Spinal News International spoke to Jeffrey Wang, professor, Department of Orthopedic Surgery, University of California Los Angeles, USA, and chairman of the Global Spine Congress held in late March in Barcelona, Spain.
Biologics is one of your fields of interest. Beyond bone morphogenic proteins (BMPs), are there any new products on the horizon that look promising?
There is been a lot of work on the bone morphogenic proteins because those are FDA-approved for certain uses in the United States and to gain FDA-approval and begin research on any new type of protein or molecule. But having said that, there are so many different exciting new potential therapies out there that are in the very early stages and that is exciting to me. It is a very long and expensive process.
There are the BMP-binding proteins, those are exciting to me because I think those will help reduce a lot of the complications we see with BMPs. We will be able to use them more effectively, and I also think the addition of stem cells is critical—not just for fusion but for disc degeneration and spinal cord regeneration. I do not think we are going to see spinal cord regeneration or disc degeneration without the use of a combination of those things.
What are your views on the off-label use of rhBMP2 which has been in the news lately and the controversy surrounding that?
I think it has to be studied. You have to really look at the data, but the most important thing is you have to talk to the patients. In the United States, it is used off-label very frequently and we do use it in certain situations off-label in our institution, but you only use it when you feel there is a need for it.
You have to completely disclose to the patient the potential complications. I run through the entire list of complications every time I am even thinking of using it and I ultimately let the patient make the decision and I try to be as unbiased as possible. I present the data, I present the complications and I present why, to the patient, I am thinking that it might be beneficial.
Patients are actually very intelligent these days, they have read the news, they have been on the Internet, and I think the patients we are seeing now are more highly educated than the ones we have seen in the past. But you always have to talk to the patient and make them aware, and I think it has to be a patient-driven decision.
You are currently involved in many clinical trials in the treatment of spine problems. Are there any new findings that are interesting that have emerged from these trials you’re involved with?
I am very excited about the use of new growth factors and the use of tissue engineering with new techniques such as gene therapy for disc regeneration. I really do think that it is not just something we are talking about in generalities as an ideal situation. I think it is going to be attainable hopefully in our lifetime.
As chairman of Global Spine, could you name a few of the best research findings to emerge from the conference so far?
Well, I hate to be biased, but AOSpine is multifaceted. We deliver educational content and also fund very good high quality research presentations–some great prospective and randomised studies and based on our peer review blinded scale, many of the best papers were a couple of studies funded by AOSpine North America.
Now, we do not micromanage our regions but the region of North America has had a particularly strong interest in research, and when we talk about different levels of research, we want level one, which is the highest—prospective, randomised multicentre studies and there are two in particular which were funded by AOSpine North America that fit into our top 10 abstracts and presentations.
One was the geriatric odontoid fracture1, and the other one was the cervical myelopathy paper2. They were both presented in the best papers section and I think those really stand out. And again, I know I sound very biased because they were funded by our organisation, but in particular they stand out because that is the type of evidence that we will make changes in the way we treat our patients, the way we look at what we do, and how it will affect their lives. In addition, there was another study out of Seattle, the University of Washington that looked at complications from a huge database that they collected prospective data from, and again that gave some very valuable information, so those are the things that really stood out for me.
1. A01-02 The AOSpine North America cervical spondylotic myelopathy study: perioperative complication rates associated with surgical treatment based on a prospective multicenter study of 302 patients – Michael Fehlings
2. A02-04 Functional and quality of life outcomes in geriatric patients with type II odontoid fracture: One year results from the AOSpine North America multicenter GOF prospective study – Michael Fehlings