Sunday, December 20, 2009

The End of a Decade in Spine

In ten days, the industry will close the door on the first decade of the twenty-first century in spine. The industry has come a long way considering our history. When TSB entered spine, there were a few companies in the market. Most of us did not have any idea how quickly the industry would grow in twenty plus years. You know the old Virginia Slims (a now defunct brand of cigarettes) marketing and advertising platform, "You've Come a Long Way Baby!" The industry has come a long way since the Harrington Rod was developed by Dr. Paul Harrington, and the constrained Caspar, Raveh and Morscher plates set off a new wave and craze in anterior cervical discectomy fusions, Orion and CSLP shortly followed, and we were off to the races. We had surgeons like Roy Camille, Magerl and Anderson inventing techniques in posterior cervical plating using lateral mass screws, Jurgen Harms contributed to interbody devices with the invention of the Harms Cage, the TSRH established a new standard in pedicle screw fixation, while a little known product developed by Alan Olsen, aka Danek, came to be known as the cross connector. In 1965 Marshall Urist discovered intramuscular implantation of demineralized bone matrix marking the beginning of the development of what has come to be known as bone morphogenic proteins. These were some of the pioneers and emerging technologies that established a new paradigm in the future modality of treating patients with chronic and debilitating spine disease. These surgeons were the visionaries that provided future generations with a versatile armamentarium in treating their patients.

The last decade has provided the industry with technological and scientific advancements in materials, dynamic stabilization, total disc arthroplasty, minimally invasive surgery and biologics including stem cells. Similar to the automobile industry of yesteryear, the industry has exploded with companies claiming that not only were these products innovative, but that these products would improve upon the patient's quality of life. Nearly ten years ago, the clinical mantra from the podium focused on anterior motion preservation utilizing the first commercially available artificial disc in the U.S. marketplace, whereas today, thought leaders have shifted their focus to the tri-complex of the spine to address pain relief. One has to wonder if the practitioner resects enough of the patients anatomy and replaces it with anterior, posterior and interbody hardware with biologics, will the patient have pain relief? Minimally Invasive Surgery was the marketing buzz word for companies to differentiate themselves from their competition, soft-tissue preservation became important in enhancing the healing process. Today there are more dynamic stabilization systems with variations in design that claim one over the other even though many questions remain as to what constitutes the optimal design. In addition to many of these wonderful technologies, an entire new mind set developed due to economic forces affecting the industry. Questions remain unanswered about the true intent of some of these ventures. Were and are some of these technologies looking for an indication? The commercialization of medicine, and especially spine, has changed the way we once did business. No longer was it honorable to build a foundation and establish a business, entrepreneurial fever became an epidemic in the earlier part of the decade. The acquisition of the ProDisc by Synthes, and Charite by DePuy set off an entrepreneurial frenzy. "If they could do it, why can't we?" Unfortunately, timing and serendipity are important factors in becoming rich in today's economic environment.

So, what does TSB expect as we move into the next decade? Industry consolidation will become key if the we are to survive the many unexpected changes that are in store with the enactment of a new healthcare bill. Research and development along with manufacturing will be exported to countries with a cheaper labor force and product cost as a response to the ever increasing pricing pressures in the US market. The business development model will evolve based on investors need to increase or sustain margins resulting in a more direct-to-consumer (the hospital) by- passing the old sales model. Product development will become more focused. Transparency and accountability will become a tenet of the industry. Money will be always be available, but there will be greater scrutiny in providing capital. This will not be a bad thing, because it will force the industry out of its comfort zone, one that has layered companies with the same executives that still continue to do the same thing over and over expecting different results. TSB wants to know what our readers think?


  1. TSB, your very short selective list cries out for a more comprehensive one naming the pioneers who created and advanced the SCIENCE of spine surgery:

    Albee, Asher, Buetner-Jansz, Caspar, Cloward, Cotrel, Dick, Dubousset, Dwyer, Fernstrom, Halm, Harmon, Harrington, Heinig, Hibbs, Knodt, Louis, Luque, Magerl, Robinson, Roy-Camille, Shufflebarger, Smith, Steffee, Urist, Verbiest, Wiltse, Zielke.

    No doubt there are others, but is noteworthy how the majority of these names hail from an era before the "new mindset" developed in response to "economic forces" - did you mean to say greed?

  2. History Buff:

    Thank You for reminding our readers of the others that played an integral role in spine. I must respectfully apologize to them for not mentioning them by name. Based on your final paragraph, I need not say any more. Merry Christmas and a Happy Holidays to all!

  3. With the increase in minimally invasive techniques, what are your thoughts on laser surgery for the back and spine?

  4. Minimally Invasive Spine Surgery (MISS) procedure is used increasingly. Would like to know your thoughts on the same.