Use of Bone Graft Extenders in Spinal Surgery

Abstract

Numerous materials have emerged as viable candidates for use as bone graft extenders in the setting of spinal fusion. These materials are intended to be mixed with autologous bone harvested locally (eg, from the lamina or spinous process) or from the iliac crest to reduce the total amount of autogenous bone tissue needed. A trend of decreasing reliance on iliac crest autograft coupled with a higher incidence of complex spinal surgery has driven the development of several categories of bone graft extenders, including demineralized bone matrix, calcium phosphate-based materials, calcium sulfate-based materials, bioactive glasses, and synthetic polymer composites. The goals of this article are to describe the structure, composition, and mechanisms of action of each of these material categories, and to summarize the available clinical and preclinical evidence regarding their efficacy in the setting of spinal fusion.

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