Applications of Atelocollagen in Spine Surgery: A Systematic Scoping Review of Preclinical and Clinical Evidence

Atelocollagen, a pepsin-processed derivative of native collagen with reduced immunogenicity, has been investigated as a biomaterial for spinal tissue engineering. However, no prior systematic review has consolidated evidence across its diverse applications in spine surgery. This systematic scoping review, conducted according to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews) guidelines and prospectively registered with the Open Science Framework, mapped and critically appraised the available preclinical and clinical evidence on atelocollagen in spine surgery. PubMed, Scopus, Web of Science, Embase, and the Cochrane Library were searched from inception through February 2026. Seventeen studies met the inclusion criteria and addressed 4 application domains: intervertebral disc regeneration (n=9), spinal fusion scaffolds (n=2), paraspinal muscle preservation (n=2; 726 total patients, with reported reductions in muscle atrophy and improvements in pain scores), and spinal cord injury repair (n=4). Most studies originated from Japan (n=8) and South Korea (n=5). No randomized controlled trials were identified. Atelocollagen showed broad applicability and a favorable reported safety profile across several spine surgery applications. Although the preclinical evidence is encouraging, the clinical evidence remains limited. Well-designed multicenter randomized controlled trials are needed to establish clinical efficacy.