Chair: W. Mark Erwin, DC, PhD
Recent publications, meetings and shared experience make it clear that there is no consensus regarding the best choice of treatment in the case of fusion/nonfusion for appropriate cases (single or even two level degenerative disc disease that requires stabilization). The evidence is disparate with strong arguments on both sides of the question. This may speak to industry concerns; choice of surgery; type of device used; and short-, medium-, long-term data. Is there any? What is long-term?
Why do some surgical treatments result in failure while others do well? What about the development of multisegment degeneration? What lessons do genetics provide? Are there biomarkers that could help instruct us for proper patient selection? Finally, biology versus biomechanics within the context of treatment options (do nothing, surgery, exercise therapy, cognitive behavioral therapy)? This course addresses these questions and discuss treatment options.
Upon completion of this session, participants should gain strategies to:
- Review the salient biology of disc degeneration with a special emphasis upon the cellular/molecular contribution to the function of the disc. Do biology, genetics, and biomechanics data inform us of the best approach?
- Compare endplate “failure” and normal “ageing” versus pathological degeneration (same, similar or different?) intersections, and the consequences with respect to the decision of fusion versus nonfusion. The artificial disc needs to sit upon an endplate; does it matter what the endplate is like? Or is it better to fuse the whole thing?
- Explain evidence that adjacent segment pathology is associated with altered biomechanics imposed by fusion. Is this an urban/surgical myth? For surgical treatment of the spine where stabilization is required, what does the data tell us? Is there support for disc arthroplasty or has it arisen secondary to imperfect science and theory regarding induced forces as a consequence of fusion? Has industry preceded the science?
- Arrive at a consensus of what the data tells us to date. What are the best determinants of the successful surgery? Sagittal alignment? Where does surgical skill meet the biology/physics of the intervention? How much is the success a consequence of the skill of the surgeon?
- Describe the current state of the art concerning biologically-based therapy, stem cells and growth factors. Hope or hype? Are we any closer?
The North American Spine Society designates this live activity for a maximum of 3.75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Agenda
Welcome and Introduction of Faculty
W. Mark Erwin, DC, PhD
Etiology: Biology Versus Biomechanics
Biology: James Kang, MD
Biomechanics: Edward Benzel, MD
Vertebral Endplate Changes and Degenerative Disc Disease
Gwendolyn Sowa, MD, PhD
Stem Cell Injections
Jason Savage, MD
Debate/Panel Discussion
Questions
Faculty Panel