Becker's Spine Review

19 BIOLOGICS Dr. Frank Phillips: Key trends in spinal biologics and regeneration By Laura Dyrda F rank Phillips, MD, is the director of the section of minimally invasive spine surgery and director of the division of spine surgery at Chicago-based Rush Uni- versity Medical Center. He was among the first sur- geons to perform minimally invasive spine procedures in Chicago in the 1990s and continues to focus his practice on finding less invasive procedures for spine surgery. Here, Dr. Phillips discusses where he sees the field of spine biologics headed. Question: What research are you working on today around spinal biologics and regeneration? Dr. Frank Phillips: Regeneration of intervertebral discs and the use of stem cells in spine remain a challenge. There is a conspicuous absence of clinical data to sup- port the use of these technologies for disc regeneration and the marketing of these products with unsubstantiated claims represents a challenge to those attempting to do high quality research in this field as well as to the credibility of spine practitioners. Clinical studies in this space are at various stages and will hopefully provide validated data to guide treatment choices. The use of biologically active implants based on various surface characteristics, biomaterials and chemical compo- sitions to promote more rapid and reliable spinal fusion is an area of intense interest. Q: What are you most excited about today in the spine field? FP: The field of robotics and augmented reality to make spine procedures more efficient, safe and reproducible is front and center in the spine space. Current iterations of robotic assisted computer navigated spine surgery es- sentially reflect the use of standard navigation with a ro- botic arm providing an alignment guide for placement of screws. Their adoption has largely been driven by inves- tor hype and perceived marketing advantages rather than demonstration of value. As these technologies evolve, it is incumbent on the spine community to prove any clinical advantages that these systems provide. I am particularly excited by the use of augmented reality in spine surgery. Recently the FDA has approved a unique system that comprise a headset with integrated tracking cameras and direct retinal near-eye-display that provides for virtual 3D visualization of the spinal anatomy as well as standard 2D CT navigation images. At Rush we performed the cadaveric testing of this system that resulted in FDA approval and I was highly impressed with the advantages this system provides. Q: How do you anticipate the spine surgery and back pain treatment will change in the next decade? FP: There will certainly be advances in the understanding of the role of biologic therapies for reducing spinal pain. In addition to treatment solutions, we need better tools to diagnose the source of pain in the spine. Functional imag- ing techniques are currently being studied for this appli- cation; the progression to less-invasive spinal surgeries is inevitable. Minimally invasive approaches are widely performed for less complex spinal pathologies, but over the next decade we will better study and understand their role in the treat- ment of patients with complex pathologies and deformi- ties. At the same time we will continue to see the migration of spinal surgeries to the ASC environment. Although mo- tion preservation techniques are attractive and in certain cases appropriate, for many spinal pathologies fusion will remain the appropriate treatment. Spine stakeholders will need to develop less morbid ap- proaches — perhaps enabled by sophisticated image guidance or robotic approaches) with technologies (bio- logic and biomaterial — that provide more rapid and reli- able healing of the fusion. n and disease can spread in the hospital setting, even with the most sophisticated infection control practices in place. As a result, people will want to have their procedures in an ASC whenever possible and return home for recovery. "I think ASCs will open for elective procedures sooner than hospitals that had to convert their operating rooms into ICUs and are taking care of COVID-19 patients. ASCs will have an easier time ramping up," said Dr. Sharan. "e initial elective volume will be picked up by ASCs, and if they can prove that they deliver safe, effective surgical care, patients will tell their friends about the great experience. Surgeons should posi- tion themselves to be affiliated with an ASC if they can." Dr. Sharan developed the awake spinal fusion procedure as a means to safely perform outpatient lumbar fusions in the outpatient setting. As care migrates more towards the ambulatory setting he sees this as becoming a more realistic option for patients in the future. "I'm con- fident in the ability of awake spine surgery to deliver high-value more efficient care," he said. n

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