Osteobiologic agents in spine surgery

The treatment of spinal disorders has evolved greatly over the last 30. years, with developments in instrumentation and biologics. Pedicle screw technology has improved fusion rates. However, even with these advances the dilemma of non-unions in spinal surgery still exists. Patients with challenging deformities or biology continue to have high rates of non-unions and autograft harvest carries its own set of complications. With the current plethora of biologics available for use, every spine surgeon should understand bone biology and the utility of each product for the benefit of their patients. In this chapter, we will discuss the biology of spinal fusions and detail each major category of biological products, from autograft to ceramics, while detailing their indications and known complications.