An increasing trend in orthopedics is the use of biological treatment for bone and cartilage repair. According to an article published in The Journal of Bone and Joint Surgery, biologics are also on the rise for spinal surgery solutions. Clinical research on bone formation and investigation into retarding or reversing invertebral disc degereation are at the forefront of this new technology.
The full journal article provides research updates on the use of biological treatments for spine surgery patients and also discusses other recent research and trends for several types of spine surgery procedures. The article is summarized below.
Recombinant Osteoinductive Proteins
In 2009, Stryker failed to achieve approval for posterolateral spine fusion devices using rhBMP-7/collogen to stimulate fusion. After recently receiving recommendation from the Medicare Advisory Committee, the FDA granted approval for Medtronic's anterior lumbar interbody fusion technology utilizing rhBMP-2, which has demonstrated outcomes of interbody spine fusion as well as posterolateral spine fusion. Studies involving the rhBMP-2/collagen sponge with ceramic granules during posterolateral lumbar spine fusion yielded 95 percent radiographic fusion rate in the BMP group compared with 70 percent fusion rate when using iliac crest bone alone. Further studies have shown a higher success rate in patients undergoing scoliosis surgery when physicians use rhBMP-2 than in patients managed with iliac crest bone graft.
The most common side effects for patients who receive BMP treatment are heterotopic bone formation in the surgical approach track, transient radiculitis, transient vertebral body bone reorption and sterile seroma fluid collections. These complications could result from excessive BMP use and usually occur seven to ten days following surgery.
Swelling in the anterior cervical spine has been reported as a result of excessive BMP use or when BMP has been placed outside of the structural implant. Patients may not experience complications until several days after the surgery and may need reintubation or tracheotomy to prevent respiratory arrest.
Bone Graft Substitutes
Platelet-rich plasma has been used as a growth stimulant to augement bone healing, however several clinical studies reported poor results for patients receiving this treatment. A new study shows platelet-rich plasma could increase osteoinductivity of deminierlized bone matrix in vivo, as long as the treatment is utilized without thrombin activation. Bone marrow cells may be a possible substitute for both rhBMP-2 and platelet-rich plasma; however, further studies must be done.
Research is currently being conducted on the use of mesenchymal stem cells for bone and cartilage regeneration. However, further studies show that mesenchymal stem cells are an insufficient solution.
Biologic treatment for disc degeneration
Tests on animals have been conducted concerning the effect recombinant BMPs have on disc metabolism and clinical human trials are currently in the planning stage. Research suggests that BMPs may have beneficial effects on human discs.
Read The Journal of Bone and Joint Surgery's full coverage on spine surgery trends.
Read other coverage on spine surgery:
- Spine Surgery Research Update: Treatment of Cervical Spine
- First Patient Treated in Benvenue Medical's KAST Study for the Kiva Vertebral Augmentation System
- Surgeon Analysis: Outpatient Lumbar Discectomy has Excellent Results, is Safe and Low Cost at ASCs
The full journal article provides research updates on the use of biological treatments for spine surgery patients and also discusses other recent research and trends for several types of spine surgery procedures. The article is summarized below.
Recombinant Osteoinductive Proteins
In 2009, Stryker failed to achieve approval for posterolateral spine fusion devices using rhBMP-7/collogen to stimulate fusion. After recently receiving recommendation from the Medicare Advisory Committee, the FDA granted approval for Medtronic's anterior lumbar interbody fusion technology utilizing rhBMP-2, which has demonstrated outcomes of interbody spine fusion as well as posterolateral spine fusion. Studies involving the rhBMP-2/collagen sponge with ceramic granules during posterolateral lumbar spine fusion yielded 95 percent radiographic fusion rate in the BMP group compared with 70 percent fusion rate when using iliac crest bone alone. Further studies have shown a higher success rate in patients undergoing scoliosis surgery when physicians use rhBMP-2 than in patients managed with iliac crest bone graft.
The most common side effects for patients who receive BMP treatment are heterotopic bone formation in the surgical approach track, transient radiculitis, transient vertebral body bone reorption and sterile seroma fluid collections. These complications could result from excessive BMP use and usually occur seven to ten days following surgery.
Swelling in the anterior cervical spine has been reported as a result of excessive BMP use or when BMP has been placed outside of the structural implant. Patients may not experience complications until several days after the surgery and may need reintubation or tracheotomy to prevent respiratory arrest.
Bone Graft Substitutes
Platelet-rich plasma has been used as a growth stimulant to augement bone healing, however several clinical studies reported poor results for patients receiving this treatment. A new study shows platelet-rich plasma could increase osteoinductivity of deminierlized bone matrix in vivo, as long as the treatment is utilized without thrombin activation. Bone marrow cells may be a possible substitute for both rhBMP-2 and platelet-rich plasma; however, further studies must be done.
Research is currently being conducted on the use of mesenchymal stem cells for bone and cartilage regeneration. However, further studies show that mesenchymal stem cells are an insufficient solution.
Biologic treatment for disc degeneration
Tests on animals have been conducted concerning the effect recombinant BMPs have on disc metabolism and clinical human trials are currently in the planning stage. Research suggests that BMPs may have beneficial effects on human discs.
Read The Journal of Bone and Joint Surgery's full coverage on spine surgery trends.
Read other coverage on spine surgery:
- Spine Surgery Research Update: Treatment of Cervical Spine
- First Patient Treated in Benvenue Medical's KAST Study for the Kiva Vertebral Augmentation System
- Surgeon Analysis: Outpatient Lumbar Discectomy has Excellent Results, is Safe and Low Cost at ASCs