Stem cells may achieve 'breakthrough' in spine, but researchers must do due diligence, says Dr. Steven Cyr


Steven Cyr, MD, is a fellowship-trained spine surgeon who recently began providing stem cell treatments at SASpine in San Antonio.

Dr. Cyr has engaged in extensive stem cell research for the treatment of spinal cord injury, degenerative disc disease and herniated discs. He is using stem cells as an adjunct to spinal fusion to treat spinal instability, deformity and fractures.

Here, Dr. Cyr discusses regenerative medicine and the development of stem cell therapies in spine.

Question: What do you see as the next big breakthrough in regenerative medicine for spine?

Dr. Steven Cyr: I think most people would agree that restoring spinal cord function would be considered the ultimate breakthrough in regenerative medicine for the spine. There are many conditions affecting the spine that would change lives, including reproducible regeneration of degenerated, painful discs and chronically injured nerves. I believe there is potential for all those conditions to be improved. Our only limitation currently is a standardized system and research outlining the safest techniques and most effective source of stem cells and growth factors. 

Q: How do you see stem cell therapies developing in spine?

SC: I believe the most common conditions, including discogenic pain, facetogenic pain and chronically injured nerve roots will one day be treated effectively using stem cells and/or growth factors. Although more data is needed along with a standardized treatment regimen that has been proven to be effective and safe, we have already seen significant improvements in treating these conditions and other joint ailments with platelet-rich plasma, amniotic tissue and stem cells anecdotally. Clinical studies have even shown objective improvement in treating spinal and joint disorders.  

Researchers at the Mayo Clinic reported degeneration of spinal discs either decelerated or stopped when injected with stem cells. Other studies in which stem cells were injected into degenerated discs have shown improvement in both height and appearance of the discs. Additionally, for years I have seen impressive, long-lasting results that are superior to corticosteroids and viscosupplementation in both length of relief and return to function for many patients treated with regenerative techniques. However, regenerative therapies are still in their youth and we need to develop techniques that optimize the volume and efficacy of stem cell therapies with our current FDA limitations in the U.S.

Q: How do you evaluate new technologies in regenerative medicine?

SC: As with all new technologies, it is important to thoroughly vet the manufacturer or supplier of the products. I personally evaluate whether the bone bank is American Association of Tissue Banks-certified, what sterilization techniques/protocols are used, review any white papers available on the products and look at protocols for testing for infectious disease along with the standards used to ensure quality donor tissue. 

Beyond that, I look to see if there are any peer-reviewed articles evaluating the efficacy and safety of each product. I critically evaluate my personal experience with the products, following both the patients' response to the products and the clinical benefits resulting from their use. This includes regular follow-ups and radiographic studies, such as CT scans to evaluate fusions, clinical results related to radicular symptoms and axial pain as well as an MRI when evaluating potential changes in disc appearance.

Q: How are payers viewing regenerative treatments for spine conditions now? Do you see their attitudes changing in the future?

SC: Unfortunately, payers are still unwilling to pay for most regenerative treatments. I hope their attitudes change as we show clinical results and cost savings that 'force' them to pay attention. In the meantime, it's not unreasonable for them to be skeptical. I do feel we need to do a better job showing the clinical efficacy of these techniques with quality research. I'm sure that will happen in time but feel it's a shame that patients are forced to pay out of pocket for treatments that could potentially save them from chronic pain, narcotics addiction, multiple surgeries and future cost to the system. 

Where regenerative treatment promise at least the potential and hope of reversing the clock, other options merely provide a temporary solution that does nothing to alter the future of these conditions — the exception being a spinal fusion for an unstable or malaligned spine. The hope is that one day, nearly every condition ailing the human body will have a regenerative treatment that effectively eliminates, or at least dramatically improves it. 

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