Regenerative medicine in spine and orthopedics is a promising area of care with medtech companies pushing into the space and physicians exploring their options.
Here’s what spine and orthopedic experts predict for the short- and long-term.
In 12 months
Brian Cole, MD. Midwest Orthopaedics at Rush (Chicago): It has been hard to utilize the literature to make accurate decisions about the effects of orthobiologics or the use of agents that are often purported to stimulate a healing environment, and possibly, help regenerate tissue. The areas that we’ve demonstrated research success in and have published on include the use of orthobiologics to reduce rotator cuff re-tears following repair, help ACL grafts used for ligament reconstruction mature more rapidly, and to potentially minimize failure following cartilage transplantation. The most common orthobiologic investigated at our center includes bone marrow aspirate that is concentrated and utilized at the time of surgery or in the office setting.
One of our next initiatives is to capture virtually every patient who undergoes non-surgical symptom modifying treatment with the use of orthobiologics in the office setting. The literature often does not include an analysis or characterization of the substance that we are injecting. Having this information and understanding its correlation to patient reported outcomes might help us to nearly customize how we think about the use of orthobiologics in the future. This multi-center initiative (the BARB), centered at the Mayo Clinic in Arizona, involves up to 10 centers and will truly further our ability to provide predicable care and outcomes for our patients with greater precision.
In five years
Vivek Babaria, DO, FAAPMR. DISC Sports & Spine Center (Newport Beach and San Diego, Calif.): I’m cautiously optimistic because regenerative medicine remains unregulated. We don’t have a society or an institution that has published precise dosing protocols for specific conditions. With this freedom to operate, gathering quality data can be difficult. Interpreting results based on bad data can misconstrue outcomes and opinions of both doctors and patients. I hope we can have large multi-site, multi-center collaboration with large data to answer these technical nuances. I am confident that in five years we will get there. Our patients deserve it.
Craig McMains, MD. OrthoIndy (Indianapolis): There’s just a crazy amount of interest in the space. I think more people, as we get better products, will utilize things like synthetics. The innovation is going to come from personalized medicine. You’re going to have personalized biologics. You’re going to have a biologic that knows how to go into your body and stimulate it to lay down bone in the most effective and the most efficient manner possible. As we expand forward, we’re going to get to those solid fusions faster and we’re going to apply that learning of biologics into the implants themselves. Right now we put pieces of metal or pieces of biologic plastic into the body, and the body doesn’t like to have foreign substances in it. We could somehow tell the body that, “Hey this is coated in a bioactive substance,” the body recognizes whatever implant you put in as part of itself, and it’ll speed up that healing process and get a better outcome. That’s on the chemistry side of things. On the digital side the question is how do we know that we’re getting faster fusions and better fusions? We’re starting to leverage our learnings in the digital space to get real-time feedback and getting information about the real-time healing process.
