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In The News Less pain with new technique. Stem cells implanted in spine can join vertebrae that used to require metal and grafts Modesto, CA - At a key point in the surgery, Dr. Alexander Davis, used forceps to hold up a small, saturated crimson pad. The rectangular pad oozed with bone marrow that had been taken from Georgia Ford's body and put through a filter to concentrate stem cells. "That really looks good," said the veteran surgeon, who was doing this particular type of spinal fusion operation for only the second time. He then placed the pad into a large incision in Ford's back and packed it against one side of her spine. Later, he implanted a second pad on the other side. The implanted cells are busy growing bone and, within three to six months, are expected to close the gap between two segments of Ford's spine, thus stabilizing her lower back. There is nothing new about spinal fusion operations - Davis has done thousands in fifteen years as a surgeon, mostly in Modesto. But two weeks ago, he began using stem cells to create bone grafts involved in the surgery. And the technique should reduce pain to patients such as Ford, a 69-year-old Modesto woman who underwent the surgery Monday morning. "We are always striving for ways to make the patient more comfortable and have less pain as a result of the procedures," said Davis, who performed the operation at Memorial Medical Center and did a second one in the afternoon. If results are good, he said, he plans to regularly use stem cells in the spinal operations. Scientists believe that stem cells hold great promise for treating muscular dystrophy, diabetes, heart disease, spinal cord injuries and damaged organs. These cells are present in the earliest stages of human life and are different in that they don't perform specific functions. Given the proper stimulus in nature or in the laboratory, stem cells give rise to specialized cells that make up the heart, lung, skin and other tissues. The research is controversial because human embryos are deemed the best source for these powerful cells. Other sources include bone marrow, blood or skin of children and adults, but experts say these cells can generate limited types of tissue. Two years ago, Johnson & Johnson started testing a stem-cell filtering device for use in bone grafts. In recent months, the company has made it available to a few surgeons across the country, including Davis. The device has Food and Drug Administration approval and is set for widescale release this week. Many people suffer back pain when discs, or the soft, cushiony parts of their spines, wear out and create pressure on adjacent nerves. The standard repair involves clearing out the disc material and fusing two spinal segments with metal plates, screws and a bone graft. To prepare the graft, doctors have to cut through skin and muscle tissue to dig bone out of the patient's pelvis. "Even though the former procedure works well, it causes pain for the patient," said Dave Urbanz, product manager for DePuy AcroMed, a Johnson & Johnson company that developed the filter. "After the surgery, the patient's hip may hurt worse than his back does, he said. Davis said he has always looked for ways to make bone harvesting less painful, so he was interested in the new technique. "Now that I can definitely get the stem cells out without digging into the pelvis, I will be using this procedure regularly," Davis said. Ford had the standard surgery done a year ago and then suffered a fall, loosening the screws and plates of the first surgery and cracking a vertebrae. During the four-hour operation Monday, Davis stuck a needle into the woman's pelvis to harvest marrow. He then squeezed the fluid into a cartridge holding a Healos pad, where the biotech magic takes place. The pads are coated with substances to draw the stem cells from the marrow and stimulate them to create bone. When applied to the spinal column, the cells will bond with the existing bones. Because of her age and problems with osteoporosis, Davis installed an electronic device in Ford's back to stimulate the graft. Ford was expected to spend five days in the hospital and then two weeks in a skilled nursing facility. Davis said she will be scheduled for X-rays every four weeks, to make sure the fusion is taking hold. The need to repair the previous fusion stretched the time of Ford's surgery. About 2 hours, 45 minutes is normal for the stem-cell operation, same as a standard fusion. Hospitals are usually reimbursed $11,000 for fusion surgeries, Johnson & Johnson officials said. The filtering equipment costs $700, but it's a wash, because one less incision is made, they said. The normal hospital recovery time is shorter, one to three days, which should appeal to insurance companies, the product makers said. Mike Cully, spokesman for Kaiser Permanente, which formerly had a contract with Memorial, said the health management organization is open to covering new procedures grounded in good science. "If there are clinical trials to support it and a physician feels it is right for the patient, that is what we are going to go with," he said. Matt Carrillo, a specialist for DePuy AcroMed, said stem cells also can help mend broken bones that have not healed properly. There is also hope some day of allowing paralyzed people to walk again, by modifying stem cells to match the patients' genes and then injecting the cells into their injured spinal cords to regrow nerve tissue. Broader applications may depend, however, on resolving ethical debates over stem cells derived from human embryos. Opponents charge that the research destroys human life; proponents say the embryos that otherwise would be destroyed are received from in vitro fertilization clinics with the donors' consent. May 8, 2003. Ken Carlson, The Modesto Bee, p. B-1,5. BACK |
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