Advancing R&D improves spinal challenges: Specialist

A mechanical implant developed in 2003 for severe spinal conditions has been proved to help restore quality of life.

This is the Total Posterior Spine System (TOPS), which, according to Mayo Clinic (Rochester, Minnesota) orthopaedic surgeon Dr. Ahmad Nassr, has so far helped a 40-year-old patient “with a lumbar disc herniation and progressive degeneration of both the disc and facet joints.”

“The patient had an excellent recovery. Within a few months, he returned to a high level of physical activity, including demanding outdoor pursuits. At follow-up, he reported complete resolution of his back and leg pain, with preserved motion at the treated level and a return to his baseline quality of life,” said Nassr, 20 years in the field and whose work generally focuses on complex spinal disorders across ages.

Saying that Paediatrics Orthopaedics is “incredibly rewarding” because early interventions definitely has positive outcomes, Nassr also said that on the “broader” scope, the spinal challenges are degenerative (wear-and-tear overtime, nine of 10 over 50 patients in his books into physically demanding and sedentary lifestyles), deformity-related, traumatic, infectious, and tumour-related.

Herniation whereby a “disc is pressing on a nerve,” is eight of 10 cases among “active younger to middle-aged adults. Curved or misaligned spine (deformity), which is idiopathic scoliosis in teenagers and a consequence of “degeneration” among “older adults,” is six of 10.

Nassr’s commonest and “most persistent” cases are “degenerative disc disease and spinal stenosis (age-related characterised difficulty in walking and pain due to “compressed nerves” arising from narrowing spine), disc herniation (causes “radiating arm or leg pain” due to a disc being “pushed out” and thus “irritates and compresses a nerve), and spinal deformity (impacts “posture and function,” and in the worst of situations, “neurologic health”).

The Spine Fellowship director of the 137-year-old integrated academic medical centre was interviewed on the progress of research-and-development (R&D) concerning motion-preserving devices.

This, as advancements in medical science as well as the increasing openness to healthy lifestyle since the harrowing worldwide Novel Coronavirus episode, have contributed to increasing aging populations.

On his opinion on the role of Artificial Intelligence (AI) in solving spinal problems, Nassr described this as “promising tool.”

The Mayo Clinic School of Medicine Orthopaedic Surgery and Neurosurgery professor added: “But AI is not a standalone solution. It can enhance spinal care by improving imaging interpretation, assisting surgical planning, and helping predict outcomes and risks. It has the potential to support more personalised treatment and strategies.”

Nassr pointed out that AI is a “powerful apparatus” towards better “informed decisions.” He, who opted to specialise in spinal surgery “because it sits at the intersection of engineering, neurology and patient care, also stressed that “spine care remains highly individualised and often complex.”

So the “physician-patient relationship central to decision-making” is irreplaceable. With that is the relevance of advancing R&D, which, Nassr agreed, has “led to meaningful progress in motion-preserving technologies, such as artificial disc replacement. These devices are designed to maintain movement at a spinal segment rather than eliminating it through fusion.” These benefit “carefully-selected patients” in terms of “reduced stress in adjacent levels and improved long-term outcomes.”

It is carefully-selected patients” because “these technologies are not for all. Careful evaluation and patient selection are essential, and traditional approaches like fusion remain the best option in many situations. The goal is always to match the right treatment to the right patient.”

On the TOPS which the USA-Food and Drug Administration (FDA) had approved, 20 years after it was invented in 2003, Nassr, who served as the “principal investigator” for the Mayo Clinic site of the FDA “Investigational Device Exemption Trial,” said that the 40-year-old patient was among the “enrolled.”

TOPS “allows for controlled motion while maintaining stability and alignment and disc height, even in advanced degenerative cases.” It is “designed to restore the natural biomechanics” of the spine by replacing both the intervertebral disc and the facet joint complex.” Facet joint complex are the small joints that keep the spinal column together.

The TOPS device replaced the “damaged intervertebral disc and the degenerated facet joints” of the patient whose “affected nerves” were “decompressed.”