbF","https://ap.wps.com/l/cbCaihATKrFKgCbF","pdf",218478,"English","# Background and Objective\n# Methods\n# Key Content and Findings\n## Allografts and demineralized bone matrix\n## Growth factors and recombinant human BMPs\n## Synthetic peptide-based and cellular-augmented approaches\n# Conclusions\n# Introduction\n## Modifiable risk factors and nonunion\n## Definition and role of orthobiologic materials\n# Table 1 Literature search strategy","[{\"question\":\"Why are orthobiologics important in spine surgery?\",\"answer\":\"They augment spinal fusion by improving osseous union locally and helping address limitations of autologous graft harvest. The review emphasizes their role in enhancing fusion success while minimizing associated drawbacks.\"},{\"question\":\"What are the main limitations of autologous bone graft?\",\"answer\":\"Autologous graft use is constrained by donor-site pain and morbidity, limited available graft volume, and reduced osteoinductive capacity in the mineralized state.\"},{\"question\":\"How do different orthobiologic materials differ in function?\",\"answer\":\"Graft materials are described by three properties: osteoconductivity (scaffold), osteoinductivity (molecular signals stimulating osteogenesis), and osteogenicity (viable bone-forming cells). The review relates allografts, growth factors such as rhBMPs, and newer biomimetic options to these principles.\"}]","Orthobiologics in spine surgery - a narrative review | PDF",1790734125]