In July, the official journal of the North American Spine Society, The Spine Journal, released an issue dedicated to the use of recombinant bone morphogenic protein. The only BMP product on the market currently approved by the FDA for promoting spinal fusion is Medtronic's Infuse, which has been the gold standard in BMP use since it was approved in 2003. Now, surgeons and researchers are raising questions about its efficacy in off-label use because additional studies have linked it to complications, including retrograde ejaculation in male patients.

The use of Infuse even among on-label applications has recently come into question as well because some feel the field is lacking evidence-based literature proving BMP creates better outcomes. Without solid backing from strong studies, hospitals and insurance companies are hard-pressed to approve the use of Infuse, since it is considerably more expensive than the alternatives.

InVivo Therapeutics, based in Cambridge, Mass., was founded to focus on research and development of treatment for patients with spinal cord injuries (SCI). Currently, there are no effective treatments for these patients, and much of the research focuses on treating the symptoms of SCI instead of the underlying pathology.

However, InVivo has focused its efforts on both regenerative medicine and neuroprotection. Its scaffolds are designed to mitigate inflammation and prevent further cell death after SCI as well as support the repair and neuroplasticity recovery process. Co-founded by CEO and CFO Frank Reynolds and Robert Langer, ScD in 2005, InVivo Therapeutics and its scientific team have made incredible progress over the past few years and are now poised to bring the technology to human patients, which has created a stir in the global medical community.

This is a list of 10 spine surgeons who are using stem cells to promote healing during spinal procedures in their practice or who are researching and innovating in the field of spinal biologics. Inclusion on this list is not an endorsement of a surgeons' or organization's clinical abilities.

The shoulder specialty has developed significantly over the past few decades, and more surgeons are now able to conduct research and focus their practices on shoulder-related injuries and conditions. Anthony Romeo, MD, an orthopedic surgeon at Midwest Orthopaedics at Rush and team physician for the Chicago White Sox, has been on the forefront of shoulder research and development for several years and continues to train future specialists in the field.

Osteochondral graft placement in a congruent position restores part of the contact mechanics of the ankle joint during autologous osteochondral transplantation of the talus, but unique characteristics of the donor or the patient may cause problems, according to a report published in the American Journal of Sports Medicine.

Spinal Restoration, an Austin, Texas-based spine device company, received a patent for its Biostat System, according to a Spinal Restoration news release.

In June, Eugene Carragee, MD, editor-in-chief for the North American Spine Society's The Spine Journal and a spine surgeon at Stanford University School of Medicine, co-authored an article showing that the use for recombinant bone morphogenic protein was associated with retrograde ejaculation among male patients, which could cause infertility. The study, published in The Spine Journal, was surprising for many spine surgeons who had been using Medtronic's Infuse, an rhBMP-2 product, with patients for spinal fusions over several years because they weren't aware of the complication risks. At the same time, the articles' authors revealed that while Medtronic reported complications of RE to the FDA for clearance, the data about these complications was not made available for the public in peer review articles sponsored by Medtronics.

Medtronic reported $4 billion in revenue for the first quarter of the 2012 fiscal year, which is a 7 percent increase over the same period last year, according to a Medtronic news release.

Researchers at the University of Pennsylvania in Philadelphia are working on cartilage regeneration solutions that could lead to better treatments for knee conditions and injuries, according to a Philadelphia Inquirer report.

Surgeons should consider the ability to concentrate platelets and leukocytes with sensitivity to pathologic conditions during platelet-rich plasma injection preparation, according to a study published in The American Journal of Sports Medicine.