Synthetic osteobiologics in spine surgery: A review
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2025-01-01
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Osteobiologics are increasingly used in orthopedics and spine surgery to facilitate bone healing and prevent nonunion. Synthetic osteobiologics are artificial materials crafted in laboratories that aim to replicate the natural composition and functionality of bone. Notable materials such as calcium phosphate and calcium sulfate are engineered to mirror the mineral aspect of bone. They mimic human bone functionality, exhibiting osteoconductive, osteoinductive, and osteogenic properties. These characteristics promote cell attachment, migration, recruitment, and differentiation. Consequently, synthetic osteobiologics (osteoconductive grafts) have been introduced in bone fracture repair. The main strength of synthetic osteobiologics in spine surgery lies in improving fusion rates and clinical outcomes. The commercial biologics landscape boasts an excess of 350 bone substitute materials, a number that continues to grow exponentially with the development of subtypes. However, the proliferation of these products, primarily driven by the medical device industry and nonacademic entities, has been accompanied by a significant dearth of supporting empirical data. This deficiency underscores the imperative need for rigorous scrutiny and research to establish a solid foundation for their utilization. Healthcare professionals require high-quality research in large prospective studies with satisfactory follow-up periods to interpret and compare the performance of osteobiologics. It is particularly imperative to study the added cost of using these materials in spine surgery. In the current review, we provide an overview of the currently available synthetic osteobiologics used in spine surgery.
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Apaydin, Aydın Sinan, Eli Johnson, Prince Antwi, Brett Rocos, Michael M Haglund, Christopher I Shaffrey, Peter Passias, Muhammad M Abd-El-Barr, et al. (2025). Synthetic osteobiologics in spine surgery: A review. Turkish Journal of Medical Sciences, 55(1). pp. 43–51. 10.55730/1300-0144.5941 Retrieved from https://hdl.handle.net/10161/32127.
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Scholars@Duke
Brett Rocos
I joined the team at Duke University Health from London, UK, where I was a Consultant Adult and Paediatric Spine Surgeon at Barts Health NHS Trust and Honorary Consultant Senior Lecturer at Queen Mary University of London. I completed my surgical training in in the South West of the UK and at the University of Toronto, and am fellowship trained in adult spine surgery, paediatric spine surgery, orthopaedic trauma surgery, research and healthcare management.
I am driven to support patients at every stage of their care, from clinic assessment, through surgery to discharge. Making sure that every person, adult, child, family or friend understands what’s wrong, helping them to choose the right treatment for them, and what the recovery will be like is an important priority.
My research activity focusses on finding effective new treatments for spinal disorders and bringing them to patients. Focusing on spinal deformity, I have led investigations in the UK, Canada and the USA, and I sit on the Global AO Knowledge Forum for Deformity and the Research Grants Committee at the Scoliosis Research Society. I have lectured in North America and Europe about the treatment of spine disorders for the Scoliosis Research Society, Global Spine Congress, AO Spine and Eurospine, and I have worked hard to produce research that improves the care for spine patients wherever they live. Lastly, I review for several orthopaedic journals and I am Deputy Editor of the Bone and Joint 360, a leading publication with a global readership.
Michael Martin Haglund
My clinical areas of expertise include spinal surgery, especially cervical spine surgery where I have performed almost 8,300 cervical spine procedures and recently was ranked the top cervical spine surgeon in the country by MPIRICA (an analytical company that reviews surgical outcomes). I believe the whole patient is important and we emphasize time with the patient and careful discussions regarding possible surgery. Our excellent results are due to a great team of physicians, nurses, CRNAs, and anesthesiologists. I also believe in the spiritual side in taking care of my patients. As a design surgeon we are developing better ways to treat cervical spine disease through innovative approaches to the cervical spine.
Through my Masters in Academic Medicine degree, I developed the Surgical Autonomy Program which is now used in 7 Neurosurgery Programs across the country and is an innovative way to teach, assess, and provide feedback to residents in the intraoperative environment. Over the last twelve years we have developed the first ever Division of Global Neurosurgery and Neurology (launched in 2014), where I serve as the Division Chief and the Division boasts over 100 members including faculty, graduate and medical students, undergraduate students and an outstanding staff of researchers, most located in the Duke Global Health Institute. The Division has published over 120 manuscripts between 2014 and 2023. We have primarily worked in building capacity, teaching, and collaborative research projects in Uganda. In 2019 I was invited to join the faculty at the Duke-Singapore Global Health Institute and we are working with the Singapore Neuroscience Department to develop outreach and increase capacity in Jaffna, Sri Lanka.
Peter Passias
Throughout my medical career, I have remained dedicated to improving my patients' quality of life. As a specialist in adult cervical and spinal deformity surgery, I understand the significant impact our interventions have on individuals suffering from debilitating pain and physical and mental health challenges. Spinal deformity surgery merges the complexities of spinal biomechanics with the needs of an aging population. My research focuses on spinal alignment, biomechanics, innovative surgical techniques, and health economics to ensure value-based care that enhances patient outcomes.
Muhammad Abd-El-Barr
As a Neurosurgeon with fellowship training in Spine Surgery, I have dedicated my professional life to treating patients with spine disorders. These include spinal stenosis, spondylolisthesis, scoliosis, herniated discs and spine tumors. I incorporate minimally-invasive spine (MIS) techniques whenever appropriate to minimize pain and length of stay, yet not compromise on achieving the goals of surgery, which is ultimately to get you back to the quality of life you once enjoyed. I was drawn to medicine and neurosurgery for the unique ability to incorporate the latest in technology and neuroscience to making patients better. I will treat you and your loved ones with the same kind of care I would want my loved ones to be treated with. In addition to my clinical practice, I will be working with Duke Bioengineers and Neurobiologists on important basic and translational questions surrounding spinal cord injuries (SCI), which we hope to bring to clinical relevance.
Khoi Duc Than
I chose to pursue neurosurgery as a career because of my fascination with the human nervous system. In medical school, I developed a keen interest in the diseases that afflict the brain and spine and gravitated towards the only field where I could help treat these diseases with my own hands. I focus on disorders of the spine where my first goal is to help patients avoid surgery if at all possible. If surgery is needed, I treat patients using the most advanced minimally invasive techniques available in order to minimize pain, blood loss, and hospital stay, while maximizing recovery, neurologic function, and quality of life. In my free time, I enjoy spending time with my family and friends. I am an avid sports fan and love to eat. I try to stay physically fit by going to the gym and playing ice hockey.
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