Reviews: Review ArticleSurface Modification Techniques to Enhance Osseointegration of Spinal ImplantsPossley, Daniel DO; Baker, Erin PhD; Baker, Kevin PhD; Khalil, Jad G. MDAuthor Information From the Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, MI. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Possley, Dr. E. Baker, Dr. K. Baker, and Dr. Khalil. Journal of the American Academy of Orthopaedic Surgeons: November 15, 2020 - Volume 28 - Issue 22 - p e988-e994 doi: 10.5435/JAAOS-D-17-00645 Metrics Abstract Biomechanical function, specifically implantation technique and immediate surgical fixation, of orthopaedic implants is the primary consideration during the development of orthopaedic implants. Biologic and material characteristics are additional factors to include in the design process because of the direct impact on short- and long-term implant performance. The body's initial interaction with implant materials can affect protein- and cell-based function, thereby either promoting or impeding osseointegration. An understanding and inclusion of the biologic response, material surface morphology, and material surface chemistry in implant design is crucial because these factors ultimately determine implant function and patient outcomes. Highlighting the biologic- and material-related advantages and inadequacies of current and potential implant materials as well as applications may guide further research and development of implant materials and designs. Copyright 2020 by the American Academy of Orthopaedic Surgeons.