Regenerative Medicine and Interventional Endoscopic Pain Surgery for Degenerative Conditions of the Spine

Abstract

Regenerative medicine is a subspecialty of medicine that seeks to recruit and enhance the body's own inherent healing armamentarium in the treatment of patient pathology. In regenerative spine care, the intention is to assist in the repair and potentially replace or restore damaged tissue through autologous or allogenic biologics. In the authors' opinion, future spine care will likely evolve into a blend of prevailing strategies from interventional pain management and minimally invasive spine surgery. This form of spine care nowadays is commonly called interventional pain surgery. The interest in regenerative medicine in general and in interventional pain surgery of the spine is growing given the high patient awareness of problems with traditional spine surgery, whose focus is on decompression of pinched nerves and correction of spinal instability and deformity. However, reoperation- and complication rates are high with those open corrective spine surgeries as many of the spine's degenerative conditions are being only treated surgically when the disease has progressed to its end-stage. The sole application of image-based medical necessity criteria for surgical intervention in the spine seems slightly out of step with the growing demand for less aggressive and burdensome procedures that could perhaps be instituted earlier in the disease process where the goal is to heal the spinal injury or repair damage from the degenerative process more naturally. In this chapter, the authors review and discuss the current state of the art in regenerative biologic therapies and interventional pain care of the spine from their perspective as endoscopic spine surgeons. Simplifying therapeutic measures and strategies are at the heart of what patients request of us as surgeons. This field's applications in modern spine care are clearly in their infancy, except for fusion. The authors will discuss potential applications of select advanced biologics technologies and their attempts at integrating them into their endoscopic spinal stenosis surgery program to treat degenerative spinal disease and instability-related symptomatic end-stage degenerative vacuum disc disease in the elderly.