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

## TL;DR

This paper reviews strategies to improve spinal fusion surgery outcomes in elderly patients suffering from low back pain.

## Contribution

The paper focuses on novel therapeutic approaches tailored for age-related challenges in spinal fusion.

## Key findings

- Biomaterials like bioactive scaffolds and 3D-printed constructs support bone formation in elderly patients.
- Growth factor delivery systems using BMPs and VEGF enhance osteoinduction with reduced side effects.
- Cell-based therapies with MSCs and EVs show potential for osteogenic and immunomodulatory effects.

## Abstract

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.

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.

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.

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.

The review summarizes the current clinical problems of non‐spinal fusions in orthopaedics. I refers to selected biological examples of how ossification can be better achieved in elderly patients.