Advances in osteobiologics in spine surgery.

In spine surgery, fixation devices that revolutionized spinal fusion are becoming mature technologies, and new tools derived from biologics are becoming more important in clinical practice. Thus, surgeons need to become more sophisticated in evaluating and using these new biologics, which are rapidly entering the market. The majority of these biologics are aimed at enhancing spinal fusion and can be called osteobiologics. Osteobiologic products vary from recombinant proteins to specially prepared allograft or autograft materials. Their financial costs are considerable, and the level of proof for the efficacy and safety of these products varies widely. In this article, I delineate useful principles that can be used to evaluate current and future generations of osteobiologic products, and I discuss the most pertinent examples of specific osteobiologics.