Spine biologics are emerging as prominent tools, and in the next five years they may become an integral part of implants from the start, Philip Louie, MD, said.
Dr. Louie, a spine surgeon at Seattle-based Virginia Mason Franciscan Health and a member of Orthofix’s Biologics Surgeon Advisory Board, discussed his outlook.
Note: This conversation was lightly edited for clarity.
Question: What is your short- and long-term outlook for biologics in spine surgery?
Dr. Philip Louie: I feel like biologics is a polarizing topic because some surgeons stick to the same thing, and the biologics don’t play a bigger role. For them, the carpentry is really important, and the indications are really important. Biologics fills in big and small gaps that exist. I think a lot of people just use what they use because they’ve always used it. I agree to an extent in that I don’t think whether you use one biologic versus another is going to be the game changer. But what I do find really interesting is that we still need them to a certain extent, and the mechanisms of action are so wide between the different biologics and the price points are so incredibly wide between the different biologics. It makes you wonder what’s actually going on. What’s the science behind it? Why does every single implant company have a whole division dedicated to biologic offerings, and ultimately as spine surgeons, why do we like what matters at the end of the day?
I think that’s what drove me to be willing to help on the board — to figure out a way to break things down to better understand what’s best used where, and if we feel like we want to push the field forward.
Q: Can you talk more about the gaps that biologics is filling, and if they’re things that implants will never be able to address on their own?
PL: It’s funny because there is a literal physical gap and then, like, a theoretical philosophical gap. We place implants that have cages with holes in them so we can pack bone graft in there. Why not just make them fully metal or fully PEEK? But there’s also this idea that bone needs something to help fuse such as a substrate or scaffold. You don’t want to just put substances in someone’s body.
I think that at some point the biologics will be part of the implant. People will find a way to adhere it onto the implant themselves. Now it’s a lot harder than it sounds because some of these biologics are live substances that need to actually be placed on the implants. But I think there is a world where they will be more connected to each other.
Q: How long do you think it will take to get to that point?
PL: I think the next five years will be really interesting because people are starting to work with BMP a lot more. Medtronic had to hold on BMP for so long, and no one argues how powerful BMP is. I think people wonder if there’s a better way to deliver it than the sponges we’ve all been forced to use. I think what we’re starting to see are companies willing to dive into BMP and other molecules to figure out how to create the best biologic and how to deliver it. Biologics are only as good as your ability to place it in when you want it to go.
