As Neuralink aims for human trials, 3 spine surgeons weigh in on practicality


Elon Musk's Neuralink brain implant has been in development for years and tested in animals in 2020 and 2021. Mr. Musk said he aims to use Neuralink in humans this year, and its first applications would help spinal cord injury patients.

Three spine surgeons shared their thoughts about the technology and Mr. Musk breaking into the medtech space.

Note: Responses were edited for style and clarity.

Question: Do you think Neuralink will take off in spine care? How do you feel about figures like Elon Musk trying to enter the medtech space?

Kornelis Poelstra, MD, PhD. The Nevada Spine Clinic (Las Vegas): I think there is a tremendous opportunity to improve patients’ lives with a variety of neurologic conditions utilizing the Neuralink technology for spinal surgery.

Early results in animal studies have been promising. However, translation to humans is traditionally challenging, analogous to the results of prior cell-based therapies for spinal cord injured patients. Robotic techniques, precision and accuracy are going to play a key role here. For those reasons, I am very interested.

The approach with Neuralink, however, is quite different and very exciting, and I feel that having individuals such as Elon Musk enter this space with disruptive technologies, fascinating ideas and the capital to execute it would be highly beneficial.

Restoring people's functionality with Neuralink both physically as well as cognitively to allow patients with devastating neurologic ailments an improved quality of life, with the possibility to regain independence, is a fantastic goal. This deserves to be deeply researched, encouraged and peer reviewed to allow all of us to contribute where we can and always remain critical but applaud and celebrate its successes.

Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: The Neuralink platform promises a revolution in assistive technologies. Currently, its plan is in cortical applications and is implanted through a small, 8 mm burr hole. Human clinical trials are planned this year. An exciting video of a simian patient using only its brain to play Pong has been seen approximately 5.6 million times on YouTube.  

The promise of a true Brain Machine Interface seems almost within reach.  

At the same time, the fear of "mind control "algorithms, hacked brains and of course the cheesy 1980s movies depicting computer chips place into dead people’s brains and making “technozombies” or artificial intelligence chips and the machine singularity seem terrifyingly real.  

In truth, we are a very long way from all of the above.  

How this tech will fit into spine seems a tantalizing proposition. Once the major and minor kicks are worked out, I believe Neuralink could represent a serious enabling technology for patients with spinal cord injury. Patients with intact cortical functioning could interact with functional exoskeletons that we already see in use. A real life "Iron Man" may be a few decades away. Here in the present, more practical possibilities could be a diaphragmatic pacer, driven by a Neuralink interface, or being able to order groceries or medical supplies for someone who is confined to a wheelchair or otherwise challenged.  

Mr. Musk himself has always pushed the envelope and has often asked "why not?" about things like online payment, electric cars and reusable rockets. Will he have the same mojo when it comes to healthcare? His uncle in South Africa was a practicing neurologist, and I imagine his experiences with treating neurologically injured patients may have inspired his nephew to try his hand at BMI design and implementation. A polarizing figure to be sure, but certainly someone who will crash into boundaries and maybe make breakthroughs our medical establishment deemed uncrossable.  

Many times how successful a person with a vision is can be determined by how talented are the people around him. Indubitably, he has recruited serious talent. DJ Seo, who envisioned "brain dust" controlled by EM waves while at [the University of California at] Berkeley, is in charge of implants. Ian O’Hara, from Penn, is his vice president of robotics and has been in the robotics space for nearly a decade.  

Certainly, his team seems to have the chops to make this happen. There are of course, ethical and moral questions that would come up: Will everyone who needs one get one? Who determines that? Can it be hacked? When it inevitably gets hacked and someone gets hurt, whose fault is it? Should we be doing this in the first place?  

Progress, innovation, and without a doubt, failure, perhaps spectacular ones, will likely answer these questions. Regardless of the answers, Mr. Musk will certainly bring excitement, if not a lot of unpredictability, to the medtech space. Hopefully despite setbacks, much as he had initially both with the Tesla Model 3 and the Falcon Heavy reusable rocket, his failures will only inspire more grit and make him more resolute in his efforts.

Issada Thongtrangan, MD. Microspine (Scottsdale, Ariz.): According to the website, Neuralink is a device that will be surgically implanted into your brain, and with it, you’ll be able to communicate with machines and even control them. With Neuralink, a chipset called N1 will be installed in your skull that is 8mm in diameter and has multiple wires housing electrodes and insulation for the wires. These wires will be surgically placed inside your brain using a robot. As per the company, the wire is as thick as the neurons in your brain and thinner than a strand of hair at 100 micrometers. 

I have admired the initiator and the pioneer. However, I think it is still far from being used in humans. We still have to understand the pros, cons, risks and potential complications. I would like to see this technology in treating brain conditions and diseases instead of connecting with smartphones, computers, etc. It is an intriguing project, to say the least.

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