Research grants can be key to helping surgeons and scientists uncover new developments and innovations in patient care. Here's how 11 spine surgeons told Becker's they would use a $5 million grant.
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. Becker's invites all spine surgeon and specialist responses.
Next week's question: What's one clinical or nonclinical skill you wish you had learned when training to become a spine surgeon?
Please send responses to Carly Behm at firstname.lastname@example.org by 5 p.m. CST Wednesday, Feb. 8.
Editor's note: Responses were lightly edited for clarity and length.
Question: If you were given $5 million for spine research, what would you focus on?
Nitin Bhatia, MD. UCI Health (Orange, Calif.): If I received $5 million for spine research, I would focus on regenerative medicine with the goal of providing a foundation for additional developments in spine surgery that could reach large groups of people. While $5 million is a lot of money, in regards to research, that amount may only be the seed that leads to a bounty of future successes, especially in a field such as regenerative medicine, which remains in its infancy. While products such as "stem cells" and "platelet-rich plasma" are advertised regularly, their clinical utility and safety remain largely unproven.
Additionally, even how to best create regenerative treatments requires significant ongoing research. The potential benefits of regenerative medicine, including the ability to stop or reverse arthritic changes without surgery, could be applicable to large groups of patients and are, therefore, worth continued research. The research and future use of regenerative medicine, however, must be done in scientifically correct methods to ensure that patients are provided with proven and appropriate treatments. Fortunately, our group at UC Irvine is on the cutting edge of regenerative medicine for orthopedic and spine surgery, and the $5 million would be used to create the next level of regenerative therapies for patients worldwide.
Harel Deutsch, MD. RUSH Medical College (Chicago): Artificial intelligence for spine diagnosis and treatment research could yield excellent return on investment. Diagnosis and treatment is highly variable in the spine surgery space and machine learning/best practices could better standardize spine treatment.
Brian Fiani, DO. Mendelson Kornblum Orthopedic & Spine Specialists (Livonia, Mich.): I would focus on spinal cord injury research and recovery programs. Spinal cord injury research is important for the recovery and rehabilitation of spinal cord injury victims, as well as the prevention and treatment of secondary complications. Basic and applied research for spinal cord function and regeneration of that function could dramatically and miraculously improve the lives of millions of people. From a monetary and fiscal perspective, reversing the primary functional deficits from traumatic or non-traumatic insult, condition or disease of the spinal cord and the development of innovative neuro-prostheses could save hundreds of millions of dollars annually for medical cost spending.
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: My focus would be on acute spinal cord injury and on developing treatments to mitigate the swelling associated with acute trauma. My anticipation is that there is more we can be doing to help minimize the long-term effects of concussive forces on the spinal cord by things like duraplasty and potentially lumbar drain placement. These are straightforward interventions that can be done to treat patients quickly and maximize their recovery.
Pawel Jankowski, MD. Hoag Pickup Family Neurosciences Institute (Newport Beach, Calif.): My primary focus would be on developing surgical planning tools that would tailor each specific spine surgery to the patient and their disease process. With consideration on decreasing need for re-operation, minimizing degenerative changes in the non-operated spine segments, maintaining optimal balance and mobility.
This will involve partnering with the artificial intelligence sector to help design the proper planning platforms for surgeons in addition to designing implants that can provide feedback. One of the weaknesses we suffer currently in spine surgery is that there is no way of knowing or validating currently that a surgical plan, especially involving spinal fixation devices, will stand the test of time and mechanical stresses. Before a bridge or airplane is built it has to undergo certain validations to be certain it will endure environmental stressors. The second point is that we have very little knowledge about what is happening at the implant-bone interface other than static imaging modalities. For example, certain cardiac devices can provide feedback to the physician that is then used to direct the treatment(s) accordingly. We need something similar in the spine realm. Finally we need to understand better what is happening in the regions of the spine that are not operated on.
Jason Liauw, MD. Hoag Orthopedic Institute (Laguna Hills, Calif.): In the last decade of spine surgery, there has been a large push for minimally invasive spine surgery and surgical robotics in spine surgery. However, I would say that these platforms are still converging towards transforming the industry, yet are not there yet. Most spine surgery unfortunately is still done in the hospital. If I were to spend research money, I would focus the money on advancing minimally invasive technologies to drive spine surgery into the outpatient setting, as a lot of orthopedic joint surgeries have already gone. The technologies that I believe will enable this are the miniaturization of expandable implants and improved surgical guidance to make incisions and exposure more precise. Additionally, I believe sensor technologies to measure intrinsic strain on surgical hardware will also reduce hardware failure in the future and building this sensing technology up will enable smarter surgery.
Luke Macyszyn, MD. DISC Sports & Spine Center (Newport Beach, Calif.): I would focus on tools and platforms that allow us to better collect, monitor and analyze patient outcomes after spinal surgery in a more rigorous and systematic manner. I feel like this is critical for spinal innovation so that we are developing tools, implants and methodologies that lead ultimately to improved patient outcomes and quality of life versus just another "me too" implant or procedure. However, without a rigorous analysis and monitoring of these outcomes, this research is simply not possible. In the future, all physicians, researchers and companies developing in the field of spinal medicine would have access to these tools and share a common platform that has been validated in these patients so that we can all speak and communicate using a common language. This would allow us to recommend certain treatments or management strategies that are more concretely based on objective data versus one's singular experience.
Edward Perry III, MD. Swift Institute (Reno, Nev.): I would fund research to develop a cost-effective way for patient bone marrow or stem cell autograft harvesting and preparation methods to actually improve thoracolumbar fusion rates beyond our current technology.
Vladimir Sinkov, MD. Sinkov Spine (Las Vegas): Unfortunately, no big research project can be done for $5 million nowadays. One reasonable project that I would recommend would be clinical research or safety and efficacy of various bone graft products used for spinal fusions. A lot of the bone graft products currently on the market have not been tested in-vivo and only rely on animal and laboratory testing for their FDA approval. Having "real world" human data for these bone graft materials will help spine surgeons and hospitals choose the best products for their patients.
William Taylor, MD. University of California San Diego: Artificial intelligence and its application for navigation, predicting outcomes and operative planning would be first on the list.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): As a multidecade seasoned spinal surgeon, the most devastating course of events of a spinal cord injury are resounding, lasting and challenging beyond comprehension for patient and family. While the lauded research continues to be central to injury and recovery, personally, the most impactful path in curbing these circumstances is awareness and the life changes associated with its outcomes. Furthermore, my focus would be intensive education at the high school/college-level age groups, liken to the ThinkFirst [injury prevention] program of the past.