Recent Advancements in the Role of Orthobiologic Therapy for Spine Surgery: A Review on Current Evidence, Outcomes, and Future Applications

Spine surgery technology and technique have improved considerably over the past few decades, thereby widening the breadth of pathologies that may benefit from surgical intervention. However, entities such as non-radicular low back pain, degenerative disc disease, and chronic spinal cord injury have limited if any reliable surgical treatment. As the body of literature and the reliability of preparation strategies for orthobiologics such as platelet-rich plasma and mesenchymal stem cells continues to improve, so has their potential for use in the treatment of spine pathology. The number of clinical studies and high-level trials that evaluated the use of orthobiologics in fields such as degenerative disc disease/discogenic back pain, post-decompressive pain, spinal cord injuries and surgical adjuncts during discectomy or fusion procedures has grown significantly over the past decade. While this field remains immature and most works are either uncontrolled or evaluate a small number of patients, the body of evidence that supports the efficacy of orthobiologics in areas where traditional surgical intervention is less effective continues to increase. Here, we review the current body of literature that assesses the use of orthobiologics in spine surgery and provide additional discussion as to current questions and future directions for the field. Particular attention will be paid to high-quality trials that have been completed or are currently in progress, and comment as to the quality and shortcomings of current protocols will be made.