Spinal arthrodesis is a common surgical procedure for treating degenerative, traumatic, and deformative pathologies, with osteobiology playing a fundamental role in spinal fusion. Although autografts are the gold standard due to their osteogenic capacity, they are associated with significant morbidity. This has led to the development of alternative biomaterials, such as allografts, demineralized bone matrices (DBM), and bone morphogenetic proteins (BMP). This systematic review aimed to analyze the effectiveness and safety of osteobiological materials used in spinal arthrodesis, focusing on their properties and the influence of internal fixation on fusion rates. A literature search was conducted in scientific databases following the PRISMA methodology, selecting studies that evaluated fusion rates, complications, and osteointegration in spinal surgery. Results showed that BMP-2 achieved fusion rates of 92%, while autografts reached 100% but with higher morbidity. The combination of internal fixation with bone grafts improved biomechanical stability and reduced bone resorption. Additionally, the use of teriparatide and zoledronic acid optimized bone consolidation in osteoporotic patients. These findings suggest that graft selection should be individualized, considering patient-specific factors and optimizing internal fixation to enhance clinical outcomes in spinal arthrodesis.
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