Professor Georg Duda from the Julius Wolf Institut of the Charite, talks about the biomechanics of the spine and its regeneration. Why are deep muscles so important? And might doctors one day be able to replace the spine?
DW: It's important to move and strengthen the deep muscles of the spine. What do you recommend with lumbago. If you're suffering from lumbago, you don't want to move! So what can you do?
Georg Duda: You have to do both - try to avoid extreme movements and get a good physician's advice. But in general, to prevent the problem, you need to keep up a constant activity level - usually higher than what we do in daily life.
So movement is a key element in therapy. But where do you draw the line: When do we need more than movement as a therapy, such as surgery?
One key element is trying to get balanced movement. The point when you need therapy or a surgical intervention is when your movement capacities are no longer fully available. For example, when a muscle is degraded to such an extent that it cannot independently regenerate.
What can you do then?
At the moment, we are working in the lab on stem cell therapies that help us regenerate muscle tissue that would usually end as scar like tissue stuctures. What we are doing is initiating regeneration in those muscle structures. In model systems, it works very nicely, and we have just entered a phase of clinical trials to see how far we can go to rescue muscle structures and avoid scar tissue formation in patients.
And how do you actually initiate that - how do you get the stem cells to the right tissue?
It's basically very simple. We apply the stem cells adjacent to the cut or scar area, where we would like to avoid an extension of scar tissue formation, or even try to prevent scar tissue formation completely. It's a simple delivery at those sites to the muscle and that seems to work very nicely.
So people who had surgery might heal a lot faster?
And even avoid a lack of muscle capacity later on. If it proves as it looks at the moment, then it provides a basis for any other interventions, for example in the spine, where we have larger muscle problems or if we try to initiate regeration even in smaller muscle structures.
What about bone structures, vertebra, can you also help healing with bio-medicine and stem cells?
We have some very good first results for stem cells in bone regeneration but it's not widely used. We are working on getting this on a regular basis, for example coming with interoperative cell sorting technologies that allow us to apply stem cells from the patient in the site of injury. Or a different strategy would be off the shelf products.
One day, in the distant future, you'll just substitute the whole spine?
No, I think that will never happen. The body is such a filigree, nice, general structure, highly balanced and highly interactive. What we can do is support regeneration where it is not happening otherwise.
(Interview: Ingolf Baur)