Therapeutic Approaches for Enhancing Spinal Fusion in Low Back Pain: A Review With a Focus on the Elderly.

BACKGROUND

Low back pain (LBP) is a prevalent cause of disability worldwide, particularly among the elderly, with degenerative spinal conditions often necessitating surgical intervention. Spinal fusion remains a definitive treatment for patients unresponsive to conservative therapies, yet its success is challenged by age-related factors such as osteoporosis, diminished stem cell function, and vascular insufficiency.

METHODS

This review examines current and emerging strategies to improve spinal fusion outcomes for elderly patients by analyzing advances in biomaterials, growth factor delivery systems, cell-based regenerative therapies, surgical innovations, and some novel approaches.

RESULTS

Advances in biomaterials, including bioactive scaffolds, 3D-printed constructs, and hybrid grafts, provide structural and biological support for bone formation. Growth factor delivery systems, particularly controlled-release formulations of bone morphogenetic proteins (BMPs) and vascular endothelial growth factor (VEGF), improve osteoinduction while mitigating adverse effects. Cell-based regenerative therapies utilizing mesenchymal stromal cells (MSCs) and extracellular vesicles (EVs) offer promising osteogenic and immunomodulatory potential. Furthermore, minimally invasive surgical techniques and robotic-assisted procedures provide additional options for enhancing spinal fusion in elderly patients. Novel approaches targeting cellular senescence, epigenetic modulation, and mitochondrial dysfunction are emerging to counteract age-related impairments in bone formation.

CONCLUSION

Despite significant advancements, challenges such as optimizing biomaterial integration, mitigating inflammatory responses, and ensuring long-term stability remain. Future research should leverage precision medicine, artificial intelligence, and nanotechnology to enable patient-specific fusion strategies. A multidisciplinary approach will be essential to improve spinal fusion outcomes for aging populations.