The first decade of the new millennium saw significant developments in 'metal' spinal technologies with advancements in pedicle screws, metallurgy and disc arthroplasty. That technology segment has matured and we are unlikely to see any new revolutions in the near future. The main drivers behind this are the regulatory environment, decreased appetite to finance new spine ventures and price pressures on manufacturers. I see the upcoming decade as a decade of biologics and I will highlight two trends below:
Autologous chondrocytes, which produce hyaline cartilage, seem to be a promising avenue in nucleus regeneration. For instance, one company focuses on cell expansion of juvenile cartilage cells followed by injection into the intervertebral disc. There is good basic science data that supports the hypothesis in a small animal model. There are several companies in early stage clinical trials with initial results demonstrating no adverse events associated with the technology. Currently, there is a phase 2 trial under way.
The attractive feature of mesenchymal stem cell therapy is that this cell population has the potential to be used in an "off the shelf" manner and does not appear to have many safety issues. Recently published early clinical trial data demonstrated no cell-related serious adverse events and no evidence of any ectopic bone formation in patients undergoing posterior lumbar fusion.
A recent phase 2 trial using allogeneic, mesenchymal precursor cells demonstrated rates of fusion that were comparable to autograft.
Treatment of discogenic pain with mesenchymal precursor cells is also in phase 2 trials. In the animal model, injection therapy has been shown to contribute to regeneration of new extracellular matrix in degenerated intervertebral disc.
Dr. Kris B. Siemionow, MD is a spine surgeon at Illinois Bone and Joint Institute and is Chief of Spine Surgery and Assistant Professor of Orthopaedics and Neurosurgery at the University of Illinois in Chicago.
More Articles on Spine Surgery:
5 Healthcare Reform Threats to Spine Surgeons & How to Overcome Them
7 Cost Cutting Strategies for Spine Surgery
5 Steps to Reduce Readmissions After Spine Surgery
Autologous chondrocytes
Autologous chondrocytes, which produce hyaline cartilage, seem to be a promising avenue in nucleus regeneration. For instance, one company focuses on cell expansion of juvenile cartilage cells followed by injection into the intervertebral disc. There is good basic science data that supports the hypothesis in a small animal model. There are several companies in early stage clinical trials with initial results demonstrating no adverse events associated with the technology. Currently, there is a phase 2 trial under way.
Stem cells.
The attractive feature of mesenchymal stem cell therapy is that this cell population has the potential to be used in an "off the shelf" manner and does not appear to have many safety issues. Recently published early clinical trial data demonstrated no cell-related serious adverse events and no evidence of any ectopic bone formation in patients undergoing posterior lumbar fusion.
A recent phase 2 trial using allogeneic, mesenchymal precursor cells demonstrated rates of fusion that were comparable to autograft.
Treatment of discogenic pain with mesenchymal precursor cells is also in phase 2 trials. In the animal model, injection therapy has been shown to contribute to regeneration of new extracellular matrix in degenerated intervertebral disc.
Dr. Kris B. Siemionow, MD is a spine surgeon at Illinois Bone and Joint Institute and is Chief of Spine Surgery and Assistant Professor of Orthopaedics and Neurosurgery at the University of Illinois in Chicago.
More Articles on Spine Surgery:
5 Healthcare Reform Threats to Spine Surgeons & How to Overcome Them
7 Cost Cutting Strategies for Spine Surgery
5 Steps to Reduce Readmissions After Spine Surgery