Principles of Bone Healing

Iain H. Kalfas, MD, FACS Department of Neurosurgery, Section of Spinal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio

Neurosurg Focus. 2001;10(4) 

In This Article

Abstract and Introduction


Our contemporary understanding of bone healing has evolved due to knowledge gleaned from a continuous interaction between basic laboratory investigations and clinical observations following procedures to augment healing of fractures, osseous defects, and unstable joints. The stages of bone healing parallel the early stages of bone development. The bone healing process is greatly influenced by a variety of systemic and local factors. A thorough understanding of the basic science of bone healing as well as the many factors that can affect it is critical to the management of a variety of musculoskeletal disorders. In particular, the evolving management of spinal disorders can greatly benefit from the advancement of our understanding of the principles of bone healing.


Bone is a dynamic biological tissue composed of metabolically active cells that are integrated into a rigid framework. The healing potential of bone, whether in a fracture or fusion model, is influenced by a variety of biochemical, biomechanical, cellular, hormonal, and pathological mechanisms. A continuously occurring state of bone deposition, resorption, and remodeling facilitates the healing process.

The success of many spine operations depends on the restoration of long-term spinal stability. Whereas spinal instrumentation devices may provide temporary support, a solid osseous union must be achieved to provide permanent stability. The failure of fusion to occur may result in the fatigue and failure of supporting instrumentation and persistence or worsening of symptoms. Understanding the basic biological and physiological principles of bone transplantation and healing will aid the spine surgeon in selecting the most effective techniques to achieve successful fusions. In this paper the anatomical, histological and biological features of this process will be reviewed.


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