Research Progress in Lumbar Interbody Fusion (LIF) Techniques and Bone Biomaterials

Abstract

This paper aims to review recent research progress in lumbar interbody fusion (LIF) techniques and bone biomaterials for treating low back pain resulting from lumbar instability and/or deformity. A comprehensive search was conducted in PubMed, Science Citation Index-Expanded (SCI-E), and SpringerLink databases from their inception until April 2023. The search focused on relevant articles published within the past five years, using keywords such as lumbar fusion approach, lumbar interbody fusion cage, lumbar fusion stem cells, lumbar fusion biomaterials, and bone biology of lumbar fusion. Currently, lumbar interbody fusion techniques encompass posterior, anterior, lateral, oblique, and minimally invasive approaches. The transforaminal oblique lumbar fusion approach is gaining popularity due to its ability to minimize paraspinal muscle dissection and nerve traction. Despite advancements in surgical techniques, the incidence of fusion failure after LIF remains high, ranging from 7% to 20%, and is even higher in patients with osteoporosis. This review also discusses the improvement of fusion materials properties and the development of new bone biological products incorporating nanomaterials to enhance the release of effective osteogenic proteins and mesenchymal stem cells for promoting lumbar interbody fusion. Significant advancements have been made in surgical techniques for LIF over the past few decades. However, postoperative nonfusion continues to be a major challenge. Future solutions are expected to arise through the development of more efficient surgical techniques, fusion cages, and bone biomaterials.