Regenerative medicine in spine and orthopedic surgery is growing, but its exact place in the specialties hasn't been fully cemented yet.
Here is how three surgeons are thinking about biologics:
1. Treatments from stem cell lines are creating some buzz in the industry, one surgeon says.
"Orthobiologics are really one of the tools that we use to treat our patients optimally," orthopedic surgeon Thomas Graham, MD, said. "There's a list of the biologic adjuvants, and some of them are becoming more tried and true as evidence-based such as PRP. We obviously have a long history in our highly technical specialty of utilizing material, chemical and structural things to enhance bone healing and advance motion recovery. All those things are critically important. They reside right along there with the traditional fixation mechanisms. But things that stimulate bone growth have always been important — both the osteoconductive and osteoinductive. The things that I think right now are creating a little bit more of a buzz on the biologic side reside in and around things derived from stem cell lines such as bone marrow aspirates, bone marrow concentrates, the utilization of bone morphogenic protein, mesenchymal cells and anything that has that pluripotential opportunity to accelerate healing. We're all looking for the holy grail of orthopedics, which is some form of articular cartilage replacement."
2. More research is needed in orthobiologics to figure out the best way to leverage it.
"The reality is that the research is just all over the place and hasn't consistently shown that we've figured out how to modulate or how to direct our own healing system or our biologics to do what we hope that it would do," orthopedic surgeon Michael Ciccotti, MD, said. "There has been an enormous amount of research that has looked at biologics in orthopedics … But I would emphasize that this does not mean that we give up on the potential benefit of biologic treatments. Rather, the current ambiguity of research findings is a reflection of the need to perform continued, higher-level research on its applicability and optimal use. The theory of biologics is brilliant. We just haven't figured out how to harness it yet. We need to persevere as researchers and perform more precise, continued research in order to optimize the use of biologics."
3. An area one spine surgeon is watching is orthobiologics in spinal tissue restoration.
"Currently, the majority of the biologic market is focused on promotion of arthrodesis in spinal fusion surgeries," spine surgeon Timur Urakov, MD, said. "I would like to see the next wave of development to involve products that promote healing and restoration of native tissues such as joints spaces or disk components. Telemedicine has proven to be beneficial in improving patient access and should continue being implemented. It facilitates remote consultations, follow-ups, and monitoring, as well as increasing access to care for elderly and less-abled patients. Community outreach and education is ever more important to promote spinal health and preventive measures among the aging population. Spine practices should strive to develop strong collaboration with primary care providers to streamline referrals and ensure preventative and conservative care for the patients."