Andrew Cash, MD, director of the Desert Institute of Spine Care in Las Vegas, discusses the current state of biologics in spine surgery and where there is the best opportunity for growth in the future.
Q: What materials and techniques are at the forefront of biologics in spine surgery today?
Dr. Andrew Cash: We must first keep in mind that the carpentry (endplate preparation for intervertebral fusions) is paramount to allow bone grafting to enhance the likelihood of successful fusion. Iliac crest bone graft has been largely replaced by alternative methods including bone morphogenic protein-2 and other bone grafting strategies carrying a lower morbidity profile.
Q: Is there any new research or product development in biologics that are exciting for the spine field?
AC: The most exciting research in spine biologics is the concept of restoring a healthy disc matrix with protein injections (growth factors and/or inflammatory cytokine blockers). Perhaps a more important role will be in the prevention of disc degradation.
Q: What challenges are there in the development and usage of biologics in spine surgery?
AC: Research and development is challenged by the cost of bringing a new product to market and the associated reimbursements of the products once it reaches the market. With the costs increasing and the reimbursements decreasing, investors are significantly less likely to risk developing a new product.
Q: Where do you see the most opportunity for biologics in spine in the future?
AC: The greatest opportunity for spine biologics existing the arena of prevention, which will improve patient satisfaction, diminish time lost from work and life and will significantly reduce the overall costs of spinal healthcare on an individual to world-wide scale.
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