Issue link: https://beckershealthcare.uberflip.com/i/1089830
16 Thought Leadership Spinal biologics — Key areas of promising research and innovation By Laura Dyrda A ndrew Hecht, MD, chief of spine surgery at The Mount Sinai Health System in New York City, outlines the key trends and big opportunities in the spine device space moving forward. Question: What emerging tech- nology or technique do you think will have the biggest impact on the spine field five years from now? Dr. Andrew Hecht: The biggest technology innovation will fall under a few different categories. The first big technolog- ical innovation will be increasing the use of image guidance and robotic technology to try to make procedures less in- vasive and improve the overall accuracy of the placement of instrumentation. The other big technological innovations will revolve around improvements in the use of biologics for both the enhancement of spinal fusion and disc biology and repair. Q: Where do you see the biggest room for innovation in spine? AH: The biggest innovations in spine will continue to grow out of biological solutions to spine disorders. Some of the most promising avenues of research involve the reversal of disc degeneration and annular repair. The disc represents a unique therapeutic target for anti-catabolic and pro-anabolic solutions. Annular repair also represents an area of increased interest and therapeutic potential for both post-discectomy repair and annular disruptions. Q: Which technologies do you think will disappear in the next five years? AH: Technologies that should hopefully disappear over the next several years will be lumbar disc replacement as well as things like sacroiliac joint fusion. These technologies I think will, in the end, prove to be of little benefit to patients over time. n Where spine technology is headed, and what will be left behind: Key thoughts from Dr. Justin Park By Laura Dyrda J ustin Park, MD, is a board-certified orthopedic spine surgeon with e Maryland Spine Center at Mercy Med- ical Center in Baltimore. He has a special interest in minimally inva- sive surgery, spinal fusion, spinal trauma and deformity correction. Here, Dr. Park discuss- es the biggest technology trends in the field and where he sees the best opportunities for future innovation. Question: What emerging technology or technique do you think will have the biggest impact on the spine field five years from now? Dr. Justin Park: I think that motion-preservation technologies such as cervical disc replacement will become a bigger player in the surgical toolbox of spine surgeons. As insurance companies such as Medicare have become more open minded in approving these surgeries in the last five years, we will see a growing population of patients with excellent results from long-term follow-up. Q: What do you think will fade or disappear from the spine field over the next few years? JP: Overpriced implants that are 'trendy and flashy' will quickly fade into the horizon if they do not demonstrate a superiority in perfor- mance. As hospitals and insurance companies strive to cut costs and run a leaner business model, spinal implants that cost two to three times more than a standard pedicle screw will be highly scrutinized. Q: Where do you see the biggest room for innovation in spine? JP: Some of my biggest challenges today as a spine surgeon are those pa- tients with severe osteoporosis. Oentimes their spine issues arise from the osteoporosis itself (compression fractures) or their problems are exacerbated from the condition itself (hardware failure in osteoporotic bone). ere is ample room for innovation from a standpoint of general drugs to treat osteoporosis — currently Forteo is the only drug demon- strated to marginally increase bone density — and surgical implants that have better fixation in osteoporotic bone. n