Investigating the effect of combination between demineralized bone matrix and hydroxyapatite in spinal fusion: A systematic review and meta analysis

Spinal fusion is a common surgical intervention for degenerative and structural spinal disorders. Demineralized bone matrix (DBM) provides osteoinduction, while hydroxyapatite (HA) offers osteoconduction. Their combination (DBM-HA) may yield synergistic effects, though clinical evidence remains inconsistent. The purpose of this study was to evaluate the effectiveness of DBM-HA in spinal fusion compared with conventional grafting materials. This systematic review and meta-analysis followed PRISMA 2020 guidelines. Searches were conducted in PubMed, ProQuest, Scopus, Web of Science, and Cochrane Library up to May 12, 2025. Eligible studies involved patients undergoing cervical or lumbar fusion with DBM-HA compared to other grafting materials. The primary outcome was fusion rate, analyzed with odds ratios (ORs) using a random-effects model. Secondary outcomes included pain and functional recovery. Three studies with 225 patients were included. Reported DBM-HA fusion rates ranged from 52% to 89.3%, comparable to local autograft, HA, and HA–beta tricalcium phosphate. Pooled analysis showed no significant difference in fusion rates between DBM-HA and controls (OR = 0.93; 95% CI [0.28, 3.14]; p = 0.43), with moderate-to-high heterogeneity (I 2 = 62.1%). Both DBM-HA and comparator groups improved in visual analog scale (VAS) and Oswestry Disability Index (ODI) scores. Sensitivity analysis confirmed robustness. DBM-HA appears to be a feasible alternative for spinal fusion, providing outcomes comparable to conventional grafts in fusion success, pain relief, and functional recovery. Further high-quality randomized trials are needed to confirm its role across patient populations and surgical techniques.