Kevin Pauza, MD, is an interventional spine specialist and founding partner and principal of Texas Spine and Joint Hospital in Tyler.
Dr. Pauza specializes in disc biologics and developed the Discseel procedure to promote regeneration of disc tissue in the cervical and lumbar spine.
Here, he discusses the development of biologics in spine and what treatments he anticipates making a breakthrough in the field.
Note: Responses are lightly edited for style and content.
Question: How do you see biologics developing in spine?
Dr. Kevin Pauza: A need for spine surgery may always exist, however today's spine industry sits precariously on the edge of its greatest moral and financial precipice. Spine patients and payers don't want spine surgery. Instead, they want regenerative medicine because treatment options — once solely driven by surgeons, hospitals and device companies — are now patient and insurance driven.
It's because the playing field has been leveled by the internet's dissemination of information, sharing regenerative medicine's efficacy, lower cost and morbidity, all without surgery's deleterious effects. Instead of fusing, replacing or cutting discs, we're targeting and correcting pathology. The physicians and companies who embrace this new paradigm will prosper.
Q: How do you evaluate new regenerative technologies?
KP: I'm critical of regenerative medicine companies who have the most 'franchises' yet fail to tabulate their data using respected, independent outcome registries. Outcomes cannot be considered accurate or reliable in companies taking the easy path by not allowing unbiased oversight. That's why my research teams enroll every patient into an institutional review board study using the independent Smart Outcomes Data Collection Efficiently Collect Data Registry.
My mandate includes subjects treated with the Discseel procedure or other regenerative treatments. This also allows comparison of surgical and regenerative treatments while providing transparency. The other large regenerative medicine companies without independent data will fall by the wayside.
Q: How are payers viewing Regenerative treatments for spine conditions now? Do you see their attitudes changing in the future?
KP: Payers increasingly want regenerative medicine. With regard to the Discseel procedure, their interest may be motivated by cost-savings, efficacy or the reliability of large-scale budgetary predictions. In my experience, payers have been pleased that 1 to 4-level fusions can be routinely replaced by the outpatient Discseel procedure in ASCs. I believe other regenerative medicine treatments will be embraced after they also provide positive independent data. There's no independent study of any other biologic treatment on the horizon, but we're waiting with optimism.
Q: What research are you currently engaging in? Is there anything you see as becoming particularly innovative in spine?
KP: I'm performing prospective clinical research evaluating the ability of fibrin to be used in other manners to seal herniated and degenerated discs, stimulating their healing while preventing breakdown of adjacent discs. In another study, we're proving that by treating discs with annular fibrin at the same time of surgical discectomy, we can eliminate recurrent disc herniations and degeneration. It's an exciting area because data suggests that treating discs with fibrin is likely to be a major player in improving spine treatment outcomes.