Here six spine surgeons discuss recent innovations in spine care that have significantly impacted the industry.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses.
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Question: Which spine care innovation has had the most impact on the industry in recent years?
William Taylor, Director, Spine Surgery, Vice Chairman, Division of Neurological Surgery, University of California, San Diego: Without a doubt the advent of minimally invasive spine surgery. Our ability to access and avoid approach-related damage continues to improve the outcome of our patients and makes surgery more accessible.
Stephen Hochschuler, MD, Co-founder, Texas Back Institute, Plano: Minimally invasive spine surgery with a lateral approach.
Brian R. Gantwerker, MD, The Craniospinal Center of Los Angeles: Lateral interbody fusion techniques have revolutionized the surgical approach and mindset of patients with degenerative scoliosis. As this technique is refined, we will see less neural palsy, better implants and better corrections.
Kenneth Pettine, MD, Founder, The Spine Institute, Johnstown, Colo.: I think the Coflex interlaminar implant has had the most impact on the industry in recent years. The fact of the matter is, the FDA has destroyed innovation in spine and orthopedics in the United States. Approximately 95 percent or more of all new implants are FDA-approved through the 510(k) process and are thus, more or less, slight improvements or direct knockoffs of preceding devices.
The Coflex went through an investigational device exemption process and is one of the very few implants to have accomplished that over the last decade. This implant is unique in the fact it is interlaminar and is supported by arguably the best study ever completed in spine. This is because their IDE study was a prospecting randomized study of class I data, but what makes it exceptionally unique is the more than 95 percent follow-up in both the study group and the control group. The results they reported are thus more reliable due to the high follow-up rate. Treating symptomatic spinal stenosis with a real decompression followed by insertion of this implant is truly an improvement over pedicle screw fusion for the vast majority of our patients. This surgery can be performed as an outpatient procedure with perhaps an overnight stay in the hospital or ASC.
Kern Singh, MD, Minimally Invasive Spine Institute, Chicago: Without a doubt the three biggest innovations in my spinal career over the last 10 years have been bone morphogenetic protein, lateral spine surgery and a tubular retractor. BMP has changed how we accomplish spinal fusions with much more predictability. Lateral spine surgery has allowed us to address even the most complex cases from an outpatient perspective and a tubular retractor has allowed us uncompromised visualization with minimally invasive surgical procedures.
Howard An, MD, Director, Division of Spine Surgery, Spine Fellowship Program, Rush University Medical Center, Chicago: The majority of patients who are undergoing fusion surgery prefer not having their iliac crest harvested for a bone graft. Therefore, biologic or synthetic bone graft substitutes developed by the industry have had a significant impact on the practice of spine surgery for last several years. Bone morphogenetic protein is one of these innovations available for clinical use, but its indication is narrow, and there is controversy surrounding side effects. Other bone graft substitutes, such as demineralized bone matrix, synthetic ceramics and stem cell products have been introduced, but more research is needed to assess their efficacy and indications.