Orthobiologics in spine surgery: a narrative review

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 features, advantages, and limitations.

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 synthesized for inclusion in this review.

Allografts, including demineralized bone matrix (DBM), provide an osteoconductive 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 replicate natural bone matrix components and enhance fusion rates.

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 into safety, efficacy, and cost-effectiveness will be critical to optimize their role in spine surgery.