BTO: Fertilise your bones for faster recovery

Business Times - 11 Apr 2009

Fertilise your bones for faster recovery

THE next time someone tells you fertiliser is for plants, show them this article, because doctors have discovered a 'medical fertiliser' that helps broken bones heal faster. Indeed, thanks to innovations in genetic science and advances in medicine, local specialists have started treating some spinal patients with biologics.

 

The outcomes so far have been very successful, says Tan Seang Beng, director of the Spine Service and chief of the orthopaedic surgery department at Singapore General hospital (SGH).

'Since mid-2008, SGH has been applying biologics to a highly select group of patients who require fusion for spinal instability or severe fractures,' he explains.

 

Conventionally, patients with unstable spines - a result of injury, bone cancer or age-related degeneration - could look forward only to a painful surgical procedure called spinal fusion, which aims to stabilise the spine by fusing together two or more vertebrae using bone grafts and metal implants.

 

The implants, which include titanium rods, screws or cages, act as supports for the spine while the bones heal. The problem is: Spinal fusion is a drawn-out process that often requires bone grafting, and patients can take up to a year or more to recover fully.

 

'Spinal fusion is a two-pronged process,' says Prof Tan. 'The first part involves putting in the metal implants to hold the spinal column in place; the second involves taking bone grafts from the pelvis, which can be traumatic for the patient.'

 

Apart from the time required for new bones to grow, pain is a big factor in such operations.

 

'Spinal fusion surgery often involves two surgical sites - one in the back and one at the pelvis,' says Prof Tan. 'The second site, in particular, can cause intense pain that lasts many weeks or even months.'

 

Researchers have therefore been looking for less-invasive ways to help stabilise the spine. The breakthrough came with biologics - genetically engineered proteins derived from human genes.

 

'Scientists in the US found that Bone Morphogenetic Proteins (BMPs) can be used to selectively drive certain functions in the body, including the formation of new bone,' says Prof Tan.

 

'When applied to the bone, these proteins attract stem cells from other parts of the body to the damaged area and encourage them to grow into bone cells.

 

'BMP is to bone what fertiliser is to plants. With BMP, there is no longer a need to harvest bone from the pelvis, which significantly reduces the amount of pain the patient suffers.'

 

More importantly, BMP hastens the bone healing process, so patients recover and become active within a few months.

 

The procedure has opened up a new vista in orthopedics, paving the way for subsequent collaboration between biotechnology and medical science.

 

Going forward, doctors believe the use of BMP will be widened to benefit more patients, including those with delayed healing of limb fractures.

 

'BMP will be particularly useful for patients going into their senior years,' says Prof Tan. 'For these people, bone grafts alone may not work, because the quality of their bones would have degenerated with age.'

 

As the global population ages, spinal fusion will become increasingly necessary. In fact, it is now the fastest-rising operation in the US. Asia, too, will not be spared an ageing population, which makes such advances in spinal surgery a matter of vital public interest.

 

BMP treatment, however, does not come cheap.

 

'Spinal fusion with BMP will come to about $40,000,' says Prof Tan. 'The success rate, though, could more than make up for it. Ultimately, the choice belongs to the patient.

 

'It's a trade-off between a long-drawn healing process, versus a potentially faster recovery at extra cost. But now, at least, there is an option.'