Issue 19, 2024

Advances in implants and bone graft types for lumbar spinal fusion surgery

Abstract

The increasing prevalence of spinal disorders worldwide necessitates advanced treatments, particularly interbody fusion for severe cases that are unresponsive to non-surgical interventions. This procedure, especially 360° lumbar interbody fusion, employs an interbody cage, pedicle screw-and-rod instrumentation, and autologous bone graft (ABG) to enhance spinal stability and promote fusion. Despite significant advancements, a persistent 10% incidence of non-union continues to result in compromised patient outcomes and escalated healthcare costs. Innovations in lumbar stabilisation seek to mimic the properties of natural bone, with evolving implant materials like titanium (Ti) and polyetheretherketone (PEEK) and their composites offering new prospects. Additionally, biomimetic cages featuring precisely engineered porosities and interconnectivity have gained traction, as they enhance osteogenic differentiation, support osteogenesis, and alleviate stress-shielding. However, the limitations of ABG, such as harvesting morbidities and limited fusion capacity, have spurred the exploration of sophisticated solutions involving advanced bone graft substitutes. Currently, demineralised bone matrix and ceramics are in clinical use, forming the basis for future investigations into novel bone graft substitutes. Bioglass, a promising newcomer, is under investigation despite its observed rapid absorption and the potential for foreign body reactions in preclinical studies. Its clinical applicability remains under scrutiny, with ongoing research addressing challenges related to burst release and appropriate dosing. Conversely, the well-documented favourable osteogenic potential of growth factors remains encouraging, with current efforts focused on modulating their release dynamics to minimise complications. In this evidence-based narrative review, we provide a comprehensive overview of the evolving landscape of non-degradable spinal implants and bone graft substitutes, emphasising their applications in lumbar spinal fusion surgery. We highlight the necessity for continued research to improve clinical outcomes and enhance patient well-being.

Graphical abstract: Advances in implants and bone graft types for lumbar spinal fusion surgery

Supplementary files

Article information

Article type
Review Article
Submitted
25 Jun 2024
Accepted
14 Aug 2024
First published
20 Aug 2024
This article is Open Access
Creative Commons BY license

Biomater. Sci., 2024,12, 4875-4902

Advances in implants and bone graft types for lumbar spinal fusion surgery

G. M. Cheers, L. P. Weimer, C. Neuerburg, J. Arnholdt, F. Gilbert, C. Thorwächter, B. M. Holzapfel, S. Mayer-Wagner and M. Laubach, Biomater. Sci., 2024, 12, 4875 DOI: 10.1039/D4BM00848K

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