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

Background: 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. Methods: 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. Results: 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. Conclusion: 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.