Spine biologics is a realm ripe for exploration of its potential and applications in patient care.
Five spine surgeons share where they want to see more research in regenerative medicine.
Question: What areas of spine biologics need more research?
Benjamin Elder, MD, PhD. Mayo Clinic (Rochester, Minn.): We need more specific research on bone healing on the main populations undergoing spine surgery, ie elderly and osteoporotic patients, and many of these patients were specifically excluded in FDA IDE studies to allow for a more uniform population. We likely need targeted biological therapeutics for this population that may be substantially different than what has the most benefit in the general population.
Tiffany Perry, MD. Cedars Sinai Spine Center (Los Angeles): Ultimately the goal of biologics in spine surgery is to promote arthrodesis. With the advent of increased use of motion preservation systems, an area of biologics that would be interesting to develop is biologics that counteract or diminish calcium build-up or osteophytes at levels of disc replacements and motion preservation procedures to maintain motion at these levels.
For instance, TNF-inhibitor treatments in ankylosing spondylitis have been shown to decrease the spondylitis in the synovium of AS patients. Are there similar local treatments we could consider to preserve motion segments at levels of disc replacements?
William Taylor, MD. University of California San Diego Health: Stem cell treatment of degenerative disease.
Vijay Yanamadala, MD. Hartford (Conn.) HealthCare: Novel products are continuously put on the market with robust company data demonstrating their superiority. However, truly independent data that demonstrates the safety and efficacy of most products is lacking. Do we really need a bioactive product for a particular case or not? Do we really need bone morphogenetic protein for a particular case? When should we use these products and when are they unnecessary? As we think about the cost of care and the value of care delivered, we need to deeply think about these questions.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): The recombinant human bone morphogenetic protein (Rh-BMP-2) controversial indications, widespread off-label use and publicized adverse effects doomed this product. Yet, the results were noticeable. Further scrutiny may ensure the successes needed for so many plagued with degenerative bone pathology and poor healing mechanisms.