Issue link: https://beckershealthcare.uberflip.com/i/1293265
47 No stem cell treatment yet has strong clinical data to prove effectiveness, but the basic science shows promise. "I believe the use of stem-cells in the treatment of degenerative spine condi- tions has great potential," said Scott Middle- brooks, MD, of Regsurgens Orthopaedics in Atlanta. "Use in augmenting spinal fusion has been shown to be effective. e use in the re- generation of the degenerated intervertebral disc is not as clear. Preliminary studies have shown them to be generally safe. Clear evi- dence of efficacy and specific indications for use are the primary limitations currently. I am hopeful that with the progression of the current research we will have more evidence to allow practitioners to be confident in the use of stem cell-based therapies to improve the lives of our patients suffering from degenerative spinal conditions." SI joint. e SI joint has been a tricky area for spine surgeons and pain management special- ists to treat effectively, but several recent inno- vations could make that easier. Inspired Spine developed the Trident Sacroiliac Joint Fusion System with one main screw and two side screws for single procedure that takes around 15 minutes. e procedure was developed by surgeons, but doesn't currently have FDA clear- ance. SI-BONE, which has been in the SI joint space for more than a decade, is transitioning now into a comprehensive sacropelvic company. Known for its iFuse Implant System, SI-BONE is working with 22 academic institutions to adopt SI joint treatment for deformity appli- cations and expanded into the trauma market with fractures involving the SI joint. 3D printing. ree-dimensional printing tech- nology has many uses in the spine space. In 2019, New York City-based Hospital for Spe- cial Surgery formed a partnership with Lima- Corporate to launch a provider-based additive manufacturing 3D printing facility for custom orthopedic implants. Companies such as RTI Surgical developed the Fortilink Interbody Fu- sion 3D printed implants for degenerative disc disease treatment and Nexxt Spine expanded its 3D printing capabilities last year, adding two machines from GE Additive. Nexxt Spine also launched its 3D-printed ti- tanium cage for use in the cervical spine and thoracolumbar spine in March. e device, Matrixx corpectomy system, is designed to re- place a disc or damaged vertebral body. Stryker also has a line of 3D-printed spinal implants, including the Tritanium C Anterior Cervical Cage, Capri Cervical 3D Static and Expandable Corpectomy systems and Sahara Lateral 3D Ex- pandable Interbody System. "Where it can and should shine is potentially having a 3D printer intraoperatively that can construct a custom cage based on intraoper- ative CT scans or imaging," said Brian Gant- werker, MD, of e Craniospinal Center of Los Angeles in Santa Monica and Encino, Calif. Customized implants. e trend toward 3D printing ushered in the potential for more cus- tomized implants in spine. In February, Medi- crea received FDA clearance for the UNiD IB3D Patient-matched interbody cages as part of the UNiD ASI platform technology. It was the first FDA clearance issued for patient-matched im- plants intended for load-bearing applications in spine surgery. e 3D-printed titanium im- plants provide customized cage dimensions and endplate morphology. Engineers designed the system's cages to restore proper height and angulation using precise mapping and preoper- ative surgical planning. "Beyond the implant, customization is also coming to the way surgeons approach each procedure," said Kee Kim, MD, chief of spinal neurosurgery at UC Davis School of Medicine and co-director of the UC Davis Spine Center in Sacramento, Calif. "Individual deformity correction will be customized so we do not, for example, end up fusing all patients from T4 to pelvis." OLIF. e oblique lateral interbody fusion is an innovative spine surgery approach that allows surgeons to achieve the same outcomes as open procedures with less tissue disruption. Camber Spine's SPIRA-O, which has an arch design for the oblique position, can be used in the OLIF procedure in which patients are placed in the lateral decubitus position so gravity can drain away the peritoneal contents. "When you ap- proach the anterior spine obliquely, you're no longer retracting the lumbar plexus in the way that we do when we do transpsoas surgery," said John Williams, MD, of SpineONE in Fort Wayne, Ind. "You essentially eliminate plexus injury, limb numbness, quadriceps weakness and other issues we have with transpsoas sur- gery." e oblique lateral lumbar interbody fusion procedure from Inspired Spine has also been performed in more than 1,000 cases in the U.S. e procedure is intended for patients with de- generative disc disease, herniated disc, scoliosis and spinal stenosis. e procedure is designed to heighten the disc and limit disc movement while preserving muscles and the adjacent tis- sue. Augmented Reality. Augmedics made a splash in the spine field in June when three neurosur- geons at Johns Hopkins Hospital in Baltimore performed the first spinal fusion on a living patient using its augmented reality system. e company's FDA-cleared Xvision spine system enables surgeons to visualize the 3D spinal anatomy intraoperatively so they can navigate instruments and implants while looking at the patient instead of a remote screen. Timothy Witham, MD, director of the Johns Hopkins neurosurgery spinal fusion labora- tory, performed the first procedure alongside Daniel Sciubba, MD, director of spinal tumor and spine deformity at Johns Hopkins. Cami- lo Molina, MD, also assisted. "For the surgeon, Augmedics provides increased visualization of the entire spine and tumor anatomy, allowing complete tumor resection to be accomplished safely," said Dr. Sciubba. "e technology also allows a more efficient surgery and saves time in the operating room. Finally, augmented real- ity also limits the use of radiation to the patient, to the surgeon, and to the operating room staff. In short, it allows for the most effective treat- ment for the removal of spine tumors I have experienced in the last 20 years of doing such surgeries." Artificial intelligence. Artificial intelligence has great potential in healthcare and can be particularly beneficial in spine. AI tools can help with surgical decision making and reading imaging studies. e technology won't replace surgeons, but it can enhance the surgeon's data processing capabilities to develop the best treat- ment process for patients. "In spine fracture management, a main focus for us is predicting which patients will fracture or not," Joseph Schwab, MD, chief of orthope- dic spine surgery at Boston-based Massachu- setts General Hospital said. "One of the biggest trends in the field right now is using machine learning or artificial intelligence to predict fractures. is trend will allow for prediction models that are currently relatively static to be replaced with AI to offer a more personalized and accurate description of where fractures will happen on a patient." Regenerative medicine. Regenerative medi- cine is still in its infancy in the spine field as companies innovate alongside surgeons en- gaged in basic science and clinical trials to prove effectiveness. One treatment is Discseel in which the surgeon injects fibrin into a torn disc to seal tears within the annulus fibrosus. e procedure is an off-label use of an FDA-ap- proved corticosteroid. Kevin Pauza, MD, an interventional spine specialist and founding partner of Texas Spine and Joint Hospital in Ty- ler is conducting clinical research on the pro- cedure and examining whether the treatment can eliminate recurrent disc herniation and degeneration. "Payers increasingly want regenerative med- icine. With regard to the Discseel procedure, their interest may be motivated by cost-savings, efficacy or the reliability of large-scale budget- ary predictions," said Dr. Pauza. "In my experi- ence, payers have been pleased that 1 to 4-level fusions can be routinely replaced by the out- patient Discseel procedure in ASCs. I believe other regenerative medicine treatments will be embraced aer they also provide positive inde-