Biologics in Interventional Spinal Procedure: The Past, the Present, and the Vision

Abstract

BACKGROUND: Orthobiologics have shown promise in repair, restoration and regeneration of damaged and degenerated spine, joint and musculoskeletal tissues. The role of MSCs is to reduce inflammation, gliosis, and oxidative stress, while encouraging angiogenesis, neuronal proliferation, cell survival, and differentiation. While autologous MSCs have homologous advantages, they present with challenges related to donor predisposition, harvesting skills, and processing times. In this regard, allogenic MSCs show promise, but face ethical challenges, contamination, and survival risks. Ongoing efforts to overcome challenges and enhance performance include bioprinting, tissue engineering, artificial intelligence, nanotechnology, and microenvironmental alteration, among many others. Genetically programmed MSCs are being explored and tissue regeneration is now considered a real possibility. In this article, we discuss some of the leading-edge technologies in the process of being developed and perfected for widespread clinical application. OBJECTIVES: The aim of this narrative review is both to update on orthobiologics, especially MSCs and provide a vision for their future potential in interventional spine medicine. STUDY DESIGN: Narrative review. METHODS: The PubMed database of the National Institute of Medicine and Google Scholar were searched for keywords “mesenchymal stem cell,” “mesenchymal stem cell + regenerative medicine,” and “mesenchymal stem cell + spine.” The bibliographies of these articles and authoritative Web sites were also consulted. RESULTS: There are hundreds of ongoing clinical trials exploring the role of MSCs in regenerative medicine for treating a wide range of diverse conditions, including spine conditions, neurodegenerative disorders, and cardiovascular disease. LIMITATIONS: This visionary narrative review has several limitations. It is a narrative, rather than a systematic review. Many of the ideas and treatments presented here are not perfected and are still in development. CONCLUSIONS: The role of MSCs in regenerative medicine is still emerging, but their promise for spinal cord injury and other disorders of the spine is clear. Using allogenic or autologous MSCs can help stimulate healing and neural regeneration remains a tantalizing possibility. KEY WORDS: Mesenchymal stem cell, regenerative medicine, spine, spinal cord injury, nanotechnology, bioprinting, neural regeneration, degenerative disc disease, low back pain