Becker's Spine Review

14 THOUGHT LEADERSHIP AI, regenerative medicine and more: What 11 spine surgeons would do with a $5M grant By Carly Behm R esearch grants can be key to helping surgeons and scientists uncover new developments and innovations in patient care. Here's how 11 spine surgeons told Becker's they would use a $5 million grant. Editor's note: Responses were lightly edited for clarity and length. Question: If you were given $5 million for spine research, what would you focus on? Nitin Bhatia, MD. UCI Health (Orange, Calif.): If I received $5 million for spine research, I would focus on regenerative medicine with the goal of providing a foundation for additional developments in spine surgery that could reach large groups of people. While $5 million is a lot of money, in regards to research, that amount may only be the seed that leads to a bounty of future successes, especially in a field such as regenerative medicine, which remains in its infancy. While products such as "stem cells" and "platelet-rich plasma" are advertised regularly, their clinical utility and safety remain largely unproven. Additionally, even how to best create regenerative treatments requires significant ongoing research. e potential benefits of regenerative medicine, including the ability to stop or reverse arthritic changes without surgery, could be applicable to large groups of patients and are, therefore, worth continued research. e research and future use of regenerative medicine, however, must be done in scientifically correct methods to ensure that patients are provided with proven and appropriate treatments. Fortunately, our group at UC Irvine is on the cutting edge of regenerative medicine for orthopedic and spine surgery, and the $5 million would be used to create the next level of regenerative therapies for patients worldwide. Harel Deutsch, MD. RUSH Medical College (Chicago): Artificial intelligence for spine diagnosis and treatment research could yield excellent return on investment. Diagnosis and treatment is highly variable in the spine surgery space and machine learning/best practices could better standardize spine treatment. Brian Fiani, DO. Mendelson Kornblum Orthopedic & Spine Specialists (Livonia, Mich.): I would focus on spinal cord injury research and recovery programs. Spinal cord injury research is important for the recovery and rehabilitation of spinal cord injury victims, as well as the prevention and treatment of secondary complications. Basic and applied research for spinal cord function and regeneration of that function could dramatically and miraculously improve the lives of millions of people. From a monetary and fiscal perspective, reversing the primary functional deficits from traumatic or non- traumatic insult, condition or disease of the spinal cord and the development of innovative neuro-prostheses could save hundreds of millions of dollars annually for medical cost spending. Brian Gantwerker, MD. e Craniospinal Center of Los Angeles: My focus would be on acute spinal cord injury and on developing treatments to mitigate the swelling associated with acute trauma. My anticipation is that there is more we can be doing to help minimize the long- term effects of concussive forces on the spinal cord by things like duraplasty and potentially lumbar drain placement. ese are straightforward interventions that can be done to treat patients quickly and maximize their recovery. Pawel Jankowski, MD. Hoag Pickup Family Neurosciences Institute (Newport Beach, Calif.): My primary focus would be on developing surgical planning tools that would tailor each specific spine surgery to the patient and their disease process. With consideration on decreasing need for re-operation, minimizing degenerative changes in the non-operated spine segments, maintaining optimal balance and mobility. is will involve partnering with the artificial intelligence sector to help design the proper planning platforms for surgeons in addition to designing implants that can provide feedback. One of the weaknesses we suffer currently in spine surgery is that there is no way of knowing or validating currently that a surgical plan, especially involving spinal fixation devices, will stand the test of time and mechanical stresses. Before a bridge or airplane is built it has to undergo certain validations to be certain it will endure environmental stressors. e second point is that we have very little knowledge about what is happening at the implant-bone interface other than static imaging modalities. For example, certain cardiac devices can provide feedback to the physician that is then used to direct the treatment(s) accordingly. We need something similar in the spine realm. Finally we need to understand better what is happening in the regions of the spine that are not operated on. Jason Liauw, MD. Hoag Orthopedic Institute (Laguna Hills, Calif.): In the last decade of spine surgery, there has been a large push for minimally invasive spine surgery and surgical robotics in spine surgery. However, I would say that these platforms are still converging towards transforming the industry, yet are not there yet. Most spine surgery unfortunately is still done in the hospital. If I were to spend research money, I would focus the money on advancing minimally invasive technologies to drive spine surgery into the outpatient setting, as a lot of orthopedic joint surgeries have already gone. e technologies that I believe will enable this are the miniaturization of expandable implants and improved surgical Image Credit: Adobe Stock

• Cover