Friday, April 30, 2010

The Weekend Update - Lookin at Lucky

Recently, one of our readers questioned why there haven't been as many posts on TSB. We must apologize that we are not as "witty" as some platforms writing April Fools posts. For those that are curious, TSB has been seeking new technologies. So with the Derby on hand, TSB was feelin' lucky heading down to the Kentucky Derby. Just like jockey Garrett Gomez, TSB has done his job and is "Lookin at Lucky." Outside of today's race, there hasn't been anything exciting to report. So what's new? If another " total" motion preservation system is what you want, then we saw plenty of them last week. But, are they really worth writing about? Just because its your product or you have some "skin" in the game doesn't mean its going anywhere. Remember, just like in horse racing there is a major difference between the thoroughbred, the rider and the owner. Just look at the products that we reported about last week. They aren't the attractive two-year olds that TSB was looking at this morning. If the response in the comment section to the Spine Technology Summit Meeting and SAS is a barometer of things to come, the industry has way too many meetings. This industry is no longer built on patient care and clinical efficacies, it now panders to the desires of the Street better known in Louisville as the bookmakers. How does one generate realistic growth when the economic environment in healthcare has changed? What are the odds? Five or six years ago, when these meetings were being developed, industry professionals questioned the motivation, who was running them, and, was this industry becoming too commercial for its own good, placing profits before patients? If this is where we have arrived, it's time for new blood. If attendance and climate is a barometer of things to come, this meeting has seen its day. Besides, there are prettier phillys in Lexington today. Those that drink the "spine kool-aid" can discuss the papers and posters that were presented, just look at whom is placing their clinical imprimatur on these papers and one has to wonder has SAS become a meeting of something old, something new, something borrowed, and something blue? Yuan, Hochshuler, Blumenthal Young, Davis, McAfee, Philips, Krishna, Friesem, even Viscogliosi etc..... Old jockeys attempting to ride young and new horses. Unfortunately, egos, personal portfolios, and investor capital still rule when it comes to spine. One of the many questions that must be posed to our readers is, when will our Captains of Industry realize that the party is over? Hope still looms based on Baxter's recent acquisition. Yet, like today's line, the odds are always modified to benefit the race based on the forecast. Over the past years industry growth rates hovered around 15-20%, today, the titans of Wall Street have modified the industry guidance to 8-10%.

If there is anything that is worth reporting it must be NuVasive. How does this company continue to razzle and dazzle the track? Could this company be running on today's odds for Stately Victor? Could it be because of the jockey riding this horse, Alex Lukianov? Considering that this company is truly a one-trick pony platform, XLIF and NeuroVision how do they continue to win every quarter? Eventually, all thoroughbreds are put out to stud. Spare us the Osteocel story because Devil May Care is running at 11-1 odds to win. Is it consulting agreements? Mission Impossible 20-1. Is it a sophisticated educational platform? Ice Box is running at 9-1. Is it the wining and dining? Pick Super Saver at 8-1. Let's face it, NuVasive is beating Synthes, Medtronic and DePuy at their own game. But why? One has to wonder how long they will ride this horse? As long as that three-tiered training program for XLIF exists, they've got the surgeons by their hearts and minds, and you don't even need the kool-aid. But our readers must admit, it gets entertaining when a new CFO is now an expert on XLIF and spine surgery because he works for NuVasive.

So in closing, TSB is standing near "Lookin at Lucky," and I'm feeling pretty lucky. So I'll be ordering another mint julep and thinking about those not fortunate enough to take in this event. TSB wants to know what our readers think?


  1. The Derby is in Louisville not Lexington, home of horse racing's greatest event and the nation's most dense conglomeration of highly paid surgeon "consultants" per capita within the spine industry. Enjoy your mint juleps.

  2. Thanks for the correction, way too many mint juleps by this infidel

  3. Just ran into TSB at Churchhill Downs with an entourage of family, friends and a bevy of beauties, asked for his dark horse pick, he still likes Lookin at Lucky, but may ride Super Saver.

  4. Devil May Care only philly in the field.

  5. 100k on Super Saver! Crazy Kelvin.

  6. Why does everyone insist NuVasive is just a one trick pony? Even with your post you mentioned 2 technologies (2 ponies) that Danek, Synthes, Depuy and Stryker are years behind on. What ponies do these companies have in the race that NuVasive doesnt? Alex Lukianov is much like Todd Pletcher, trainer of Derby winner SuperSaver, not only did he have the winning pony, he had 3 other ponies in the race too. Looks like NuVasive is a lot more than just a one trick pony!

    Thanks for the blog!

  7. 8:27...what are the 2 technologies that danek, synthes, deupy, and stryker are years behind on? Surely you aren't counting Osteocel?

  8. "...this company is truly a one-trick pony platform, XLIF and NeuroVision"

    You can't discount the technology behind Osteocel Plus either. It might not be the end all be all but, what MSC technology do the big 4 companies have?

    There are other ponies in the nuvasive bag that are helping nuvasive, as MS Man stated, "continue to razzle and dazzle the track."

  9. What I would like to know is since how you put Krishna in the same sentence as McAfee et al? That is like putting my son who flies model rockets in the same sentence as Neil Armstrong.

  10. Either you work for Globus or you're a secret admirer of Paul"David Paul is a genius" McAfee.

  11. Danek, Synthes and Depuy all have a DLIF spacer now, with better design and support. The advantage of second generation product and deeper pocketbooks. Being first in the pool doesn't make you the best swimmer.

  12. JC, how exactly are these companies designs better? Nuvasive is way past second generation lateral technology, look at XLIF Corpectomy, XLIF TRR, Thoracic XLIF, multiple implant options etc.

    I agree, being first in the pool doesnt make you the best sweimmer BUT, an olympic swimmer is more experienced and better than the kids in the kiddie pool.


  13. Nice concept and surely NUVA is working on something, but will it truly improve lumbar DDD outcomes and increase motion?


    Nuvasive is the largest of the few remaining spine hardware companies that still offer financial incentives to surgeons in return for using their products. Other companies like Depuy and Medtronic were forced by the OIG to stop federal kick-back law violations. The financial incentive for a surgeon to use Nuvasive is SIGNIFICANT.

    In addition, an XLIF is in effect a two-part procedure. The removal of the disc laterally which is replaced by a cage which is followed by the placement of screws and rods placed in the pedicles posterior. The major development is the change from would have been an ALIF (anterior removal of the disc) to XLIF (lateral removal of the disc).

    This approach to the disc space transcects the actually transects several major neural pathways placing the nerves at significantly higher risk to injury. As opposed to the anterior approach which places these nerves at no risk at all. So why would a surgeon choose an XLIF over an ALIF? Not just because Nuvasive offers him significant financial incentives in the forms of dividends and the like, but because for the lateral approach, the orthopedic/neurosurgeon does not need to call for the assistance of a general surgeon to do the approach and consequently can bill for both procedures himself, instead of splitting them with a general surgeon.

    The orthopedic/neurosurgeon is told by Nuvasive that the increaded risk to these neurological structures are mitigated by the Neurovision device which is said to allow the surgeon to identify the endangered nerves. The problem with all this is the Neurovision is not FDA approved for intraoperative neurological monitoring, nor does it provide the standard of care a patient and the surgeon needs to safely approach the disc space laterally.

    Oh, by the way, the ortho/neuro surgeon is told that he can bill out for Neurologists' services (like he can the general surgeons') if he uses the Neurovision machine, instead of requesting that a board certified neurophysiologist provide neurological protection for the patient with neurological monitoring.

    I know of several patients that have suffered serious neurological injuries undergoing XLIF procedures, and one fatality- all of which I know of either first or second hand.

    I am a board certified neurophysiologist, I have worked in spine surgeries for 7 years protecting patients neurological integrity.

    Anyone considering spine surgeon should seek the recomendation of any board certified neurophysiologist to recomend a highly skilled orthopedic/neurosurgeon.

    There is a small unknown segment of the medical profession of neurophysiologists whose sole job it is to identify and prevent neurological trauma during surgeries.

  15. I'm a spine surgeon and am interested in what is being done with "consulting agreements" with Nuvasive. Not that I want anything to do with a consulting agreement, but I am looking into someone who the DOJ might be interested in going after. How are they arranged? How is the the cash transferred? How much money is involved?