Understanding Spine Biologics: A Systematic Review of Demineralized Bone Matrix in Spinal Fusion From 2014-2024

Study DesignSystematic Review.ObjectivesDemineralized bone matrix (DBM) is an allograft material commonly used as an adjunct in spinal fusion. This review summarizes literature from the past decade describing DBM use in spinal fusion and provides an updated analysis of fusion outcomes based on product type and characteristics.MethodsA systematic search was conducted using MEDLINE and CENTRAL. Risk of bias was assessed with the Cochrane Back and Neck criteria for randomized studies and the Methodological Index for Non-Randomized Studies criteria for nonrandomized studies. Extracted data included study design, sample size, procedure type, DBM product, fusion outcomes, complications, and follow-up duration. Additional product characteristics, such as DBM form (fiber-based or particulate-based) and sterility method (aseptic or terminal irradiation), were identified from tissue bank data.ResultsTwenty-one studies met inclusion criteria: 3 randomized (level I evidence), 4 level II, ten level III, and 4 level IV. Seven studies examined cervical procedures, and 14 addressed lumbar procedures. Posterior lumbar fusion (n = 6) and anterior cervical discectomy and fusion (n = 6) were most common. Among 18 comparative studies, 17 found no significant difference in fusion outcomes between DBM and comparison groups.ConclusionsDBM used as an autograft extender demonstrated fusion rates comparable to alternative graft materials. However, the predominance of nonrandomized, retrospective designs and limited controlled data result in low overall evidence quality. Further high-quality prospective studies are warranted to better define the role of DBM in spinal fusion.