Restorative Spinal Therapies Lab (ReST)


Our lab recognizes that the best future treatments for our patients consist of therapies that do not require incisions at all. Toward this end, Dr. Malhotra has led research into injectable therapies for disc degeneration for more than a decade. Starting in 2006, Dr. Malhotra began investigating injectable polymers designed to treat spinal disc degeneration. Partnering with a polymer chemist, Weiliem Chen, and mentored by a mechanical engineer, Dawn Elliott, the team developed polymers that would act like the native spinal disc when injected. In 2012 Dr. Smith joined the lab and co-leads efforts to bring the therapy to fruition. Several key colleagues partner on this endeavor, including, but not limited to, Rob Mauck, George Dodge, and Tom Schaer, amongst others.


Symptomatic spinal disorders are among the most devastating clinical problems for the individual, the labor force, and the economy. Intervertebral disc degeneration is implicated in common pathways to back pain and is a cascade of cellular, structural and mechanical changes. There is a critical need for new innovative therapies for disc degeneration to halt or reverse its course in order to both alleviate painful symptoms and restore pre-degenerative structure and function. The ReST/TSRL laboratory is successfully exploring synergistic therapeutic strategies that combine injectable hydrogel implants, sustained anti-inflammatory drug release, and stem cells that are uniquely conditioned to survive in the oxygen and nutrient-poor in vivo disc environment. Having had success in vitro (human and ovine models), and as the ReST lab approach to mimic the pre-degenerative disc matured, focus has turned toward in vivo translation . We have established a large animal model (goat) of disc degeneration for preclinical evaluation and as a prelude to future clinical translation.

In the area of cell-seeded hydrogels and attenuation of catabolic inflammation for intervertebral disc tissue engineering the ReST/TSRL Lab has made important contributions towards the production of functional tissues for human implantation. The team has demonstrated therapeutic potential to reverse disc degeneration with polymer and cell based therapies. Ongoing and future studies will assess implant performance, ability of preconditioned cells to maintain phenotypic characteristic of the pre-degenerative disc cells and the ability to attenuate catabolic inflammation in a large animal model. Collaborative research teams involving engineers, surgeons, and scientists optimize the function and translatability of these emerging technologies to improve intervertebral disc repair and regeneration in humans.


The team is credited with developing a new large animal model (large frame goat) for spinal disc degeneration. With funding from the NIH, foundations, donor support, and VA Merit awards, the team continues to progress toward an efficacious injectable therapeutic to reverse spinal disc degeneration.

The Lab's disc regeneration research has led to many top conference and abstract awards including being selected as Best of the Academy at the 2014 Academy of Neurological Surgery Meeting, amongst neurosurgery’s most prestigious societies. Numerous meeting awards have been bestowed on lab members and these are noted in individual cv’s.