Monument Valley in Arizona

The Edwin Smith surgical papyrus from Egypt, written around 2500 B.C., offers the earliest descriptions of spinal ailments and their treatment. In the ensuing centuries, physicians interested in the spine continually sought new and better ways to restore function and to alleviate pain in patients with spinal injury and disease. Now, 4500 years later, we stand on the brink of a new era in spinal treatment as highlighted in this issue of the Barrow Quarterly coordinated by Christopher Ames, MD.

Our exploration of these new developments begins by considering the application of targeted tissue engineering to spinal surgery. Ames and coworkers review research on the ability of bone morphogenetic proteins (BMPs) to promote bone growth. When used in conjunction with spinal fusion procedures, BMPs improve the biomechanical strength and rate of fusion. The hope is to eliminate pseudarthrosis and related complications, eventually perhaps by rebuilding rather than by replacing the natural stabilizing systems of the spine. The possibility of fostering the regrowth of tendons and cartilage using BMP-like proteins is also under investigation. One day these innovations may help restore the function of diseased and injured spines by promoting the growth of healthy, functioning tissue.

Another technological advance that promises to improve the long-term outcomes associated with spinal surgery, specifically for the treatment of degenerative and herniated disks, is the resorbable anterior graft containment cervical plate. Ultimately, the efficacy and feasibility of using nonmetallic material for spinal implants for this purpose must be established by large, randomized clinical trials. The article presented here evaluates the disadvantages and advantages of resorbable plating and the basic methodology for testing such materials. On a related note, Gerber and coworkers review the history, design, risks, and current status of spinal disk arthroplasty. A functional prosthetic disk that would preserve the physiological motion of the involved segments might decrease the incidence of adjacent segment disease by maintaining the functional integrity of the spine and would be another welcome addition to the spine surgeon’s armamentarium.

Since its introduction in the early 1990s, image guidance has also been embraced as a valuable surgical adjunct. This technology has improved the surgeon’s ability to place spinal instrumentation accurately and hence has improved the safety of spinal surgery. To illustrate the value of image guidance, Nottmeier and colleagues explore the application of this technology to particularly challenging spinal cases.

When combined with surgical expertise, some or all of these new treatments may well transform spinal surgery in the coming years. As an active participant in such cutting edge research, the Barrow Neurological Institute is pleased to share this exciting issue with its readers. We hope you will find it a valuable addition to your library; in return, please consider expressing your support by using the enclosed envelope to send a tax-deductible donation to help maintain the quality of this publication.
Robert F. Spetzler, MD