Four spine surgeons discuss trends in the use of spine biologics.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses.
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Question: Will the use of spine biologics continue to grow over the next decade?
Kern Singh, MD. Co-Director of Minimally Invasive Spine Institute at Midwest Orthopaedics at Rush (Chicago): Biologics has been an emerging field of research and development within spine surgery. Biologic materials have advanced spine procedures by promoting cellular growth and differentiation. However, these advances have occurred at a tremendous and significant cost for the surgical encounter. In my own practice, I have already switched all thoracolumbar procedures to iliac crest bone graft via a percutaneous approach. I believe that ultimately global payments will drive down the costs and utilization of biologics in the near term.
Payam Farjoodi, MD. Spine Surgeon at Center for Spine Health at Orange Coast Memorial Medical Center (Fountain Valley, Calif.): Yes. Biologics have advanced spine surgery by providing excellent fusion rates without having to expose patients to the morbidity of iliac crest bone harvest, and there is much more to be accomplished. Stem cells and platelet rich plasma are being increasingly studied in orthopedics and with promising results. I anticipate some great applications for the treatment of spine conditions.
Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: I feel this market has actually grown over the past several years. Like all markets, it will reach saturation. I am seeing better products being offered but as the healthcare system moves further away from fusion, for better or worse, this market might contract soon and become more of a niche-type business. There will always be a market for biologics, its just they are expensive research and development-wise, and some of the smaller companies may just not want to get involved.
Richard Kube, MD. Founder and CEO of Prairie Spine & Pain Institute (Peoria, Ill.): The short answer is yes. We have only just begun to understand much of the molecular biology of the structures of the spine. Certainly, multiple new treatments using stem cells, growth factors and potentially gene therapy, in the future, are on the horizon. Also, as we increase our understanding there are opportunities for better variety and hopefully more accurate diagnostic tools to improve patient selection. Careful study must be done with the utmost ethical practices as we strive to answer our questions.