Neel Anand, MD, serves as professor of orthopedic surgery and director of spine trauma at the Cedars-Sinai Spine Center in Los Angeles.
Dr. Anand has dedicated his practice to the advancement of minimally invasive spine surgery and served as principal investigator in several FDA clinical trials.
Here, Dr. Anand discusses the hype around stem cells and what he sees as the next big breakthrough in spine.
Source Becker’s Spine Review
Question: Is there any biologic research you see having a particular breakthrough in spine?
Dr. Neel Anand: Most of the biological research is on bone fusion products and enhancing bone fusion, and of course stem cells, the buzzword of today. How realistic will stem cell’s impact be? Nobody knows. Current research is looking at the reproduction and multiplying ability of stem cells, but it’s very basic animal research. We’ve a long way to go from here.
Q: Do you anticipate any big developments in stem cells over the next 10 years?
NA: My honest answer is no. Some people may be surprised but I believe there is significantly more hype for stem cells in orthopedics and spine surgery than there is reality. There’s not one iota of data that stem cells do anything in spine surgery. All the products out there do not actually have stem cells — 99 percent of injections provided today do not have stem cells. They’re basically a blood product that is being injected.
Q: How has the hype around stem cells reached this level in spine? Who are the biggest contributors?
NA: Everybody: spine and pain management physicians, vendors, the industry and medical device companies. False advertising and the media have also contributed to this hype around stem cells and now everybody is looking for them. I think stem cell injections are unethical practice because there are no stem cells in them. There is far more data and clinical research behind platelet-rich plasma, but that is also marketed as stem cells when it is not — it’s PRP. I think stem cells are very promising but it’s very, very far away. One day we may be able to genetically break the code and program stem cells to do what we need them to, like reproduce organs or a disc. All the hype around stem cells today is just that — hype.
Q: Has the hype around stem cells impacted your practice? Do patients frequently request and enquire about stem cell therapies?
NA: All the time. That’s from the hype that the spine community has created. It has become a global phenomenon that we have all created. It’s really sad. The reason why most of these PRP injections work is because PRP increases the proliferation and secretion of anti-inflammatory cytokines. When you inject that, it’s like injecting steroids — you feel great. Most of the pain in our musculoskeletal body is inflammatory so when you inject an anti-inflammatory like that, you feel great. So, patients that think they need it initially feel fantastic because they’ve had a steroid-like injection and think they’ve had stem cells. Then they go back every six weeks.
Q: What do you think about spine surgeons who are focusing on these treatments and centering their practices around stem cells?
NA: It’s happening. In Los Angeles, there are physicians who charge $10,000 for one injection of so-called stem cells. It’s unethical, not right and someone needs to call it out. I’m not saying there is anything wrong with the injections, but don’t call them stem cells and mislead the public because they are not stem cells. PRP is what it is. And that’s fine — it’s used in knees and other areas of orthopedics.
There is no stem cell injection in spine that’s therapeutic. It’s all experimental. That’s the problem, it’s a result of marketing hype and false advertising. There are practices that are immensely surviving on that buzzword and I think that’s so sad.
Q: Outside of biologics, what do you see as the next big breakthrough in spine surgery?
NA: I think the biggest breakthrough for the treatment of back pain is going to be in diagnostics — being able to find out what exactly is wrong and why you have this back pain, beyond a disc herniation or an obvious arthritic spine. The last diagnostic device we had for the spine was the MRI and that was in the 1990s. There are many patients whose MRIs look reasonably normal, but they still experience significant pain. This advancement is not there but it is definitely needed.
There’s a lot of research on the presence of bacteria in the disc itself and if infections are creating degenerated discs. There’s some evidence that 20-25 percent of so-called degenerated discs creating back pain may be due to bacteria creating the degeneration. Diagnosis for me is the biggest advancement that we need in terms of handling back pain. Treatment-wise, without a question, minimally invasive surgery is going to progress leaps and bounds.