Spine surgeons see promise in biologics, regenerative medicine


Regenerative medicine in spine surgery is an area of the field that still has room for research and growth. 

From stem cell therapy to bone graft substitutes, there's several areas of biologics that are expected to grow in the field.

Six spine surgeons shared their predictions.

Note: Responses were lightly edited for clarity.

Question: What area of spine biologics has the most potential for growth?

Brian Fiani, DO. Mendelson Kornblum Orthopedic & Spine Specialists (West Bloomfield, Mich.): There are several areas within spine biologics that have potential for growth, such as stem cell therapy, growth factors, and bone graft substitutes. Stem cell therapy, in particular, holds promise for regenerating damaged tissue and promoting healing in spinal conditions. Research and development in these areas can lead to innovative treatment options and improved outcomes for patients with spine-related issues. 

Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: Spine biologics was at one point, the main money maker for many of the large spine companies. The promulgation of biologics has slowed considerably, likely due to various pressures from the healthcare spending reallocation and decreasing pressure to innovate for less return on their research and development. I think biologics is a fairly stagnant market, to the detriment of patients. My hope is that our healthcare system will not continue to stagnate and stifle this innovation.  

Arya Shamie, MD. UCLA Health: Degenerative disc disease is a common cause of chronic low back pain. Stem cell therapy is being explored as a way to regenerate the damaged intervertebral discs. Researchers are investigating the use of mesenchymal stem cells (MSCs) to stimulate the production of new, healthy disc tissue, potentially alleviating pain and restoring function without the need for invasive surgery. Spinal fusion remains to be a common surgical procedure to treat conditions like spinal stenosis or spondylolisthesis. 

Inductive agents like bone morphogenetic proteins (BMPs) and newly researched peptide enhanced bone grafts are being used to enhance the bone healing process and improve the success rate of spinal fusion surgeries. By stimulating the body's natural bone-forming mechanisms, these factors can help achieve a solid fusion more reliably. 

PRP therapy involves using a concentrated solution of the patient's own platelets, which are rich in growth factors, to promote healing in injured tissues. In spine care, PRP is being studied for its potential to treat conditions like facet joint arthritis or discogenic pain, offering a minimally invasive option to reduce inflammation and stimulate tissue repair. The utility of PRP in spine remains to be experimental with no concrete evidence of efficacy at this time. 

Researchers are also exploring the use of biodegradable scaffolds combined with stem cells and growth factors to regenerate damaged spinal cord tissue. This approach aims to create an environment that supports nerve regeneration and functional recovery after spinal cord injuries. It is an exciting area of ongoing research, with the potential to improve function for this subset of severely disabled spine injury patients.

Vladimir Sinkov, MD. Sinkov Spine (Las Vegas): There is still more research to be done to determine which bone graft substitutes are most effective for what type of patients. The biggest areas of growth, however, will be further research into stem cells and injectable biologics (such as PRP) to heal spine injuries and possibly help with chronic degeneration or pain without surgical interventions.  

William Taylor, MD. University of California San Diego Health: I continue to believe that interdiscal biologics for disc regeneration, repair and treatment should be the next opportunity of growth.

Although the possibly misguided notion that stem cells would be the answer, there are multiple other companies working on alternative treatments.

I would point you towards Notogen. They are using novel proteins to repair and regenerate the space in a relatively hostile environment, unkind to stem cells and other mechanisms.It represents an example of underlying effort through the scientific process and long-term results using animal studies. Then, slowly working towards human data in an appropriate setting.

Timur Urakov, MD. University of Miami (Fla.): Currently, the majority of the biologic market is focused on promotion of arthrodesis in spinal fusion surgeries. I would like to see the next wave of development to involve products that promote healing and restoration of native tissues such as joints spaces or disk components. 

Telemedicine has proven to be beneficial in improving patient access and should continue being implemented. It facilitates remote consultations, follow-ups, and monitoring, as well as increasing access to care for elderly and less-abled patients. Community outreach and education is ever more important to promote spinal health and preventive measures among the aging population. Spine practices should strive to develop strong collaboration with primary care providers to streamline referrals and ensure preventative and conservative care for the patients.

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