Becker's Spine Review

13 SPINE SURGEONS The Future of Spine Biologics — Where 4 Spine Surgeons See it Heading By Anuja Vaidya Four spine surgeons discuss trends in the use of spine biologics. Question: Will the use of spine biologics continue to grow over the next decade? Kern Singh, MD. Co-Director of Mini- mally Invasive Spine Institute at Midwest Orthopaedics at Rush (Chicago): Biologics has been an emerging field of research and development within spine surgery. Biologic materials have advanced spine procedures by promoting cellular growth and differ- entiation. However, these advances have occurred at a tremendous and significant cost for the surgical encounter. In my own practice, I have already switched all thoraco- lumbar procedures to iliac crest bone gra via a percutaneous approach. I believe that ultimately global payments will drive down the costs and utilization of biologics in the near term. Payam Farjoodi, MD. Spine Surgeon at Center for Spine Health at Orange Coast Memorial Medical Center (Fountain Val- ley, Calif.): Yes. Biologics have advanced spine surgery by providing excellent fusion rates without having to expose patients to the morbidity of iliac crest bone harvest, and there is much more to be accom- plished. Stem cells and platelet rich plasma are being increasingly studied in orthope- dics and with promising results. I anticipate some great applications for the treatment of spine conditions. Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: I feel this market has actually grown over the past several years. Like all markets, it will reach saturation. I am seeing better products being offered but as the healthcare system moves further away from fusion, for better or worse, this market might contract soon and become more of a niche-type business. ere will al- ways be a market for biologics, its just they are expensive research and development-wise, and some of the smaller companies may just not want to get involved. Richard Kube, MD. Founder and CEO of Prairie Spine & Pain Institute (Peo- ria, Ill.): The short answer is yes. We have only just begun to understand much of the molecular biology of the structures of the spine. Certainly, multiple new treatments using stem cells, growth factors and poten- tially gene therapy, in the future, are on the horizon. Also, as we increase our under- standing there are opportunities for better variety and hopefully more accurate diag- nostic tools to improve patient selection. Careful study must be done with the utmost ethical practices as we strive to answer our questions. n Investigative Journalist Takes on the Spine Industry in New Book By Laura Dyrda C athryn Jakobson Ramin, an investigative journalist by trade, published a book in May examining the back pain and spine surgery industries. The book, titled Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery, is based on Ms. Jakob- son Ramin's experience managing chronic back pain. She describes spending money on unsuccessful treatments and pairs her personal narrative with statistics and interviews with spine specialists. The book touches on spine surgery as well as pain manage- ment, therapy, chiropractic care, opioid use and alternative pain management methods. She also interviews chronic back pain patients and examines how they navigate life with back pain. The Amazon book description reads, "Ramin shatters as- sumptions about surgery, chiropractic methods, physical therapy, spinal injections and pain killers, and addresses evi- dence-based rehabilitation options — showing, in detail, how to avoid therapeutic dead ends, while saving money, time and considerable anguish." Among the spine specialists quoted in the book include for- mer North American Spine Society President Heidi Prather, DO, who said physical therapy often fails to solve back pain because physicians don't communicate details of the pa- tient's pain to the therapists or a recommended treatment plan. "It's hoping the PT knows what he's doing, and sending the patient into space with no tether and no supervision," she said. Ms. Jakobson Ramin also cautions against unproven proce- dures, cutting edge therapies and unnecessary diagnostic treatments. n "Biologics have advanced spine surgery by providing excellent fusion rates without having to expose patients to the morbidity of iliac crest bone harvest." - Dr. Payam Farjoodi of Center for Spine Health at Orange Coast Memorial Medical Center

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