18
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Precision Spine Care: A New Era of Discovery, Innovation, and Global Impact

      editorial
      , DSc, , PhD, , MD, , MD, PhD, , MS, FRCS, MCh, PhD, , MD, PhD, , MD, , MD, PhD
      Global Spine Journal
      SAGE Publications

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Currently, government resources and initiatives, such as the White House Precision/Personalized Medicine platform and large-scale biobank cohorts located in Asia, Europe, and the United States focusing on big data biometrics (eg, genetics, blood biomarkers, imaging, tissue, and clinical profiles) have declared the urgent need for more precise medical care on an unprecedented level to improve health care utilization and patient outcomes. As such, we have now entered an era of “precision” medical care. However, such a platform has largely focused on cardiovascular disease, diabetes or cancer whereby targeted therapeutic drugs based on patient profiling and genetic variation have dramatically improved patient outcomes and led to more cost-effectiveness. 1 Although such platforms have seen substantial success, the health care community has to date overlooked the more debilitating disorders of the musculoskeletal system, in particular as they relate to the spine. According to the recent Global Burden of Disease Study, low back pain (LBP) is the world’s most disabling condition, affecting every population worldwide. 2 Individuals with LBP have noted decreased daily function, diminished quality of life, work disability, and psychological distress. 3 Studies have even noted that individuals with chronic LBP have significant loss of brain tissue that can affect cognitive function. 4 Such pain is associated with tremendous socioeconomic and health-care consequences. Indirect and direct costs related to the treatment of LBP are estimated to be approximately US$90 billion per year in the United States with similar adjusted rates in other countries worldwide. 5 Nonetheless, proper diagnosis of LBP and identification of pain mechanisms are questionable, outcomes of LBP treatments are often tenuous and have been criticized, and prognostication potential of various pain and disability dimensions as well as management options have limitations. As a result, such limitations have led to increased health care costs to the patient and medical provider with often unsatisfactory patient outcomes. In fact, spine specialists have been often challenged by the popular press, patients, and insurance providers globally because of their frequently poor outcomes in treating patients with LBP. Importantly, although numerous generalized protocols/algorithms and guidelines for the treatment of LBP have been proposed, these often fail to account for more “personalized” or “precise” patient variation with regards to lifestyle, occupation, underlining systemic conditions (eg, patient psychological profile, blood chemistry/inflammatory biomarkers, genetics, etc), patterns of imaging findings and other biometrics that have tremendous potential in the management of LBP. 6,7 For example, we now know that specific pain genes may predict outcomes following treatments for various spine disorders, and that such genetic make-up provides further insight into pain intensity and disability. 8 Such systemic conditions and others have been found to assist in identifying subtypes of pain that may be more amenable to various treatments, understanding patients’ pain thresholds and perceptions, predicting outcomes, and further identifying specific pain generators to assist in more tailor-made or “precise” treatments. 9 In fact, the same applies for other spine conditions, whose occurrence, diagnosis, treatments, and outcomes remain uncertain. For example, disc degeneration is a common condition that affects individuals in every population. 10 It still remains speculative why an individual develops disc degeneration and overall different patterns of spinal changes. Nonetheless, it has been a long-held belief that severe disc changes may lead to pain in the low back or in the neck. 11 However, not everyone who has disc degeneration is painful and not every individual who has neck pain or LBP has severe disc changes. 12 Moreover, it remains a mystery as to who may progress to more severe forms of disc degeneration or who may develop disc herniations and resolution of such conditions. Regenerative therapies to treat disc degeneration have taken center stage in the past decade. However, outcomes in human subjects have remained short from stellar with often unsatisfactory results. It remains unknown as to which patients may benefit from such therapy and/or predict their outcomes with some certainty. 13 In fact, regenerative biologics have yet to account for the overall personalized profile of an individual to fine-tune therapeutic dose, approach, and effectiveness to not only regenerate the disc but also to delay progression or protect its integrity. The above not only applies to “de novo” degeneration, but it is also relevant to degeneration/disease that may develop adjacent to an operated disc. Such a condition may also necessitate future conservative treatment (eg, physical therapy, medication, injections, etc) or surgery. However, who may be more prone to develop such conditions, how to prevent and manage them, and predict their outcomes is poorly understood. Furthermore, spinal deformities, such as adolescent idiopathic scoliosis, can be life-altering conditions. Who may progress to more severe deformity and additional comorbidities, respond to conservative treatment (eg, bracing) or obtain optimal surgical outcomes continues to perplex the spine specialist. Preventative measures for such patients continue to remain speculative. Moreover, in general, not all individuals who undergo conservative management for various spine conditions have favorable outcomes. In other words, the “one-size-fits-all” guideline- and protocol-based approach to treating patients with spine-related conditions, is no longer adequate. More precise approaches to identifying the “right” patient for the “right” treatment as well discovering/developing targeted therapies based on more detailed or personalized patient profiling is needed. Understanding with certainty in advance as to who may have a good or bad response to a treatment would be invaluable to all stakeholders. To combat the massive global burden of LBP and other spine-related conditions, health care systems must develop coherent policies with more “precision-based” management algorithms to maximize proper diagnosis, preventative measures, tailor novel therapeutics, predict outcomes with more certainty (eg, risk assessment, predictive modeling), and overall improve patient outcomes and function. Precision medicine strategies aim to have treatments tailored specifically to the patients’ individual needs based on their genetic, immune system status, and overall systemic biomarker omics profile as well as additional phenotype information (eg, imaging, lifestyle) with the goal of improving outcomes and reducing adverse reactions via a wholistic fingerprint and oftentimes big data approach. This may lead to improved quality of life for patients, reduction in noneffective treatments and more cost-effective outcomes, translating into more productive societies. Prioritization of research and clinical applications in precision spine care can only be achieved via a more precision-based approach fueled by an interdisciplinary platform of clinicians and scientists symbiotically working together to facilitate unprecedented discovery and innovation that can ultimately develop tools to identify the right patients for the most appropriate intervention to obtain the best outcomes while simultaneously decreasing health care costs to all stakeholders for global impact. A precision spine care approach reliant on big data interconnecting numerous platforms of biometrics will be key to realize such aspirations. As such, the onus to move the spine field forward rests on the shoulders of all spine specialists, clinicians, and scientists alike. As a spine community, we need to come together on a large-scale basis to address the platform of precision spine care and its massive potential. It is via collaboration and team work that we can elevate the status quo of the spine discipline to new heights and make an impact that will resonate for generations to come.

          Related collections

          Most cited references10

          • Record: found
          • Abstract: found
          • Article: not found

          Systematic literature review of imaging features of spinal degeneration in asymptomatic populations.

          Degenerative changes are commonly found in spine imaging but often occur in pain-free individuals as well as those with back pain. We sought to estimate the prevalence, by age, of common degenerative spine conditions by performing a systematic review studying the prevalence of spine degeneration on imaging in asymptomatic individuals.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: found
            Is Open Access

            Low back pain in older adults: risk factors, management options and future directions

            Low back pain (LBP) is one of the major disabling health conditions among older adults aged 60 years or older. While most causes of LBP among older adults are non-specific and self-limiting, seniors are prone to develop certain LBP pathologies and/or chronic LBP given their age-related physical and psychosocial changes. Unfortunately, no review has previously summarized/discussed various factors that may affect the effective LBP management among older adults. Accordingly, the objectives of the current narrative review were to comprehensively summarize common causes and risk factors (modifiable and non-modifiable) of developing severe/chronic LBP in older adults, to highlight specific issues in assessing and treating seniors with LBP, and to discuss future research directions. Existing evidence suggests that prevalence rates of severe and chronic LBP increase with older age. As compared to working-age adults, older adults are more likely to develop certain LBP pathologies (e.g., osteoporotic vertebral fractures, tumors, spinal infection, and lumbar spinal stenosis). Importantly, various age-related physical, psychological, and mental changes (e.g., spinal degeneration, comorbidities, physical inactivity, age-related changes in central pain processing, and dementia), as well as multiple risk factors (e.g., genetic, gender, and ethnicity), may affect the prognosis and management of LBP in older adults. Collectively, by understanding the impacts of various factors on the assessment and treatment of older adults with LBP, both clinicians and researchers can work toward the direction of more cost-effective and personalized LBP management for older people.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Does lumbar disc degeneration on magnetic resonance imaging associate with low back symptom severity in young Finnish adults?

              A cross-sectional magnetic resonance imaging study with questionnaires on low back pain (LBP) and functional limitations. To investigate the association between lumbar intervertebral disc degeneration (DD) and low back symptom severity among young Finnish adults. Both LBP and lumbar DD are common already in adolescence, but very little is known of their association in young adults. Young adults belonging to a birth cohort (n=874) were invited to lumbar magnetic resonance imaging using a 1.5-T scanner. Data on LBP and functional limitations at the ages of 18, 19, and 21 years were used to cluster the subjects with respect to low back symptoms using latent class analysis. The prevalence and 95% confidence intervals of DD at 21 years and the sum score of DD at all lumbar levels were compared between the clusters. The contribution of DD and other imaging findings (herniations, anular tears, Modic changes, spondylolytic defects) to symptom severity was analyzed with logistic regression analysis. Latent class analysis produced five clusters from the 554 subjects, ranging from a cluster where subjects (n=65) had been painful at all time points to an asymptomatic cluster (n=168). DD was more prevalent in the three most symptomatic clusters compared to the two least symptomatic ones. Similar findings were obtained for the DD sum scores. Lumbar DD was related to symptom severity independently of other degenerative findings. Moreover, moderately degenerated discs were more likely than mildly degenerated discs to be associated with the most severe low back symptoms. Intervertebral DD was associated with low back symptom severity among young adults, suggesting that the symptoms may have a discogenic origin at this age. However, DD was also found in one-third of asymptomatic subjects.
                Bookmark

                Author and article information

                Contributors
                Journal
                Global Spine J
                Global Spine J
                GSJ
                spgsj
                Global Spine Journal
                SAGE Publications (Sage CA: Los Angeles, CA )
                2192-5682
                2192-5690
                15 June 2018
                June 2018
                : 8
                : 4
                : 321-322
                Affiliations
                [1-2192568218774044]Rush University Medical Center, Chicago, IL, USA
                [2-2192568218774044]AO Research Institute, Davos, Switzerland
                [3-2192568218774044]Rush University Medical Center, Chicago, IL, USA
                [4-2192568218774044]Oulu University Hospital and University of Oulu, Oulu, Finland;
                [5-2192568218774044]Finnish Institute of Occupational Health, Oulu, Finland
                [6-2192568218774044]Ganga Hospital, Coimbatore, Tamil Nadu, India
                [7-2192568218774044]Pontificia Universidade Catolica do Paraná, Curitiba, Brazil
                [8-2192568218774044]University of Southern California, Los Angeles, CA, USA
                [9-2192568218774044]Radboud University Medical Centre, Nijmegen, Netherlands
                Article
                10.1177_2192568218774044
                10.1177/2192568218774044
                6022953
                8f682872-6bdb-47f9-ab73-31d16c6d364a
                © The Author(s) 2018

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License ( http://www.creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Categories
                Editorial

                Comments

                Comment on this article