Orthobiologics are the biologically derived materials from the body to promote the repair and regeneration of muculoskeletal tissues. Orthobiologics has got special attention in recent past and become the focus of study of researchers in various traumatic and nontraumatic spinal pathologies. Efforts were made to develop materials capable of bone formation and which encourage healing of fractures. When they are used in higher concentrations than normally present in the body, they can potentially help speed up the healing process. The substances which are considered to be orthobiologics are: bone grafts, autologous blood, autologous conditioned serum (ACS), platelet-rich plasma (PRP), growth factors, and stem cells.
Various clinical and animal studies have shown variable results. This review gives an outline regarding the currently available clinical information and application of orthobiologics in various spinal pathologies for therapeutic use.
OrthoInfo. Available from: http://orthoinfo.aaos.org/topic.cfm?topic=A00525 [cited 2017 Dec 13].
Friedlander GE, Tross RB, Doganis AC, Kirkwood JM, Baron R. Effects of chemotherapeutic agents on bone: Part I. Short term methotrexate and doxorubicin treatment in a rat model. J Bone Joint Surg Am 1984 Apr;66(4):602-607.
May VR, Mauck WR. Exploration of the spine for pseudarthrosis following spinal fusion in the treatment of scoliosis. Clin Orthop Relat Res 1967 Jul-Aug;53:115-122.
O'Beirne J, O'Neill D, Gallagher J, Williams DH. Spinal fusion for back pain: a clinical and radiological review. J Spinal Disord 1992;5:32–38.
Steinmann JC, Herkowitz HN. Pseudarthrosis of the spine. Clin Orthop Relat Res 1992 Nov;284:80-90.
Zdeblick TA. A prospective, randomized study of lumbar fusion: Preliminary results. Spine 1993 Jun 15;18(8):983-991.
Arrington ED, Smith WJ, Chambers HG, Bucknell AL, Davino NA. Complications of iliac crest bone graft harvesting. Clin Orthop Relat Res 1996 Aug;329:300-309.
Banwart JC, Asher MA, Hassanein RS. Iliac crest bone graft harvest donor site morbidity: a statistical evaluation. Spine 1995 May 1;20(9):1055-1060.
Fernyhough JC, Schimandle JH, Weigel MC, Edwards CC, Levine AM. Chronic donor site pain complicating bone graft harvesting from the posterior iliac crest for spinal fusion. Spine 1992 Dec;17(12):1474-1480.
Finkemeier CG. Bone-grafting and bone-graft substitutes. J Bone Joint Surg 2002 Mar;84-A(3):454-464.
Greenwald AS, Boden SD, Goldberg VM, Laurencin CT, Rosier RN; American Academy of Orthopaedic Surgeons. The Committee on Biological Implants. Bone-graft substitutes: facts, fictions, and applications. J Bone Joint Surg Am 2001; 83-A Suppl 2 Pt 2:98-103.
Cammisa FP, Lowery G, Garfin SR, Geisler FH, Klara PM, McGuire RA, Sassard WR, Stubbs H, Block JE. Two-year fusion rate equivalency between Grafton DBM gel and autograft in posterolateral spine fusion: a prospective controlled trial employing a side-by-side comparison in the same patient. Spine 2004 Mar 15;29(6):660-666.
Urist MR. Bone: formation by autoinduction. Science 1965 Nov;150(3698):893-899.
Termaat MF, Den Boer FC, Bakker FC, Patka P, Haarman HJ. Bone morphogenetic proteins. Development and clinical efficacy in the treatment of fractures and bone defects. J Bone Joint Surg 2005 Jun;87-A(6):1367-1378.
Yamaguchi A. Regulation of differentiation pathway of skeletal mesenchymal cells in cell lines by transforming growth factor-beta superfamily. Semin Cell Biol 1995 Jun;6(3): 165-173.
Samarzis D, Khanna N, Shen FH, An HS. Update on bone morphogenetic proteins and their application in spine surgery. J Am Coll Surg 2005 Feb;200(2):236-248.
Epstein NE. Complications due to the use of BMP/INFUSE in spine surgery: the evidence continues to mount. Surg Neurol Int 2013 Jul 9;4(Suppl 5):S343-S352.
Wright-Carpenter T, Klein P, Schaferhoff P, Appell HJ, Mir LM, Wehling P. Treatment of muscle injuries by local administration of autologous conditioned serum: a pilot study on sportsmen with muscle strains. Int J Sports Med 2004 Nov;25(8):588-593.
Frisbie DD, Kawcak CE, Werpy NM, Park RD, McIlwraith CW. Clinical, biochemical, and histologic effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis. Am J Vet Res 2007 Mar;68(3):290-296.
Goni VG, Singh Jhala S, Gopinathan NR, Behera P, Batra YK, R H A, Guled U, Vardhan H. Efficacy of epidural perineural injection of autologous conditioned serum in unilateral cervical radiculopathy: a pilot study. Spine (Phila Pa 1976) 2015 Aug 15;40(16):E915-E921.
Becker C, Heidersdorf S, Drewlo S, de Rodriguez SZ, Krämer J, Willburger RE. Efficacy of epidural perineural injections with autologous conditioned serum for lumbar radicular compression: an investigator-initiated, prospective, double-blind, reference-controlled study. Spine (Phila Pa 1976) 2007 Aug 1;32(17):1803-1808.
Dhillon MS, Behera P, Patel S, Shetty V. Orthobiologics and platelet rich plasma. Indian J Orthop 2014 Jan-Feb;48(1):1-9.
Ferrara N, Houck K, Jakeman L, Leung DW. Molecular and biological properties of the vascular endothelial growth factor family of proteins. Endocr Rev 1992 Feb;13(1):18-32.
Lind M, Deleuran B, Thestrup-Pedersen K, Søballe K, Eriksen EF, Bünger C. Chemotaxis of human osteoblasts. Effects of osteotropic growth factors. APMIS 1995 Feb;103(2):140-146.
Lowery GL, Kulkarni S, Pennisi AE. Use of autologous growth factors in lumbar spinal fusion. Bone 1999 Aug;25 (2 Suppl):47S-50S.
Weiner BK, Walker M. Efficacy of autologous growth factors in lumbar intertransverse fusions. Spine (Phila Pa 1976) 2003 Sep 1;28(17):1968-1970.
Hee HT, Majd ME, Holt RT, Myers L. Do autologous growth factors enhance transforaminal lumbar interbody fusion? Eur Spine J 2003 Aug;12(4):400-407.
Carreon LY, Glassman SD, Anekstein Y, Puno RM. Platelet gel (AGF) fails to increase fusion rates in instrumented posterolateral fusions. Spine (Phila Pa 1976) 2005 May;30(9): E243-E246.