The International Society for the Advancement of Spine Surgery is calling for updated insurance coverage policies to reflect advances in spinal fusion bone graft technologies while preserving surgeons’ authority to select graft materials.
The society’s 2026 bone graft policy update examines expanded FDA indications and clinical evidence for recombinant human bone morphogenetic protein-2 and P-15 peptide technologies. The review builds on ISASS’ 2018 recommendations.
The update highlights the FDA’s February 2026 expansion of INFUSE bone graft approval for specified lumbar fusion procedures, along with regulatory and clinical developments involving i-FACTOR and PearlMatrix. ISASS recommends that payer policies reflect current FDA indications and supporting evidence.
“The science of spinal fusion continues to advance, and our policies must evolve alongside it. This updated ISASS position statement recognizes the significant progress in bone graft technologies, particularly the growing clinical evidence supporting newer biologic and synthetic alternatives,” Alexander Vaccaro, MD, PhD, president of ISASS, said in an email to Becker’s.
“As spine surgeons, we must critically evaluate these innovations based on scientific evidence, safety, and demonstrated clinical effectiveness, not simply regulatory classification or reimbursement policies. Ultimately, the treating surgeon must make the selection of bone graft materials, tailored to the individual patient’s needs. ISASS remains committed to ensuring that evidence-based policy supports innovation, preserves physician autonomy, and, most importantly, advances patient care,” he said.
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