The recent guidelines that were published by the AAOS on the use of vertebroplasty or kyphoplasty for spinal compression fractures (SCFx) has raised many questions as to efficacy and cost. Sources estimate that $17 billion is spent annually on the universal treatment of SCFx . Those figures probably reflect universal treatment. Annually, 1.5 million fractures are diagnosed with an estimated 200 to 300 thousand patients undergoing some type of vertebro/kypho procedure. The cost per procedure can be as low as $2,400 and as high as $4,000. In order to minimize cost per procedure, it may behoove the industry to have this procedure performed in an ambulatory surgery center. Yet, the biggest question that is being debated is whether surgical intervention should take precedents over conservative care? And, what is the rationale behind the AAOS' findings?
To recap the players, we have Kyphoplasty (MSD), Osseoplasty (Osseon w/DePuy Distribution), No Confidence (DePuy), RF Kyphoplasty (DFINE Be Fine), Parallex EZ Flow (Arthrocare), CDV/LP2 (Biomet), Stryker, and Cortoss (Orthovita). TSB apologizes if there have been any omissions. Considering that many of these systems have their own features and benefits, TSB though it would be interesting to table these products and offer the industry a unique forum to discuss the pro's and con's of each system. Some of the questions that we have heard include the following;
Do surgeons choose cost over retrospective data, intra-operative performance and post-op results?
Why one system over another?
Which system has provided the industry with a revolutionary or evolutionary advancement and why?
Which cement has the best workability, viscosity, and settling characteristics?
Is an articulating tip for unipedicular access an advantage or disadvantage, and why?
Is mimicking the physiological properties of bone important, if so then who has the best material?
Can one product legitimately minimize the potential for adjacent vertebral body fracture (ALFx), and does a lack of interdigitation contribute to ALFx?
Is thermal necrosis of nerve endings in the affected level a bad thing?
Is there a mechanical and chemical advantage of Cortoss over PMMA?
Considering that this is a hot market and that there has been some serious capital invested into some of these companies, TSB wants to know what our readers think?