Abstract
Osteobiologics are the core of successful fusion and thus have seen an explosion in the variety of available materials. Currently there is approximately 350 bone filler materials on the market, expanding rapidly in different regions of the world. While there is a rapid growth in the types and sub-types of various osteobiologics, there is an immense lack of high level of evidence supporting their use. This is to a certain extent due to the unregulated dissemination of data, often coming from the medical device industry and not academic institutions. The end results is confusion and adrift among surgeons. Innovative minimal invasive spine surgery demands from the surgeon reliable data on osteobiologics and their fusion potential for an accurate risk evaluation of outcomes. Studies comparing the performance of osteobiologics with and without specific comorbidities in large, well-defined patient populations and with an appropriate follow-up time are needed to establish the impact of comorbidities on the efficacy of fusion graft materials. In addition, the surgeon is responsible for the cost development of spine surgery which has increased between 60 and 160 percent in the last decade among different countries. Therefore, there is a need for an international guideline to provide spine community clarity on how and when to use osteobiologics in ACDF surgery.
Osteobiologics are of the core areas of investigation within AO Spine Knowledge Forum Degenerative (KF Degen). In 2019 KF Degen developed and initiated AOGO project. Over 150 AO Spine member from across the globe responded to the call for participation and more than 73 of them were invited and joined actively in the study. The core team developed fifteen working groups with authors and co-authors focusing on the most relevant research questions around osteobiologics use in ACDF. Each study was executed through a systematic review and meta-analysis when applicable. In a collaboration with McMasters GRADE group the AOGO team was able to execute recommendations for the use of osteobiologics in ACDF.
AOGO is aiming to help various stakeholders including surgeons on choosing the right osteobiologics, companies on developing and advancing osteobiologics products, hospitals on using cost-effective osteobiologics, and regulatory authorities on overseeing osteobiologics development and application. By developing a guideline for osteobiologics usage, we aim to encourage evidence-based research on osteobiologics and develop clinical tools that will facilitate decision making process. AOGO is just a start, where continuous effort should be made to update the guideline when new strong evidence is available.