As spine leaders look ahead to 2026, enthusiasm around regenerative medicine and neuromodulation continues to build. But much of the conversation still flattens a field that is far more complex than it appears, according to Ann Parr, MD, PhD.
Dr. Parr is vice chair of research and a professor of neurosurgery at the Minneapolis-based University of Minnesota, where she also serves as director of spinal neurosurgery. She said one of the most persistent misconceptions is the idea that “spine” represents a single therapeutic problem and that advances in biologics or stimulation will rapidly replace surgery.
“I think one of the things that’s most misunderstood is the fact that all spine problems aren’t the same,” Dr. Parr told Becker’s.
In her work, the word “regeneration” spans very different meanings, from disc pain and joint degeneration to spinal cord injury, where damaged neural tissue does not naturally repair itself. Treating those conditions as interchangeable, she said, has distorted expectations about how quickly research breakthroughs might translate into care.
Biologics, pain relief and the limits of regeneration
Much of the attention around regenerative spine care has focused on biologics used to treat discogenic pain. But Dr. Parr said many of those therapies are better understood as anti-inflammatory treatments than as tools that restore damaged anatomy.
“A lot of therapies aimed at disc pain are aimed at anti-inflammatory properties,” she said.
While such treatments may help reduce pain, Dr. Parr does not see them as replacing surgery. Instead, she expects biologics to be layered onto existing procedures, whether to reduce inflammation or potentially improve outcomes such as fusion rates.
“One of the messages I would have for spine surgeons is not to worry about being put out of business,” she said. “I don’t think they’re going to replace spinal procedures.”
Why timing matters in spinal cord injury
Where misunderstanding deepens, Dr. Parr said, is in spinal cord injury, particularly when acute and chronic injury are discussed as though the same therapies apply to both.
In acute and subacute spinal cord injury, the initial trauma cannot be undone. What follows, she said, is a cascade of inflammatory events that can significantly worsen damage. For that reason, much early-stage spinal cord injury research focuses on limiting secondary injury rather than regenerating tissue.
Chronic spinal cord injury, she said, presents a different challenge altogether.
“What you’re looking at with chronic spinal cord injury is actual regeneration,” she said.
From cells to signals: The rise of exosomes
For years, researchers have explored transplanting cells into injured spinal cords. But Dr. Parr said improvements seen in some animal models may not come from the cells themselves integrating into neural tissue.
“There’s a high likelihood that it’s not actually the cells themselves, but the things that the cells are making,” she said.
That realization has helped drive interest in exosomes, vesicles released by cells that contain growth factors and signaling molecules. Because immune rejection is tied to proteins on the surface of transplanted cells, exosomes may help avoid some of those risks.
In theory, Dr. Parr said, exosomes could be developed as off-the-shelf treatments for acute or subacute spinal cord injury. Early clinical trials are beginning, and her lab is also working in this area.
Neuromodulation’s promise and its blind spots
For patients with chronic spinal cord injury, electrical stimulation of the spinal cord has already changed what was once thought possible. Neuromodulation has enabled voluntary movement in some patients who were previously paralyzed.
Still, Dr. Parr cautioned against viewing the technology as a finished solution. “It’s still in its infancy,” she said.
Current systems require manual adjustment of stimulation settings and do not automatically respond to what the body is doing. “There’s no automatic feedback loop,” she said.
Some research groups are exploring ways to integrate stimulation with movement and neural feedback, allowing settings to adjust based on what the stimulation is doing. Even as neuromodulation advances, Dr. Parr said one major limitation remains: sensory recovery.
“The one thing I don’t think it does very well is sensory function,” she said.
Patients may regain the ability to move their legs, she explained, but without sensation they often do not know where those limbs are in space unless they are watching them.
Because of those limitations, Dr. Parr does not believe the field will converge on a single cure. Instead, she said true regeneration, rebuilding damaged neural circuits, may ultimately need to be paired with neuromodulation to help guide newly implanted cells.
“It’s one thing to squirt in a bunch of neurons and hope they make the right connections,” she said. “If you put cells in a person who can’t move their legs, how are the cells going to know what connections to make?”
Building “mini spinal cords”
To address immune rejection, Dr. Parr’s lab uses induced pluripotent stem cell technology, which allows researchers to generate spinal cord–specific cell types. Using 3D bioprinting, her team places those cells in defined locations within scaffolds.
Over time, she said, those constructs begin to organize themselves. “They form these mini spinal cords,” she said.
Only a few research groups worldwide are pursuing similar approaches. Dr. Parr said she is closely watching a Japanese trial using iPSC-derived cells in subacute spinal cord injury that has reported early safety results, as well as an upcoming Israeli trial using a hydrogel-based method.
Barriers beyond the lab
Even as the science advances, Dr. Parr said the path from research to routine care remains constrained by practical barriers, including cost, regulation and the challenge of long-term follow-up.
She noted that spinal cord stimulators are not FDA-approved for spinal cord injury, which means they are often used off-label and may not be covered by insurance. As a result, some patients travel abroad to receive implants, only to return without a clear system for ongoing management.
“These need to be optimized, and every patient’s different,” she said. “And it might change over time.”
“There aren’t any places where somebody can just show up and say, ‘I have the stim in now. I need someone to follow it,’” she added.
Cell-based therapies face a different set of hurdles. While Dr. Parr believes automation could eventually make patient-specific treatments financially feasible, she does not expect that shift to happen in the near term.
“I don’t think it’s coming in 2026,” she said.
Progress, even when it’s hard to see
Patients with chronic spinal cord injury are often frustrated by the slow pace of progress, Dr. Parr acknowledged. Still, she said the field has moved forward in meaningful ways, particularly in neuromodulation, even if much of that work has unfolded outside the public spotlight.
“I do think we’ve made progress, even though it doesn’t always seem that way,” she said.
At the same time, she cautioned that speed cannot come at the expense of safety. “We don’t want to plow forward with something that’s going to harm somebody,” she said.
As results continue to emerge from ongoing trials, Dr. Parr said she hopes the next phase of spinal cord research will bring greater clarity and momentum.
“I’m hoping that’s going to come soon,” she said.
