Becker's Spine Review

11 SPINE SURGEONS Spinal fusion with stem cells vs. BMP: 4 key findings By Laura Dyrda A study published in the February 2019 issue of the International Journal of Spine Surgery com- pares fusion rates between rhBMP-2 and mesenchymal stem cells for min- imally invasive transforaminal lumbar interbody fusion. The study authors examined patients who underwent surgery performed by a single surgeon and compared the fusion rate between patients who had rhBMP-2 or cellularized bone matrix to promote fusion. The researchers in- cluded data from 78 patients in the ret- rospective review, with 39 who received rhBMP-2 and 39 who received CBM. Four key points: 1. The CBM group reported a 68 per- cent fusion rate, compared to 78 per- cent in the rhBMP-2 group. 2. Hypertension was a predictor of ra- diographic non-union, and among the seven smokers spread between the two groups, one from each group reported pseudarthrosis. 3. Three patients in the CBM group re- quired revision as a result of symptom- atic pseudarthrosis, compared to one patient in the rhBMP-2 group. 4. The study authors concluded no sig- nificant differences in fusion rates or re- vision rates for patients in both groups. n What spine surgeons need for better patient care, that don't exist already By Laura Dyrda F our spine surgeons discuss big opportunities in spine innova- tion and what they need in the future to provide better care. Question: Where do you see the biggest room for in- novation in spine? What do you need to provide better care that doesn't currently exist? Andrew Cordover, MD. Andrews Sports Medicine & Orthopaedic Cen- ter (Birmingham, Ala.): Having im- proved diagnostic options (functional scanning) and newer ways to determine what disease is clinically significant would be a huge asset. We must con- tinue to emphasis evidence-based outcomes research to maintain viable spine-care delivery. The biggest room for innovation in spine is clinical evaluation. Roger Hartl, MD. Weill Cornell Medi- cine (New York City): Biologics are start- ing to enter the surgical arena, but we are still at the beginning. We need better data that biologics really have an impact on disc regeneration and repair. Many groups are working on this and we will likely have much more and better evi- dence soon. Also, the advantages of tissue engineering (in addition to just inject- ing cells) have not been taken advantage of. So far, we just use cells but a combination with tissue engineered materials and strategies for annular repair and disc regeneration may have an additional positive impact. Khalid Kurtom, MD. University of Maryland Shore Regional Health (Easton, Md.): Development of enhance recovery aer sur- gery protocols. e goals are to reduce length of stay, enhance return to work, reduce narcotics dependence, reduce cost of care and im- prove overall quality of life and performance metrics. Frank Shen, MD. University of Virginia Health System (Charlottesville, Va.): I think that improved interfaces must be developed between the physician and the patient. For example, currently the EMR acts as a clumsy, and clunky, method for recording and storing medical, social and economic information. Physicians currently must interact both with the patient and the EMR simultaneously. is creates a physi- cian-patient and physician-EMR relationship that is both simultaneous and competing at the same time. e current workaround for this prob- lem is to utilize either third-person scribes or delayed charting, both of which have limitations. However, we need to develop a different paradigm. One that is more seamless; one where the EMR actually helps to improve and facilitate the interaction and relationship between the physician and the patient. is could be viewed schematically simply as a physician-EMR-patient interface. Whether this is utilizing a handheld iPad, video and audio recording, touchscreen tablets, virtual visits or combinations of all or none of these technologies, it must be realized that medical records are not simply about recording and storing information. A sufficiently ad- vanced medical record should also focus on developing improved tech- niques for retrieval, sharing and processing of information as well. n

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