Bradley K Weiner, director, Spine Advanced Technology Laboratory, The Methodist Hospital Research Institute, Houston, USA, will be giving the talk “Nanotechnology—Ortho and Spine Surgery” at the International Society for the Advancement of Spine Surgery (ISASS) annual meeting (3–5 April, Vancouver, Canada). He spoke to Spinal News International about this issue.
“Nanotechnology” is often featured in science fiction. But, what is it really?
Nanotechnology is essentially the use of devices and materials (man-made and natural) that range in size from 1 to 100 nanometres. Use of these tiny devices/materials allows “work” to be done at the molecular level. This is important in that it affords what I term as “size-specific communication”. Much of what we do in medicine generally, and in spinal surgery, specifically occurs at a very gross size level. For instance—to obtain a spinal fusion, we use large chunks of autograft or allograft bone, metal cages and rods and screws, and massive dosages of bone morphogenetic proteins (BMPs) etc. But what we are looking for is simple bony ingrowth to form the fusion, and this occurs at the cellular and molecular level. Nanotechnology rests on the principle that if we are working at that molecular level, we can get more done, more efficiently, and more specifically (less morbidity). Our current situation is like elephants trying to talk to or shake hands with ants—the molecular level gets bullied or crushed or does not understand. We believe other ants are the best negotiators/persuaders (if you will!).
How could nanotechnology be used in spinal surgery?
The potential applications of nanotechnology to spinal surgery are already being actualised. Sam Stupp and Ramille Shah, with whom we [Spine Advanced Technology Laboratory] have worked with in the past and who are leaders in the field, have developed peptide amphiphiles capable of encouraging rapid bone formation for fusions. Our focus has been on the use of silicon-based nanoparticles and other carrier systems capable of drug delivery (BMPs and other growth factors [smaller doses/fewer side-effects]; bisphosphonates and other drugs to combat osteoporosis; antibiotics; analgesics; etc) and use in tissue engineering/tissue regeneration. There is much research going on at the basic science and animal study level, and much of this will be outlined at ISASS.
How close are we to using nanotechnology in spinal surgery?
How “close” we are to seeing real nanotechnology applications clinically depends greatly upon the FDA and on costs. It is clear that nanotechnology will work to help our efforts in spinal surgery, but it can be costly to develop (is it worth it if we have generally good success rates already?) and difficult to get approved (the FDA is concerned about side-effects). That is why people like Dr Stupp’s group in Chicago and my group here in Texas have focused on low-cost confirmed-safe technologies for the short-term horizon, while still pursuing more “out-there” ideas for the long-term.
What benefits could spinal surgery with nanotechnology provide?
The potential benefits to spinal surgery are revolutionary. Targeted, controlled therapies administered in the early stages of degenerative conditions and even later might change the way we practise entirely.