Marketing has the tendency to get in front of the science in many areas of orthopedics, which can result in suboptimal patient outcomes and significant steps back for the technology.
Five surgeons told Becker's about spine technologies they believe do not live up to their hype.
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. Becker's invites all spine surgeon and specialist responses.
Next week's question: How do you anticipate the selling and mining of data evolving in healthcare over the next decade?
Please send responses to Alan Condon at firstname.lastname@example.org by 5 p.m. CST Wednesday, Dec. 1.
Editor's note: The following responses were lightly edited for style and clarity.
Question: What spine technology do you think promised more than it delivered?
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: Hype is always a difficult thing to see past. Spinal technologies that I think were less than stellar are the intervertebral distraction devices that became popular about two years ago. A slew of these devices were put into patients with the promise of relief from spinal stenosis. I have at least two spinous process fractures from these devices and have taken out at least one. I sincerely hope these devices will be retooled or removed from circulation altogether.
Alok Sharan, MD. NJ Spine and Wellness (East Brunswick, N.J.): I believe the robot promised more than it delivered in spine surgery. In other fields of medicine, such as gynecology and urology, there have been tremendous advancements in the use of robotic surgery. Initially, the spine community thought the same successes in those fields would apply to spine surgery. Due to a variety of reasons (capital costs, workflow issues, etc.), we have not seen a tremendous leap in adoption in robotic spine surgery.
The challenging part of the healthcare industry is that every disease process is different. What works in cardiac care may not work in urology, etc. Because healthcare is not a true system, such as the military, lessons learned in one field of medicine do not apply directly to another field.
Christian Zimmerman, MD. Saint Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): The PEEK rod system, touted by many companies, failed to alleviate the adjacent level failure phenomena that so many of us anticipated and cared for in our careers. The five-year run (or so it seemed) saw mitigation of pain issues because of lessened surgical intervention but saw returns for the additional surgeries years later for related symptoms of failure or persistence. Although the fracture rate of the rods was rare, this also became a concern in the older populace. As interest waned, the healthcare industry, applicable economics and the evolution of forward-thinking spinal care remedied this issue with eventual phase-outs by most corporations.
Michael Goldsmith, MD. The Centers for Advanced Orthopaedics (Bethesda, Md.): Interspinous and interlaminar devices were widely considered innovative technologies that could address spinal stenosis and were initially seen as less invasive options to spinal fusion or laminectomy. However, the results of these techniques in practice have not always delivered on the promise of addressing symptoms of neurogenic pain. Spine surgeons — and the healthcare industry in general — can learn that we must still abide by the basic principles of decompression, and stabilization when necessary, to achieve our patients' goals.
Ehsan Jazini, MD. Virginia Spine Institute (Reston): While laser technology promises precision in our ability to address spinal problems in the vast majority of the cases, it has failed to do this safely. Laser technology poses a risk due to the thermal collateral damage it imposes on the surrounding structures. Although laser technology has been used successfully in many industries, it has failed to live up to its hype for spine surgery and has little utility in our field. With the advancement in motion-preserving techniques, robotics and ultrasonic technologies, we can more effectively address structural spine conditions while preserving motion which laser technology can’t successfully address.