Synthetic osteobiologics in spine surgery: a review

Osteobiologics are increasingly used in orthopedics and spine surgery to facilitate bone healing and prevent nonunion. Synthetic osteobiologics are artificial materials crafted in laboratories that aim to replicate the natural composition and functionality of bone. Notable materials such as calcium phosphate and calcium sulfate are engineered to mirror the mineral aspect of bone. They mimic human bone functionality, exhibiting osteoconductive, osteoinductive, and osteogenic properties. These characteristics promote cell attachment, migration, recruitment, and differentiation. Consequently, synthetic osteobiologics (osteoconductive grafts) have been introduced in bone fracture repair. The main strength of synthetic osteobiologics in spine surgery lies in improving fusion rates and clinical outcomes. The commercial biologics landscape boasts an excess of 350 bone substitute materials, a number that continues to grow exponentially with the development of subtypes. However, the proliferation of these products, primarily driven by the medical device industry and nonacademic entities, has been accompanied by a significant dearth of supporting empirical data. This deficiency underscores the imperative need for rigorous scrutiny and research to establish a solid foundation for their utilization. Healthcare professionals require high-quality research in large prospective studies with satisfactory follow-up periods to interpret and compare the performance of osteobiologics. It is particularly imperative to study the added cost of using these materials in spine surgery. In the current review, we provide an overview of the currently available synthetic osteobiologics used in spine surgery.