Harnessing the power of the community and spine surgeon collaboration—thank you for making AO-GO possible!


The AO Spine Guideline for Using Osteobiologics in Spine Degeneration project (AO-GO) has been published as a focus issue in the Global Spine Journal. The launch of this evidence-based guideline represents a watershed moment in Anterior Cervical Discectomy and Fusion (ACDF) and was made possible thanks to an incredible collaborative effort by members of the spine community. A handy quick reference guide is also available. 

The first guidelines to focus on osteobiologics in ACDF

Led by Dr. Hans Jörg Meisel and Dr. Zorica Buser, the new guidelines are developed as an important addition to the clinical landscape in ACDF. Through a series of evidence-based recommendations, they will support surgeons with clinical decision making. As a result, it will be possible to tailor osteobiologic use more carefully to individual patients and to improve safety and efficacy outcomes. The ultimate goal of the AO-GO team is to provide guidelines with recommendations that specify which osteobiologics can be used at single level or multilevel ACDF in a range of clinical scenarios. The guidelines will also serve as a valuable, up-to-date resource for the whole ACDF community and will promote the conduct of more high-quality research in the field.

The AO-GO team is a global alliance of experts focused on promoting best-practice in osteobiologics and ACDF

Helping clinicians to improve patient outcomes was the primary focus of the AO-GO guidelines. However, developing the guidelines has had additional benefits. The AO-GO project has connected surgeons and researchers with varied backgrounds in terms of culture, experience, and treatment preferences from across the world. As a result, the AO-GO team has grown into a global community of experts in degenerative spine disease that consists of 73 members from 22 countries.

Thanks to this diverse group of participants, the guideline is applicable internationally. Furthermore, working on the AO-GO guidelines provided fantastic opportunities for each of the members to contribute their unique expertise and gain new skills. This included the chance to lead study teams and practice leadership and teamwork skills.

Sathish Muthu sees many opportunities that being a part of the AO-GO team have on his clinical practice:

“More than arriving at recommendations for using osteobiologics in ACDF surgery, being a part of the AO-GO network helped me to be a part of an active global research community in spine surgery, opening opportunities to solve many problems that I find it difficult to solve as an individual.”

Amit Jain also emphasizes the importance of collaborations:

“I enjoyed the collaborations the most. The opportunity to work with and learn from experts from around the world on topics of mutual interest was really cool!”


AO Spine and AO Spine Knowledge Forum Degenerative provided a boost to the AO-GO team

The development of the AO-GO Guidelines would not have been possible without the incredible support provided by the AO Spine and AO Spine Knowledge Forum Degenerative (KF Degen) networks. AO Spine is the leading global academic community for innovative education and research in spine care, inspiring lifelong learning and improving patients' lives. AO Spine KF Degen works on exciting and innovative projects to understand and treat degenerative spinal disorders.

Both of these networks facilitated the identification of an international group of ACDF experts with a passion for osteobiologics to form the AO-GO team. Furthermore, the expert steering committees of these respective networks provided invaluable guidance and mentorship to the AO-GO members, allowing them to produce robust guidelines of the highest standard. Funding provided by KF Degen enabled the AO-GO team to consult with top-level experts in the field on the content of the guidelines. In addition, the project management and coordination provided by AO Spine helped to transform the guidelines from a concept into a reality. As a result of their engagement with AO-GO AO Spine and KF Degen also saw positive outcomes which included new members for KF Degen and an overall boost in participation in AO Spine’s spine degenerative research.

Patrick Hsieh sees a long-term impact in the collaboration for improving patient outcomes:

“Based on our research thus far, it's clear that the data for most osteobiologics in the market is still quite limited. However, through collaborative research using the Degen Pro project from the AO Spine KF Degen, we will fill gaps in our data and knowledge of the efficacy of osteobiologics that are present today to improve fusion and patient outcomes for our future patients around the world.”

The AO-GO project is a fantastic example of what can be achieved when stakeholders work together: great results for patients and the spine community alike. Here’s to teamwork!

Here the team leads consider how they experienced the collaborative study and being part of AO Spine Knowledge Forum Degenerative

Arun Kumar:

Do osteobiologics augment fusion in ACDF surgery performed with mechanical interbody devices (PEEK, carbon fiber, metal cages) and is the fusion rate comparable to that with autograft? A Systematic Review

“The concept of AO-GO itself is very new and refreshing. Getting spine experts from different parts of the world and making them work on 13 projects was unthinkable! At the initial meet, I was excited to be selected as a topic leader in AO-GO. Through the process we had several meetings with leaders from across the globe for reviewing process, study inclusions, data extraction, as well as for manuscript preparation. During the process I had interactions with many spine experts from Europe, Middle East, America, Africa, Australia, other parts of Asia, and so on. Everyone coming to a consensus on the subject based on evidence was the primary key to success of the project.

The most difficult moments during AO-GO were having to sacrifice sleep at night to attend review meetings. After many long years, AO-GO has again given me sleepless nights. I enjoyed those nights and AO-GO project has been very close to my heart.”

Amit Jain:

Structural Allograft Versus Mechanical Interbody Devices Augmented with Osteobiologics in Anterior Cervical Discectomy and Fusion: A Systematic Review

"I enjoyed the collaborations the most. The opportunity to work with and learn from experts from around the world on topics of mutual interest was really cool! The AO-GO effort brings together a group of surgeon scientists who are dedicated to discovery and research. AO Spine KF Degen is an exceptional group, and it is my great honor to be part of this wonderful organization that is dedicated to improving patient outcomes through research."

Gianluca Vadalà:

Do osteobiologics augment fusion in zero-profile and unplated ACDF constructs, and are the fusion rates, outcomes, and complications comparable to that with plated constructs? considering different numbers of surgical level and whether bracing is used.

"The AO-GO team represents a great example of how a worldwide community of colleagues interested in the same topic can work together, trying to bring about improvements in the context of biologics in ACDF. As a topic leader I really enjoyed working in such a fashion with people who are very responsive and interested."

Sathish Muthu

Does the Use of Autograft Influence the Fusion and Complication Rates in Patients undergoing 1 or 2 level Anterior Cervical Discectomy and Fusion Surgery? A Systematic Review and Meta-Analysis

"I was introduced to this project as a topic member but when the situation demanded, I stepped up as a topic lead to drive the project to completion. I enjoyed working with surgeons from different countries with different perspectives on the common problem at hand, making us a more effective team.

More than arriving at recommendations for using orthobiologics in ACDF surgery, being a part of the AO-GO network helped me to be a part of an active global research community in spine surgery opening opportunities to solve many problems that I find it difficult to solve as an individual. I highly appreciate the opportunities given to every Associate Member of AO Spine KF Degen to present our own projects ideas that we find difficult to address as an individual or as a regional team. The AO-GO project stands as an example of this."

Ricardo Rodrigues-Pinto:

Complications of the use allograft in 1- or 2-level anterior cervical discectomy and fusion: a systematic review

What is the evidence supporting osteobiologic use in revision ACDF surgery?

"I was involved in the above mentioned two projects. Osteobiologics are a great tool to enhance fusion in spinal surgery, particularly in ACDF. However, the lack of standardization and guidelines has made their assessment and outcomes difficult to analyze. The AO-GO project allowed us to analyze all the literature on the use of osteobiologics in ACDF and to provide guidelines regarding their use. It also highlighted gaps in the literature that should be addressed in future studies. Participating in the AO-GO project allowed me to create a network of people involved in spine surgery and research and to further my knowledge in the field of osteobiologics."

Juan Pablo Cabrera Cousiño:

Complications with Demineralized Bone Matrix, Hydroxyapatite and Beta-Tricalcium Phosphate in Single and Two-level ACDF Surgery Analysis of Complications in Multilevel ACDF using Osteobiologics other than BMP: A Systematic Review

"This AO project was born from the urgent need to respond—through the best available evidence—to a set of high-impact issues in cervical spine surgery for which there was not much support for clinical practice. Leading a part of this project was a very enriching experience, since it meant not only carrying out advanced research but also coordinating a group of researchers from all over the world.

A truly international working group was formed, with different degrees of experience, which allowed us to learn from each other and obtain the best contribution from each one, but always integrating it into the global project, holding meetings for discussion and analysis, with continuous support from the AO Spine Knowledge Forum. This hard work established recommendations, as well as identified topics where future research is needed."

Christopher Martin:

Comparative Complications Associated with BMP Use in Patients Undergoing ACDF for Degenerative Spinal Conditions: Systematic Review and Meta-Analysis

"I was a topic lead for AO-GO, a study divided into a series of important questions regarding biologics in spine surgery. Each topic lead was assigned a specific clinical question and conducted a systematic review and meta-analysis. As topic lead, I coordinated the review, worked with my team to review each individual article in the analysis, and assisted with each stage of the statistics and manuscript preparation.

Being a part of AO-GO is a wonderful opportunity to work with other AO Spine members to build relationships and to answer important research questions. I am hopeful that our work will form a starting point to help us better understand biologics in spine surgery and I feel fortunate to be part of such a productive team."


Pieter-Paul Vergroesen:

The Use of Osteobiologics in Single Versus Multi-Level Anterior Cervical Discectomy and Fusion: A Systematic Review

"I was one of the topic leads, leading a single systematic review, as part of the larger AO-GO guideline development. What I enjoyed was the ease with which like-minded people from all over the globe were able to participate in a single effort. The network and brand of AO allowed me to quickly find relevant partners in scientific endeavors. It is the foundation for a global effort to bring evidence-based medicine into all corners of spine surgery."

Chris Arts:

The evidence for the use of osteobiologics in hybrid constructs (Anterior Cervical Discectomy and Fusion (ACDF) and total disc replacement (TDR)) in multilevel cervical degenerative disc disease: A Systematic Review

"I had a role as a topic leader, and I also was involved in several other topics providing feedback as a biomaterials expert. I enjoyed reaching common ground with fellow scientists and clinicians around the world on the application of bone grafts and biomaterials in ACDF. This can help in improved education on these materials as well, which I think can still be improved and AO can have a leading role in this. Also, with the execution of systematic reviews we get a clearer understanding of the actual level of evidence in the use of biomaterials in spinal surgery which is important for clinical decision making.

Being in a multidisciplinary expert group consisting of both healthcare professionals and scientists is always an opportunity to learn. Additionally, you receive insights on spinal surgery topics from a global perspective and can learn from each other's best practices.

The work being performed within the AO Knowledge Forum groups and AO-GO is important for the future of spinal surgery. By sharing ideas, insights and best practices we strive to continue improvement of spinal care in patients."

Waeel Hamouda:

Dosing strategy for osteobiologics used in ACDF surgery, influence on fusion rates and associated complications. An up-to-date systematic literature review

"I led a group investigating the efficacy and related morbidities of the used osteobiologics doses, but the good part was that I had to read through the search results and the conclusions of the other twelve AO-GO groups, I definitely learned a lot!

Working with colleagues from different countries and different surgical and research backgrounds allows a rich unmatched experience, on both personal and professional levels. It is amazing and impressive how more than 30 spine surgeons from all over the world are willingly investing their time, effort, and experience in the pursuit for providing "the truth, the whole truth, and nothing but the truth" in the available science of degenerative spine conditions and its management."

Patrick Hsieh:

Do osteobiologics result in an earlier fusion in ACDF surgery? What is the appropriate interval and modality for fusion assessment?

"I was a member of the project development team and a lead on the topics for the systematic reviews. It was really a pleasure to work with many international spine experts and AO members around our global community. One of my favorite experiences was listening to surgeons around the globe discuss their challenges and unique solutions to optimize fusion with their available osteobiologics options.

I am excited to be a part of a group that is interested and invested in developing the best available evidence for using osteobiologics in spine fusions. Based on our research thus far, it's clear that the data for most osteobiologics in the market is still quite limited. However, through collaborative research using the Degen Pro project from the AO Spine KF Degen, we will fill gaps in our data and knowledge of the efficacy of osteobiologics that are present today to improve fusion and patient outcomes for our future patients around the world.

Despite the advances in spine surgery and treatments over the past few decades, we still have a lot to learn and many knowledge gaps in optimizing patient outcomes. I am excited to be a part of the AO Spine KF Degen which is constantly working together and exploring opportunities to improve the knowledge and clinical treatment to improve patient care for spine patients around the globe. While there is a lot of work ahead of us, I believe that the AO Spine KF Degen will make significant contributions to our field in the future. I am honored and excited to work with this collective group of spine experts who are motivated and eager to conduct collaborative research around our international community to improve spine treatment outcomes for patients."

Andreas Demetriades:

What is the evidence surrounding cost-effectiveness of osteobiologic use in ACDF surgery?

“The AO-GO project was a demonstration of how effective and efficient teamwork can be. I was project lead for the topic on cost effectiveness for biologics in ACDF surgery, a big market with very little evidence based recommendations. Being part of this team allowed everyone to make new professional connections and to strengthen academic ties. It also encouraged very useful brainstorming sessions which have already lead to further collaborations.

The quality of effort put together by the AO Spine Knowledge Forum Degen is truly excellent, and it has been a great pleasure and privilege to be part of it.”

Stipe Ćorluka:

How Do Patient Comorbidities Affect the Choice of Osteobiologics for Anterior Cervical Discectomy and Fusion? A Systematic Review

"AO Spine KF Degen Steering Committee honored me to lead the systematic review on the topic 'How do patient comorbidities affect the choice of osteobiologics for anterior cervical discectomy and fusion?' It was a great teamwork between 4 reviewers with full support from the AO-GO ACDF project core team. I enjoyed this concept because it was a broad collaboration between ortho & neuro spine surgeons and scientists from all around the world.

Most of us had never met before in person, but in a really short time established full communication as if we'd known each other for years and worked together on several projects. I think that is the most positive side of the AO-GO project: it connected people from around the globe, regardless of age, working background or anything else, just the good will to make a change for better in understanding spine care is what matters.

In my opinion, the AO-GO network is a perfect platform to establish a connection between the daily routine of spinal surgery with evidence-based data on the use of osteobiologics. Also, being a part of the AO-GO network gives you an opportunity to have information about what we know, but more importantly what we don't know yet about the use of osteobiologics in spine surgery.

AO Spine KF Degen and AO-GO gave me the opportunity to learn a lot about degenerative spines beyond my clinical experience and knowledge so far. Our online and in-person meetings provide a chance to discuss equally all actual and hot topics with an international team of experts regardless of academic title or degree."

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