The future of spinal biologics, regeneration and MIS treatment: Q&A with Dr. Roger Härtl


Roger Härtl, MD, has devoted much of his career to finding the best, least invasive treatment for back and neck pain. That mission has led him to research and innovate in the field of spinal biologics.

Dr. Härtl is the director of spinal surgery and neurotrauma at the Weill Cornell Brain and Spine Center in New York and director of the Weill Cornell Medicine Center for Comprehensive Spine Care. Along with the biomedical engineering department at Cornell, Dr. Härtl is working on tissue-engineering techniques to repair and regenerate spinal discs. He also participates in medical mission work in Tanzania and recently had a clinical article accepted to the Journal of Neurosurgery: Spine about his findings.

Here, Dr. Härtl discusses the big trends and most exciting aspects of spinal biologics today.

Question: What research are you working on today around spinal biologics?

Dr. Roger Härtl: Our main focus of research is regeneration repair and replacement of spinal discs. These are highly relevant topics currently given the incidence of back pain and degenerative spinal issues and the really limited options that we have in terms of treating them. I am most excited about some of the work that we have been doing on annular repair. We're working on a collagen derived glue type implant that will repair and seal the end of the defect and prevent recurrent disc herniations.

We have shown in experiments that not only does this seal the defect, but it also prevents degenerative changes down the line. This can be used in patients who undergo discectomy, but it could also be used in patients who have adjacent segment disease or annular tears leading to back pain. We're currently working with a company called 3D bio and are preparing clinical trials.

Another exciting area of research is spinal total disc replacement using biological tissue-engineered 3D printed implants. We're currently optimizing a scaffolding material that we use to provide stability for the initial phase of implantation. We believe that once this technology has been refined this will offer an important alternative to spinal fusion or mechanical disc arthroplasty especially in the cervical spine.

Q: What are you most excited about today in the spine field?

RH: My research and clinical interests surround less invasive and MIS surgery and biologics of course. But I'm also a big believer in the interdisciplinary and holistic approach to degenerative spine problems especially in patients with significant pain. I'm also very excited about some of the work that has been done recently to address primary muscle pain. We still do not understand the role of muscle in patients with back and neck pain. I think that in general we just do not really understand well enough what leads to pain and suffering in our patients. This has to be all put together in a scientific and organized way in order to come up with better treatment algorithms for patients.

In that regard I most excited about the advances that have been made in MIS surgery, biologics for disc repair and regeneration, our understanding of muscle pathophysiology and finally about the increased tendency in the spine world to work effectively in an interdisciplinary and holistic way.

Q: How do you anticipate the spine surgeon back pain treatment will change in the next decade?

RH: I believe that what we will see in the future is a much more interdisciplinary approach. Complex pathologies such as significant deformities should be treated in specialized centers and an interdisciplinary approach should be chosen for initial assessment and treatment selection. If surgery is required, this should be done by well-trained experts in large centers very much as we address other complex issues, for example cardiac surgery and neurosurgery.

I think that we have to show better the value, of course, of our treatment intervention and how the surgery has a positive impact on patient outcome and value-based care. I believe that noninvasive techniques will penetrate more and more of the field and will become a more important part of what's [performed by] spinal surgeons to worldwide.

Based on our work that we do in Tanzania, it is amazing to see how quickly things change over a short time., especially in that part of the world. It is exciting to be part of this change and to initiate change and to support colleagues especially worldwide who suffer from limited resources and to help them achieve better care for their patients.


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