Here, four spine surgeons discuss the use of biologics and regenerative medicine.
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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Please send responses to Anuja Vaidya at avaidya@beckershealthcare.com by Wednesday, June 29, at 5 p.m. CST.
Question: How do you see biologics and regenerative medicine growing in spine care?
Andrew Cordover, MD, Andrews Sports Medicine and Orthopaedic Center, Birmingham, Ala.: Biologics and regenerative medicine are beginning to enter into spine care. Spinal injuries can at times require invasive surgery, sometimes involving fusions and an extended recovery. However in recent years, the use of biologics has supplemented quicker and more reliable healing.
Some physicians have begun using stem cells to treat osteoarthritis, degenerative disc disease and other musculoskeletal pathologies. Biologics and stem cell therapy can begin with a Bone Marrow Aspirate procedure, or donor stem cells. During this process, a physician can harvest bone marrow from the patient's iliac crest. A centrifuge separates the stem cells from other cells. The surgeon will then inject the stem cells into the injured area. This procedure initiates healing. Biologics and stem cell therapy will continue to grow in spine care as more research is developed concerning the types of patients it will most benefit.
Brian R. Gantwerker, MD, The Craniospinal Center of Los Angeles: As much as I would like to see them used more, insurance companies have pretty much throttled those developments. They are labeling everything (including bone graft) "experimental" and I am afraid that very little innovation will come until we change the landscape.
Richard Kube, MD, Founder, CEO, Prairie Spine & Pain Institute, Peoria, Ill.: Clear those history cobwebs and think manifest destiny. These technologies are the new frontier in our specialty. Much like the settling of the West, we will experience pitfalls, challenges and the realization of great opportunity to change the lives of our patients in ways we never imagined.
Hooman Melamed, MD, DISC Sports & Spine Center, Marina Del Rey, Calif.: This is a very interesting area that has a lot of potential. The goal would be to use less foreign material and rely more, predominately, on natural substances, such as the patient's own bone or fresh frozen bone. Use stem cells and other growth factors directly harvested from the patients themselves and mix that with the bone in order to promote healing and fusion. This way we avoid using other materials and artificial products, such as BMP, which can result in other complications. More importantly, stem cells and other potential growth factors can potentially be harvested from the patients and used to regenerate the damaged disc in order to avoid any surgery in the first place. I feel this is very exciting because we can potentially prevent many patients, especially young patients, from having to undergo any spine surgery.