This systematic review aims to compare clinical evidences related to autologous iliac crest bone graft (ICBG) and non-ICBG (local bone) with allografts and synthetic grafts for spinal fusion procedures in adult and young patients. A systematic search was carried out in three databases (PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials) to identify clinical studies in the last 10 years. The initial search retrieved 1085 studies, of which 24 were recognized eligible for the review. Twelve studies (4 RCTs, 5 prospective, 3 retrospective) were focused on lumbar spine, 9 (2 RCTs, 2 prospective, 4 retrospective, 1 case-series) on cervical spine and 3 (1 RCT, 2 retrospective) on spinal fusion procedures in young patients. Calcium phosphate ceramics, allografts, bioglasses, composites and polymers have been clinically investigated as substitutes of autologous bone in spinal fusion procedures. Of the 24 studies included in this review, only 1 RCT on cervical spine was classified with high level of evidence (Class I) and showed low risk of bias. This RCT demonstrated the safety and efficacy of the proposed treatment, a composite bone substitute, that results in similar and on some metrics superior outcomes compared with local autograft bone. Almost all other studies showed moderately or, more often, high incidence of bias (Class III), thus preventing ultimate conclusion on the hypothesized beneficial effects of allografts and synthetic grafts. This review suggests that users of allografts and synthetic grafting should carefully consider the scientific evidence concerning efficacy and safety of these bone substitutes, in order to select the best option for patient undergoing spinal fusion procedures.

本系统综述旨在比较与成人同种异体移植和人工移植自体骨骨移植（ICBG）和非ICBG（局部骨）相关的临床证据，以进行成年和年轻患者的脊柱融合手术。在三个数据库（PubMed，Scopus，Web of Science，Cochrane对照试验中央注册）中进行了系统的检索，以鉴定过去10年的临床研究。最初的搜索检索了1085项研究，其中24项被认为符合审查条件。十二项研究（4项RCT，5项前瞻性，3项回顾性）针对腰椎，9项（2项RCT，2项前瞻性，4项回顾性，1例病例系列）针对腰椎，3项（1项RCT，2项回顾性）针对脊柱融合手术在年轻患者中。磷酸钙陶瓷，同种异体移植物，生物玻璃，在脊柱融合手术中，已经对复合材料和聚合物作为自体骨的替代品进行了临床研究。在本评价中包括的24项研究中，只有1项关于颈椎的RCT被归类为证据水平高（I类），并且偏倚风险低。该RCT证明了所提议的治疗方法（一种复合骨替代物）的安全性和有效性，与局部自体骨相比，可产生相似的结果，并且在某些方面还具有更好的结果。几乎所有其他研究都显示出中等程度或更常见的偏见发生率较高（III类），因此无法得出关于同种异体移植物和合成移植物的假定有益效果的最终结论。这项审查表明，同种异体移植和合成移植的使用者应仔细考虑有关这些骨替代物功效和安全性的科学证据，