Five spine and neurosurgeons share insights on the development of stem cell-based therapies in spine.
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.
Next week's question: How does the US healthcare system compare to other countries you have worked in or traveled to?
Please send responses to Alan Condon at firstname.lastname@example.org by Wednesday, March 18, 5 p.m. CST.
Note: The following responses were edited for length and clarity.
Question: What is your opinion on stem cell-based therapies in spine?
Brian Gantwerker, MD. Craniospinal Center of Los Angeles: The use and future of stem cells is still very much nebulous. At least 1-2 times per month I get asked about the use of stem cells in regenerating spinal discs. The truth is, none of the current technology permits or promises their widespread use or adoption — yet. To me, there will be a day where their use will start to come into their own. Regenerative medicine is a very interesting and not so nascent field. They do push the envelope and will likely drive the adoption of new technologies and substances in this field. It is up to responsible clinicians to discern when the use of these future therapeutics is appropriate. I do not think stem cells should be dismissed out of hand as 'quackery' or 'snake oil.'
Scott Middlebrooks, MD. Resurgens Orthopaedics (Atlanta): I believe the use of stem-cells in the treatment of degenerative spine conditions has great potential. Use in augmenting spinal fusion has been shown to be effective. The use in the regeneration of the degenerated intervertebral disc is not as clear. Preliminary studies have shown them to be generally safe. Clear evidence of efficacy and specific indications for use are the primary limitations currently. I am hopeful that with the progression of the current research we will have more evidence to allow practitioners to be confident in the use of stem cell-based therapies to improve the lives of our patients suffering from degenerative spinal conditions.
Issada Thongtrangan, MD. Microspine (Phoenix): It is still in an infancy phase as proper prospective randomized studies are time consuming and costly. I see it continuing to evolve slowly but I predict another 5-10 years for stem cell-based treatments to develop for spinal disorders, such as spinal cord injury and degenerative disc disease.
Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): I am optimistically cautious about stem cell-based therapies in spine. There is certainly a lot of hype about stem cells in all areas of medicine at this point. Quite a bit of groundbreaking research has been done and a lot more is underway. Unfortunately, there is also a lot of misinformation and inappropriate use of stem cell technology out there as well. As clinicians, we must be cautious in the way we communicate about it with our patients. Our opinions and treatment decisions must be based on sound scientific judgement and available high-quality research, which is still very scant.
I think there is a lot of potential for stem cell-based therapy in spine. There are stem-cell based bone graft materials that have been used in spinal fusion for years and they work very well. In the future, stem cells could potentially restore damaged or a degenerated disc, nerve or joint tissue. However, a lot more work needs to be done to develop these technologies into clinically valuable treatments.
One must keep in mind that the stem cells that developed the structures of the spine — bone, disc, ligaments, muscles and nerve tissue — did so in the embryo, which was developing in a uterus suspended in fluid with very little gravity or mechanical stressors affecting the structural development, and with plenty of good blood and nutrient supply. When we place those same stem cells in an upright walking adult with a lot less blood supply and possibly additional medical problems, it would be a lot harder — and at this point impossible — for those same stem cells to 're-grow' the degenerative disc, nerves or joints. The stem cells would need to be modified to be able to sustain this 'harsh' environment and do their regenerative job.
Another challenge would be the cost to both develop and administer these therapies and whether patients and payers would be willing to pay for them. With that said, I am looking forward to further scientific and technological advances in stem cell treatments in spine to help my patients decrease pain and improve function.
Christian Zimmerman, MD. Saint Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): The role of regenerative stem cell therapies are adjunct and intermittently recompensed by payers. Actual reparations of intervertebral body discs are suspect while short and long term pain control are discussant. Adipose mesenchymal and primordial cell lines are ongoing in research efforts for spinal cord injury patients with respondents in some limited cohorts. The business of pain management perseveres yet streamlines its modeling to the affordable. The worry for most is the tepid hard science that substantiates the overuse.