Bone graft substitutes in spine surgery

Very few topics in spinal reconstructive surgery have generated such interest over the past few years as bone grafts and their substitutes have generated. The traditional standard, autogenous iliac crest bone graft, has been used for spinal fusions for nearly a century. However, the morbidity encountered during and after harvesting autograft has led to the development of biologic tools to replace autograft. Current orthopedic literature is rampant with clinical and basic science data chronicling the evolution and development of these substances by both the clinician and industry alike. This review discusses autogenous bone grafts as well as other fusion-enhancing tools with particular attention to pertinent objective clinical data. As the horizons of our knowledge of bone graft biology continue to expand, the new millennium promises to be an exciting time for the further evolution of these materials.