Bone substitutes in scoliosis surgery

In spinal fusion procedures, the local bone that is resected serves as the base bone graft for attaining biological fusion. The local bone is frequently not sufficient and requires supplementary grafting. Autologous bone transplantation is still regarded as the gold standard but might cause additional complications; also, autograft resources are limited. Alternatively, allografts and a wide variety of different bone substitutes are available. The bone substitutes currently used in scoliosis surgery are presented, and their clinical significance is elucidated by a review of the literature. Furthermore, our own experiences and clinical practice are compared with those in the literature and are critically discussed. The recently growing number of scientific publications reporting on bone substitutes reflects the immense interest and relevance of this issue. In scoliosis surgery, calcium phosphate ceramics together with bone marrow aspirate are increasingly applied. Although harvesting of autologous bone continues to be the accepted standard to extend the local autograft in scoliosis surgery, there is a clear trend toward the use of bone substitutes.