{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T22:02:43Z","timestamp":1791669763414,"version":"4.3.4"},"reference-count":73,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"18","license":[{"start":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T00:00:00Z","timestamp":1753747200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,9,17]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Lumbar spinal fusion (LSF) is a common surgical procedure for treating lumbar degenerative conditions. The use of osteobiologics to enhance fusion has emerged as a promising alternative to address the limitations of autologous iliac crest bone graft (AICBG), but their comparative efficacy and safety remain unclear. This systematic review and network meta-analysis (NMA) aimed to assess the fusion rates, safety profiles, and clinical outcomes of the use of osteobiologics in LSF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>PubMed\/MEDLINE and Scopus databases were searched for randomized controlled trials (RCTs) comparing different osteobiologics to AICBG in LSF. Data on fusion rates, complications, pain, disability, blood loss, operative time, and length of stay (LOS) were extracted. The risk of bias was evaluated using the Cochrane Risk of Bias-2 tool, and the certainty of evidence was assessed using the GRADE framework. The NMA was performed using a frequentist random-effects model to compare the efficacy and safety of various osteobiologics, along with associated perioperative and clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Forty-three RCTs including a total of 3,823 patients were identified. The use of rhBMP-2 (recombinant human bone morphogenetic protein-2) significantly improved fusion rates (odds ratio [OR]: 3.71; 95% confidence interval [CI]: 2.59 to 5.32; p &lt; 0.0001) and reduced complications (OR: 0.30; 95% CI: 0.13 to 0.68; p &lt; 0.0001) compared with AICBG, with moderate certainty of the evidence. Other osteobiologics, including ABM\/P-15 (anorganic bone matrix\/15-amino acid peptide fragment) and allograft, demonstrated reduced complication rates, although the quality of the evidence was low to very low. No significant differences were observed for pain, disability, or LOS. The use of rhBMP-2, autologous local bone, and silicate-substituted calcium phosphate was associated with decreased operative time, with rhBMP-2 additionally associated with lower intraoperative blood loss.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Use of rhBMP-2 was associated with significantly higher fusion and lower complication rates compared with AICBG, as well as decreased operative time and blood loss. Other osteobiologics may also offer benefits, but the supporting evidence is low-quality and limited by the notable underrepresentation of these materials in the published literature.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level I<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.24.01205","type":"journal-article","created":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T18:03:40Z","timestamp":1753812220000},"page":"2110-2121","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":9,"title":["Efficacy and Safety of Osteobiologics for Lumbar Spinal Fusion"],"prefix":"10.2106","volume":"107","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2424-1274","authenticated-orcid":false,"given":"Luca","family":"Ambrosio","sequence":"first","affiliation":[{"name":"Research Unit of Orthopaedic and Trauma Surgery, Faculty of Medicine and Surgery, Universita\u0300 Campus Bio-Medico Di Roma, Rome, Italy"},{"name":"Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy"},{"name":"Department of Orthopedic Surgery, Tokai University School of Medicine, Isehara, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5489-2591","authenticated-orcid":false,"given":"Jordy","family":"Schol","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Tokai University School of Medicine, Isehara, Japan"},{"name":"Center for Musculoskeletal Innovative Research and Advancement (C-MiRA), Tokai University Graduate School, Isehara, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5384-8158","authenticated-orcid":false,"given":"Shota","family":"Tamagawa","sequence":"additional","affiliation":[{"name":"Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7143-4354","authenticated-orcid":false,"given":"Sathish","family":"Muthu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Government Medical College, Karur, India"},{"name":"Department of Biotechnology, Faculty of Engineering, Karpagam Academy of Higher Education, Coimbatore, India"},{"name":"Department of Spine Surgery, Orthopaedic Research Group, Coimbatore, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4189-9270","authenticated-orcid":false,"given":"Daisuke","family":"Sakai","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Tokai University School of Medicine, Isehara, Japan"},{"name":"Center for Musculoskeletal Innovative Research and Advancement (C-MiRA), Tokai University Graduate School, Isehara, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6069-4871","authenticated-orcid":false,"given":"Rocco","family":"Papalia","sequence":"additional","affiliation":[{"name":"Research Unit of Orthopaedic and Trauma Surgery, Faculty of Medicine and Surgery, Universita\u0300 Campus Bio-Medico Di Roma, Rome, Italy"},{"name":"Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7142-1660","authenticated-orcid":false,"given":"Gianluca","family":"Vadal\u00e0","sequence":"additional","affiliation":[{"name":"Research Unit of Orthopaedic and Trauma Surgery, Faculty of Medicine and Surgery, Universita\u0300 Campus Bio-Medico Di Roma, Rome, Italy"},{"name":"Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4739-9795","authenticated-orcid":false,"given":"Vincenzo","family":"Denaro","sequence":"additional","affiliation":[{"name":"Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,7,29]]},"reference":[{"issue":"5","key":"bib1-20250917","doi-asserted-by":"crossref","first-page":"1748","DOI":"10.1007\/s00586-023-08041-4","article-title":"Clinical effectiveness of reduction and fusion versus in situ fusion in the management of degenerative lumbar spondylolisthesis: a systematic review and meta-analysis","volume":"33","author":"Wang","year":"2024","journal-title":"Eur Spine J."},{"issue":"4","key":"bib2-20250917","doi-asserted-by":"crossref","first-page":"E10","DOI":"10.3171\/2015.7.FOCUS15292","article-title":"Lumbar pseudarthrosis: a review of current diagnosis and treatment","volume":"39","author":"Chun","year":"2015","journal-title":"Neurosurg Focus."},{"issue":"1","key":"bib3-20250917","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1186\/s12891-024-07531-w","article-title":"Pseudarthrosis risk factors in lumbar fusion: a systematic review and meta-analysis","volume":"25","author":"Boonsirikamchai","year":"2024","journal-title":"BMC Musculoskelet Disord."},{"issue":"4","key":"bib4-20250917","first-page":"137","article-title":"Biotechnologies and Biomaterials in Spine Surgery","volume":"29","author":"Vadala\u2019","year":"2015","journal-title":"J Biol Regul Homeost Agents."},{"issue":"6","key":"bib5-20250917","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.31616\/asj.2022.0435","article-title":"Lumbar Interbody Fusion and Osteobiologics for Lumbar Fusion","volume":"16","author":"Kim","year":"2022","journal-title":"Asian Spine J."},{"issue":"4","key":"bib6-20250917","doi-asserted-by":"crossref","first-page":"772","DOI":"10.14245\/ns.1938006.003","article-title":"Impact of Iliac Crest Bone Grafting on Postoperative Outcomes and Complication Rates Following Minimally Invasive Transforaminal Lumbar Interbody Fusion","volume":"16","author":"Haws","year":"2019","journal-title":"Neurospine."},{"issue":"2_suppl","key":"bib8-20250917","doi-asserted-by":"crossref","first-page":"43S","DOI":"10.1177\/21925682231156865","article-title":"The Role of Osteobiologics in Augmenting Spine Fusion in Unplated Anterior Cervical Discectomy and Fusion Compared to Plated Constructs: A Systematic Review and Meta-analysis","volume":"14","author":"Vadal\u00e0","year":"2024","journal-title":"Global Spine 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What is the Optimal Graft Material?","volume":"81","author":"Paraj\u00f3n","year":"2017","journal-title":"Neurosurgery."},{"issue":"1","key":"bib14-20250917","doi-asserted-by":"crossref","first-page":"7546","DOI":"10.1038\/s41598-022-11551-8","article-title":"A systematic review and meta-analysis of fusion rate enhancements and bone graft options for spine surgery","volume":"12","author":"Tavares","year":"2022","journal-title":"Sci Rep."},{"key":"bib15-20250917","doi-asserted-by":"crossref","first-page":"n160","DOI":"10.1136\/bmj.n160","article-title":"PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ."},{"issue":"11","key":"bib16-20250917","doi-asserted-by":"crossref","first-page":"777","DOI":"10.7326\/M14-2385","article-title":"The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: 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Follow-Up","volume":"14","author":"Andresen","year":"2024","journal-title":"Global Spine J."},{"issue":"21","key":"bib23-20250917","doi-asserted-by":"crossref","first-page":"2396","DOI":"10.1097\/00007632-200211010-00015","article-title":"Clinical and radiographic outcomes of anterior lumbar interbody fusion using recombinant human bone morphogenetic protein-2","volume":"27","author":"Burkus","year":"2002","journal-title":"Spine (Phila Pa 1976)."},{"issue":"5","key":"bib24-20250917","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1097\/00024720-200210000-00001","article-title":"Anterior lumbar interbody fusion using rhBMP-2 with tapered interbody cages","volume":"15","author":"Burkus","year":"2002","journal-title":"J Spinal Disord Tech."},{"issue":"6","key":"bib25-20250917","first-page":"1205","article-title":"Use of rhBMP-2 in combination with structural cortical allografts: clinical and radiographic outcomes in anterior lumbar spinal surgery","volume":"87","author":"Burkus","year":"2005","journal-title":"J Bone Joint Surg Am."},{"issue":"6","key":"bib26-20250917","doi-asserted-by":"crossref","first-page":"924","DOI":"10.14444\/7141","article-title":"A Prospective, Randomized Study Evaluating Clinical and Radiographic Efficacy of Lumbar Interbody Fusion Performed Using a Truss Technology-Based Interbody Fusion Device With Homologous Bone or Bone Marrow Aspirate","volume":"14","author":"Chatterjee","year":"2020","journal-title":"Int J Spine Surg."},{"issue":"1","key":"bib27-20250917","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1007\/s00586-022-07440-3","article-title":"Mid-term efficacy and safety of Escherichia coli-derived rhBMP-2\/hydroxyapatite carrier in lumbar posterolateral fusion: a randomized, multicenter study","volume":"32","author":"Cho","year":"2023","journal-title":"Eur Spine 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Am."},{"issue":"22","key":"bib34-20250917","doi-asserted-by":"crossref","first-page":"2534","DOI":"10.1097\/01.brs.0000240715.78657.81","article-title":"Clinical outcomes and fusion success at 2 years of single-level instrumented posterolateral fusions with recombinant human bone morphogenetic protein-2\/compression resistant matrix versus iliac crest bone graft","volume":"31","author":"Dimar","year":"2006","journal-title":"Spine (Phila Pa 1976)."},{"issue":"6","key":"bib35-20250917","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.2106\/JBJS.H.00200","article-title":"Clinical and radiographic analysis of an optimized rhBMP-2 formulation as an autograft replacement in posterolateral lumbar spine arthrodesis","volume":"91","author":"Dimar","year":"2009","journal-title":"J Bone Joint Surg Am."},{"issue":"12","key":"bib36-20250917","doi-asserted-by":"crossref","first-page":"1899","DOI":"10.1016\/j.spinee.2020.07.014","article-title":"Randomized clinical trial: expanded 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