Lumbar interbody fusion: recent advances in surgical techniques and bone healing strategies
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REVIEW ARTICLE
Lumbar interbody fusion: recent advances in surgical techniques and bone healing strategies Bin Meng1,2 · Joshua Bunch1 · Douglas Burton1 · Jinxi Wang1 Received: 1 May 2020 / Revised: 26 August 2020 / Accepted: 5 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Lumbar interbody fusion (LIF) is a treatment option for low back pain secondary to lumbar instability and/or deformity. This review highlights recent studies of surgical techniques and bone healing strategies for LIF. Methods Relevant articles were identified by searching the PubMed database from January 1948 to April 2020, with a focus on the last 5 years, using the following keywords: LIF approach, LIF cage, stem cells for LIF, biomaterials for LIF, and osteobiologics for LIF. Results LIF procedures were traditionally performed through either a posterior approach (PLIF), or an anterior approach. Later, the transforaminal LIF approach gained popularity over the PLIF as it entailed less nerve retraction. To minimize paraspinal muscle dissections, alternative approaches including lateral LIF, oblique LIF, and minimally invasive approaches have been developed and utilized. These modifications have improved the surgical outcomes of LIF. However, the most recent rates of non-union after LIF procedures still ranged from 7 to 20% with an even higher incidence in patients with osteoporosis. This review summarizes the advantages and disadvantages of each surgical approach and current efforts to enhance LIF by improving fusion cage material properties and developing novel osteobiologic products that contain nanomaterials for controlled release of effective osteogenic proteins and mesenchymal stem cells. Conclusions There have been significant advances in surgical technologies for LIF over the past decades. Post-operative non-union remains a major challenge, which could be addressed by development of more effective surgical techniques, fusion cages, and bone healing products through joint efforts from spine surgeons, bone biologists, and material engineers. Keywords Lumbar arthrodesis · Lumbar interbody fusion · Bone healing · Bone biomaterial · Osteobiologic product
Introduction Lumbar spinal disorders are one of the most prevalent musculoskeletal conditions. While substantial heterogeneity exists among epidemiological studies of lumbar conditions that limit the ability to pool data, estimates of the 1-year incidence of a first-ever episode of low back pain (LBP) * Douglas Burton [email protected] * Jinxi Wang [email protected] 1
Department of Orthopedic Surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS #3017, Kansas City, KS 66160, USA
Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
2
range between 6.3 and 15.4%. Approximately 75% to 80% of the adult population may experience LBP at least once in their lifetime [1, 2]. LBP can be classified into primary (nonspecific/idiopathic) LBP and secondary LBP due
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