Local drug delivery challenges and innovations in spinal neurosurgery

Christina Karavasili; Thomas Young; Joshua Francis; Julianna Blanco; Nicholas Mancini; Charmaine Chang; Joshua D Bernstock; Ian D Connolly; Ganesh M Shankar; Giovanni Traverso

doi:10.1016/j.jconrel.2024.10.055

Local drug delivery challenges and innovations in spinal neurosurgery

J Control Release. 2024 Nov 11:376:1225-1250. doi: 10.1016/j.jconrel.2024.10.055. Online ahead of print.

Affiliations

¹ David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States; Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
² Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
³ Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States.
⁴ David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
⁵ Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA.
⁶ David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States; Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States. Electronic address: cgt20@mit.edu.

PMID: 39505215
DOI: 10.1016/j.jconrel.2024.10.055

Abstract

The development of novel therapeutics in the field of spinal neurosurgery faces a litany of translational challenges. Achieving precise drug targeting within the confined spaces associated with the spinal cord, canal and vertebra requires the development of next generation delivery systems and devices. These must be capable of overcoming inherent barriers related to drug diffusion, whilst concurrently ensuring optimal drug distribution and retention. In this review, we provide an overview of the most recent advances in the therapeutic management of diseases and disorders affecting the spine, including systems and devices capable of releasing small molecules and biopharmaceuticals that help eliminate pain and restore the mechanical function and stability of the spine. We highlight material-based approaches and minimally invasive techniques that can be employed to provide control over drug release kinetics and improve retention. We also seek to explore how the newest advancements in nanotechnology, biomaterials, additive manufacturing technologies and imaging modalities can be employed in this translational pursuit. Finally, we discuss the landscape of clinical trials and recently approved products aimed at overcoming the complexities associated with drug delivery to the spine.

Keywords: Drug delivery; Drug therapy; Innovation; Neurosurgery; Spinal neurosurgery; Spine.

Publication types

Review