Ninety-one adult patients undergoing instrumented posterolateral spinal fusion of one to six levels were randomized to receive BCP<μm granules (n=128 levels) on one side and autograft containing ≥50% iliac crest bone (n=128 levels) on the contralateral side. The primary outcome was fusion per level at one year, as assessed via fine-cut CT by blinded spine surgeons. Secondary outcomes included Oswestry Disability Index (ODI) and adverse events. Outcomes were assessed at one year postoperatively. Overall, the results of the study revealed a higher fusion rate with BCP<μm (79%) compared to autograft (47%), with a statistically significant difference (p<0.001). These findings suggest that standalone BCP<μm is not only non-inferior but potentially superior to autograft, even among smokers.