Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany.
Australian Research Council (ARC) Training Centre for Multiscale 3D Imaging, Modelling and Manufacturing (M3D Innovation), Queensland University of Technology, Brisbane, QLD 4000, Australia.
Biomater Sci. 2024 Sep 25;12(19):4875-4902. doi: 10.1039/d4bm00848k.
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.
全球范围内脊柱疾病的患病率不断上升，需要先进的治疗方法，特别是对于对非手术干预无反应的严重病例，需要进行椎间融合术。该手术，特别是 360°腰椎椎间融合术，采用椎间融合器、椎弓根螺钉和棒器械以及自体骨移植物（ABG）来增强脊柱稳定性并促进融合。尽管取得了重大进展，但 10%的持续非融合率仍然导致患者预后受损和医疗保健成本上升。腰椎稳定化的创新旨在模仿天然骨的特性，新型植入材料如钛（Ti）和聚醚醚酮（PEEK）及其复合材料为提供了新的前景。此外，具有精确设计的孔隙率和连通性的仿生融合器也得到了关注，因为它们增强了成骨分化，支持成骨，并减轻了应力遮挡。然而，ABG 的局限性，如采集病态和有限的融合能力，促使人们探索涉及高级骨移植物替代品的复杂解决方案。目前，脱矿骨基质和陶瓷正在临床应用中，为未来对新型骨移植物替代品的研究奠定了基础。尽管在临床前研究中观察到其快速吸收和潜在的异物反应，生物玻璃作为一种很有前途的新型材料仍在研究中。其临床适用性仍在审查中，正在进行的研究解决了爆发释放和适当剂量的相关问题。相反，生长因子具有良好的成骨潜力，这一有充分记录的事实仍然令人鼓舞，目前的研究重点是调节其释放动力学，以最大程度地减少并发症。在这个基于证据的叙述性综述中，我们全面概述了不可降解脊柱植入物和骨移植物替代品的不断发展的领域，强调了它们在腰椎融合手术中的应用。我们强调需要继续研究以改善临床结果并提高患者的幸福感。
