What is Interventional Orthobiologics?

Interventional orthobiologics is a burgeoning field of delivering biologically based therapies delivered by minimally invasive and/or nonsurgical techniques to treat musculoskeletal conditions. Many different disciplines are trained in interventional techniques (e.g. anesthesia, PM&R, family practice sports medicine, and interventional radiology), yet few of these specialties are trained on how to treat at an advanced level comprehensively. In addition, the study and specialty training in biologically based therapies is a burgeoning field without a clear “home” as far as conventional specialties. On the other hand, within naturopathic medicine, it is within our tenets to use natural and biologic therapies to treat the root cause of a person's ailment, including MSK pain.

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Within the conventional paradigm for joint issues, persistent spine pain, and rheumatologic conditions, there is quite a gap in care. There are conservative therapies such as physical therapy, chiropractic care, over the counter medications, topical pain relievers, bracing, and other various direct to consumer products. Luckily, these conservative therapies can take care of an issue and or manage a pain sufficient enough for the patient to be able to do what they’d like to do, with minimal discomfort. Yet, often these conservative measures provide non durable relief and/or are not effective for patients. Here’s the start, or bottom of the gap.

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At the top of the gap is surgical intervention. Depending on the condition, this could involve invasive surgeries with long recovery times and high complication rates. There are many MSK conditions that fail conservative therapy, yet are not necessarily a surgical candidate, or in fact surgery is likely to cause more harm than good.

So what do clinicians offer people who have failed conservative therapy, yet surgery is not indicated? This is where interventional orthobiologics comes in. Right now in the toolbox of most clinicians trying to bridge the gap are simple injections with corticosteroids, stronger medications, and more advanced interventional techniques such as radiofrequency ablation. The problem with this toolbox is that these conventional approaches are temporary–at best–and tend to destabilize the structure of interest, can have significant complications all the while with unsatisfactory long term outcomes and diminishing returns. We can do better, and this is the hope of orthobiologics.

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Yet orthobiologics can’t just be administered willy-nilly. They need to be administered with proper imaged guidance and techniques, not only to ensure patient safety, but also to make sure the therapeutic agent gets to the appropriate tissue in order to help restore tissue health and function. This is where the interventional technique comes in. That being said, this is not about putting PRP into one specific and painful arthritic lumbar facet joint. Interventional orthobiologics is more than that in that it takes into account biotensegrity, biomechanics, biochemistry, and overall metabolic systemic contributions to a patients persistent pain. Interventional orthobiologics is more comprehensive than just a transforaminal epidural or a simple large joint injection. It includes a comprehensive approach of treating the patient and treating the functional unit.

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Under the umbrella of orthobiologics, the most commonly used products at this time are platelet rich plasma (PRP), bone marrow aspirate concentrate (BMAC), microfragmented adipose tissue (MFAT). These different autologously derived tissues offer varying mechanisms with the hopes to help restore tissue health while improving function, decreasing pain, and providing durable relief. There is even mounting evidence that PRP is a disease modifying treatment for knee osteoarthritis.
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In summary, interventional orthobiologics is an interdisciplinary field that's aim is to provide durable MSK tissue function by using biologic products delivered through a non surgical means. This field is not its own specialty, and may never be, yet it continues to grow in demand, evidence, and expertise. Many of the techniques and therapies can be offered safely and effectively in an outpatient office based setting, allowing flexibility for clinicians to add these services quite readily.