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A Clinically Pragmatic Review of the Evidence Key Takeaways Bone marrow aspirate functions as a biologic component within a fusion construct , with its contribution dependent on technique, biologic dose, and compatibility with the graft material used. Cell dose and retention matter. Variability in historical outcomes may reflect dilution, delivery, and early harvesting limitations rather than an absence of marrow-derived biologic effect. Clinical and translational studies su

Key Takeaways *  Nomenclature Shift:  BMLs are not "edema" (fluid); they are active lesions of fibrosis, microfracture, and necrosis.  *  Predictive Power:  Progressive BMLs carry a  threefold higher risk  of rapid radiographic OA onset (Moradi et al., 2024).  *  The Spine Connection:  In the vertebral column, these lesions are clinically recognized as  Modic Changes , sharing the same inflammatory pathology as knee BMLs.  *  Therapeutic Target:  Long-term data suggest subcho

Preoperative spine planning is now exacting: Pelvic incidence is measured to a degree. Instrumentation is templated to the millimeter. Yet one variable that directly impacts fusion success is still often left to intraoperative judgment: 𝗕𝗼𝗻𝗲 𝗴𝗿𝗮𝗳𝘁 𝘃𝗼𝗹𝘂𝗺𝗲. A recent study in the European Spine Journal makes a compelling case that deserves more attention. 𝗗𝗲𝗳𝗼𝗿𝗺𝗶𝘁𝘆 𝗦𝘂𝗿𝗴𝗲𝗿𝘆 𝗮𝘀 𝗮 “𝗦𝘁𝗿𝗲𝘀𝘀 𝗧𝗲𝘀𝘁” 𝗳𝗼𝗿 𝗙𝘂𝘀𝗶𝗼𝗻 𝗕𝗶𝗼𝗹𝗼𝗴𝘆 Kazarian