Understanding the Future Prospects of Synergizing Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery with Ceramics and Regenerative Cellular Therapies

Abstract

Transforaminal lumber interbody fusion (TLIF) is the last resort to address the lumber degenerative disorders such as spondylolisthesis, causing lower back pain. The current surgical intervention for these abnormalities includes open TLIF. However, in recent years, minimally invasive TLIF (MIS-TLIF) has gained a high momentum, as it could minimize the risk of infection, blood loss, and post-operative complications pertaining to fusion surgery. Further advancement in visualizing and guiding techniques along with grafting cage and materials are continuously improving the safety and efficacy of MIS-TLIF. These assistive techniques are also playing a crucial role to increase and improve the learning curve of surgeons. However, achieving an appropriate output through TLIF still remains a challenge, which might be synergized through 3D-printing and tissue engineering-based regenerative therapy. Owing to their differentiation potential, biomaterials such as stem/progenitor cells may contribute to restructuring lost or damaged tissues during MIS-TLIF, and this therapeutic efficacy could be further supplemented by platelet-derived biomaterials, leading to improved clinical outcomes. Thus, based on the above-mentioned strategies, we have comprehensively summarized recent developments in MIS-TLIF and its possible combinatorial regenerative therapies for rapid and long-term relief.

Application and thinking of minimally invasive transforaminal lumbar interbody fusion in degenerative lumbar diseases

“…For single segment lumbar spinal stenosis, its level of incision length is ≤4 cm, and it has intraoperative bleeding of about 100-300 mL, postoperative bleeding of 20-250 mL, and an operation time of about 70-120 min. MIS-TLIF interbody fusion through intervertebral foramen has the advantages of less nerve interference, convenient interbody fusion, minimal epidural scar formation, and easy revision surgery (31,32). Compared with open surgery, MIS-TLIF has less trauma, faster recovery and obvious clinical effect.…”

History and Evolution of the Minimally Invasive Transforaminal Lumbar Interbody Fusion

“…A 2021 detailed review has shown that MIS-TLIF interbody implants may also be subject to change. Lo et al [ 99 ] indicate that the commonplace usage of ICBG may fade given concerns regarding the difficulty of autologous harvesting as well as potential for infection development, and suggest that bone grafting may shift towards materials such as ceramics and cell-based regenerative therapeutics (including stem cells, cellular bone matrices, and platelet-derived biomaterials). In addition, 3D printing may find a profound role in designing interbody cages of optimal characteristics.…”

Concepts of Regeneration for Spinal Diseases in 2021

“…Lo WC et al [15] performed a narrative literature review regarding materials and technologies available to improve bone grafting during minimally invasive transforaminal lumbar interbody fusion surgery. Iliac crest bone autograft and allograft, demineralized bone matrix, ceramics including hydroxyapatite, cell-based regenerative therapies including stem cells, cellular bone matrices, blood-derived biomaterials and platelet growth factors, and platelet-rich plasma, synergistically assisted with three-dimensional printed cages, have been described to achieve better surgical outcomes.…”