Regenerative medicine in spine and orthopedics is gaining momentum, and many surgeons expect further development and research for the field in the near future.
Five spine and orthopedic surgeons share their predictions.
Editor's note: Responses were lightly edited for clarity and length.
Question: Where is regenerative medicine headed in the next decade?
David Kalainov, MD. Northwestern Medicine (Chicago): Much research is still needed to identify safe and effective means of regenerating bone and soft tissues for precise applications. We are in the early stages of this scientific journey. As orthopedic surgeons, we need to maintain a careful watch over the indiscriminate use of biologic 'regenerative' agents. The American Academy of Orthopedic Surgeons is helping us to maintain this watch. I foresee a great future of combining biology, nano materials, software, hardware and 3D printing to solve numerous problems in musculoskeletal medicine from cartilage, muscle, tendon, ligament and nerve regeneration to infection resistance to brain integration of a biomechanical limb.
Randy Dryer, MD. Central Texas Spine Institute (Austin): The goal of all treatments should be the greatest benefit with least risk to patients. That would mean fewer surgeries if possible. Regenerative medicine holds great promise but is not there yet. With any such treatment, proper dosing, safety and efficiency need to be determined in controlled prospective studies. Stem cells may not succeed if placed in too high concentration or if too few used for any given environment. This will require a longer-term study with controlled variables. Lots of basic work needs to be done. Anything less is experimenting on our patients and charging a fee that is not supported by science.
William Tally, MD. Athens (Ga.) Orthopedic Clinic: Regenerative spine interventions and regenerative 'medicine' in general are at a crossroads. The FDA needs to clarify the parameters for grafting versus transplanting and what manufacturing techniques constitute minimally manipulated materials. If they come down on the side of cell-based regenerative products being tissue transplants, then regenerative medicine faces a monumental, possibly insurmountable, hurdle.
If they rule cell-based products are grafts, then the future is very bright. There are already clinically proven products for degenerative disc disease treatment that improve positional parameters. True regeneration of native tissue and function is on the horizon, but if these products are ruled 'transplants,' the financial metrics won't make sense for companies to continue these very expensive development projects.
Hooman Melamed, MD. The Spine Pro (Marina Del Rey, Calif.): I believe that we were just at the tip of the iceberg of uncovering potential phenomenal super noninvasive treatment options for many patients. We have early studies that are already showing significant promise of cartilage regeneration as well as helping patients to alleviate pain from intervertebral disc degeneration. Harvesting the power of umbilical cord ends and amniotic stem cells to potentially stop and even regenerate cartilage and disc degeneration [could] potentially be used in augmenting fusion to minimize risk of pseudoarthrosis and for fractures that are difficult to heal and decrease the risk of nonunion. Another groundbreaking area would be used in patients with spinal cord injury to reverse and allow these patients to recover motor function back. Also for uses in ligamentous injury such as ACL, which is already shown promise to allow full recovery without requiring ACL reconstruction as well as other potential ligament and tendon tears in the body. The ultimate goal is to use the power of regenerative medicine to help many patients get better and hopefully avoid surgery, especially giving patients with spinal cord injury hope of recovery.
Dalip Pelinkovic, MD. Suburban Orthopaedics (Bartlett, Ill.): With judicious use, regenerative medicine will help to avoid repeated steroid injections and its side effects. Side effects of steroids are increased blood glucose levels, cardiac arrhythmia, flush, osteoporosis, increase in blood pressure and alopecia. Regenerative medicine aims at a more long lasting rather than short term treatment effect with less need for repeat procedures. With proper indications, it will also help to avoid morbidities of more invasive surgical procedures.