Bone quality, biology, and next-generation enhancers for spinal fusion in osteoporosis: a comprehensive narrative review with systematic search methodology

Key Points

• The aim is to explore new approaches for improving spinal fusion outcomes in osteoporosis by enhancing bone quality and biology.
• Conducted a comprehensive review and systematic search methodology to gather relevant literature.
• Evaluated the effectiveness of systemic anabolic optimization and targeted novel biologics in spinal fusion.
• Assessed evidence certainty regarding these methods through available clinical data.
• Identified moderate certainty evidence for systemic anabolic optimization in improving spinal fusion.
• Noted very low certainty evidence for the effectiveness of novel biologics delivered via biomaterial scaffolds.
• Highlighted the necessity of large-scale clinical trials to validate the proposed approaches.