Thursday, March 8, 2012

Where Has All the Innovation Gone

Talk about a steady decline, how about an overall decay.  It's the last vestiges of Pompeii.  The spine industry is its own Mount Vesuvius blowing out ash and fire.  Who knows maybe one day when they unearth this industry with an archeological dig, we will all learn what happens when one self-immolates.

If we step back and evaluate some of the emerging technologies that have graced the spine industry, we can observe in shear astonishment how some of these products ever reached the marketplace, let alone generated revenue for the inventor and investors. TSB believes that many of you would agree that organic innovation, something that truly was a game changer, no longer exists at the big companies. A game changing technology, something that enhances the clinical outcomes and overall patient's quality of life.  If life is movement, and movement is life, then there isn't much movement or life coming out of the spine industry. As more start-ups continue to dump me-too products into the marketplace, the only outcome is lower pricing, lower commissions, lower profit margins, and less focus.  The emerging technologies are not coming out of the Medtronics, the Zimmers, the Biomets, the DePuy's, Orthofix, Synthes, or for that matter NuVasive. Is it the people running these companies? Is it our educational system when one looks at the quality of candidates coming out of engineering schools?  The smart guys are going to the Street. Could it be cheaper to acquire a product than develop it? Why do people continue to give some of these clowns capital only to find out that they have been played for fools?  The spine gravy train has left the station and isn't coming back.  Elvis has left the building. Could it be that even the small companies have become myopic?  Is the current business model in spine built on selling or brokering?

Look at some of the small companies, once looked upon as incubators for innovation, stagnation has taken over innovation. What is it about inventors, entrepreneurs or investors that inhibits them from bringing a game changer in today's marketplace?  Could hope spring eternal?  Where are the market-makers, or game-breakers? Every time you assess one of these start-ups you have to question whether the have the stamina to go the distance. The first couple of years, everything is usually status quo until personality flaws start to surface intra-operatively, or one of the big boys figures out a better mouse trap for your own product. Terrible two's suck. How many of you have worked for a company that had a great implant but mediocre instruments? Or, the instruments were beautiful but the implant sucked?  Or that the inventor believed that there wasn't anything wrong with the system, and that the surgeon(s) didn't know how to use the instruments or implants or weren't properly trained? FOOL GOLD my fellow bloggers. Based on some of your comments many of these people along with the people that manage these ventures are living in a fantasy world deluded by too many hallucinogens. TSB bets that there are many of you out there that have plenty of stories to share with one another.

Recently some of our sources were in the OR and reported that if one saw the quality of what is being offered as new and innovative technology is...... well......crap at best.  Mediocre instruments. Mediocre implants.  If you were a surgeon would you want to subject yourself to intra-operative torture?  So why have we stooped to this level?  Poor management?  Financial ineptness?  No experience? Bullheadedness?  Who wants to wallow in mediocrity, when suicide is painless.  So TSB wants to know has anything here seen my old friend Jurgen Harms, can you tell me where he's gone,  he designed some interesting things and now I look around and its all gone?

Money has always been important, but maybe there's a lesson to be learned that if you focus on the basics, we can return to some semblance of yesteryear, but then again, as long as human nature plays a role in outcomes, maybe not.  TSB can hear that the wind cries help me and wants to know what will it take?

194 comments:

  1. I have to agree - very tired of seeing only “Michaelson technology at work.” Problem is in this day in age, will the FDA clear it and will insurance cover it.

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  2. It seems so easy to point the finger at the industry leaders themselves, but they are seeking to manage the symptoms caused by the real problem... THE OVERSIZED US GOVERNMENT. Where did innovation go? Probably the same place that our many of our long lost freedoms went. One day at a time, this administration seeks to bring the people to our knees, and keep us there, with the populus ignorant believing that big govt will bail us out. Govt stopped innovation, Govt makes it harder to stay profitable, Govt took away incentives to innovate, Govt allows the shady issues to continue. Shit rolls down hill, and it starts with the Govt. Unfortunately, there are few execs that have found a way to make it work, and when they do... Obama will tax em some more. TSB, i understand your thoughts about the industry leaders, but our Nation leaders say BOHICA every day.

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    1. Not entirely true. Phoenix MIS by Orthofix is an example of continual ingenuity in spine.

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  3. NuVasive...Bendini...already FDA approved...already in alpha testing...the age of percutaneous long construct PSF is now upon us.

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    1. How do you do osteotomies through a perc system? Perc long construct sounds great but doesn't make much sense.

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    2. Longitude!!

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    3. Why do osteotomies when you can achieve indirect decompression via XLIF or ALIF?

      I guess if you're too old school for that, NuVasive also has an instrument in the new Precept system that allows for percutaneous facetectomy. It uses the same incision as the perc screw, and works very well.

      There's your innovation, TSB.

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    4. "Bendini"? REALLY ?!? LOL! !
      (Old joke punchline: "Bendit, He##, I BROKE IT!")

      Who makes this up now, sixteen year olds?

      Anyone recall "Bendmeister" from twenty years ago?

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    5. "Why do osteotomies when you can achieve indirect decompression via XLIF or ALIF? ...Bla Bla Bla..."

      Scott, You just don't get it, do you, Do ya? You don't.

      Hint: Ostoeotomies are for a different purpose. Read up on it.

      They've been using tubes to do this for many years, Nuvasive is embarrassingly late to the party.
      Do yourself a favor and research K. Foley, research perc facet fusions, then realize you a a newbie (despite how many years you've been toiling in the dark) and face the cold hard fact you dont know squat.

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    6. How do you insert a bent rod and rotate? It is a gimmick and cannot achieve true correction. Just taking off the facets on tight curves is not enough to loosen up the spine.

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    7. Can one insert a bent rod and rotate ? yes its done all the time.
      Can it achieve true correction? Yes, sometimes, maybe 75%. Is it the best? No.
      Is just taking the facets off on tight curves enough? Of course not, not always.

      So, then.... Its a minimally invasive gimmick that yields "So so" results with more fuss and possibly less morbidity, possibly more. But if nobody yet GETS it, that is the Purple Way. So now might be the time for you to finally GET IT: MARKETING.

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    8. There is some sucking from the big bulging purple Kool Aid dispenser going on there...9:52.

      Indirect decompression by elevating the disc space isn't nearly the same thing as the direct decompression achieved by osteotomy. These are for different indications. The one area of crossover is in the very elderly population where you may try to lesser morbidity indirect decompression, rather than risking the more aggressive procedure.

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    9. Ryan is that you? Go ahead and try to rotate that rod and watch your perc screw extenders pop right off! Even better train all the residents how to use that widget, so when they are finally in the real world they will know exactly how to use a french bender. im sure hospital will gladly buy one of these since your traditional rod bending techniques are not working.

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    10. Ahh, the Bendmeister. Fond memories. Hey, it worked for Christopher Reeve.

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    11. It isn't the FDA that is stifling innovation in spine. It's scared little reps (like the haters above) that trash anything new and interesting because their company didn't develop it.

      To the idiot above that thinks osteotomies are required on every single long construct PSF (which by the way, does not mean that it has to be a deformity), I would like to ask you this; do you even know why a surgeon does an osteotomy? What is he trying to accomplish by doing this? Have you ever heard the expression, "there is more than one way to skin a cat"?

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    12. .."like the haters above..". ??

      I'm sorry for you that you just identified yourself as an idiot.
      Likely a very, very green one too, to use a term like that.

      Yes, some things in life are worth hating. Or life is just pablum. And just repeating cliche meaningless catch phrases. Your choice, greenhorn. But I'd recommend you grow up, grow some balls, and get a clue.

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    13. The reason they are doing osteotomies is to loosen up the spine so they can get a correction. If they didn't do the osteotomies the screws would pull out during complex maneuvers. I am not hating on perc deformity correction, but it cannot correct a true deformity......I wish it could. It is one thing to deliver a 500mm rod through a perc system, it's another thing to deliver a contoured rod and perform complex maneuvers. It simply is not a game changing innovation.

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    14. +1.

      Young 'uns take notes.

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    15. The original post about Bendini said nothing about correcting long deformities. It said, "the age of percutaneous long construct PSF is now upon us". To say that this new technology is not of value in any way is naive at best, and foolish at worst. Even if it helps JUST ONE patient achieve a better outcome, it should be a welcomed step forward by all.

      You all complain about the lack of innovation in spine, and then you proceed to bash anything new that comes along that may have even the slightest bit of promise. I think you should all look in the mirror and ask yourselves if you really want the spine industry to move forward, or if you would rather things stay the same because that is where feel the most comfortable.

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    16. Ah Bendini.... Original yes. Outdated before launch... Yes. Open cases = YES! Perc = NO! Additional Nuva revenue = NO....

      Bendini is much like a fart in the hand. It is pleasing, useful if properly applied in application, somewhat satisfying, but in the end fruitless in utility...

      Onward & Upward!

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    17. The "...fart in the hand..." analogy is the best post ever! It could be applied to commentary on Bendini, the industry at large, spine surgeons or spine surgery. Whoever wrote that is a complete genius.

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    18. 10:33pm, please tell me how Bendini is "outdated before launch". And it won't work with perc? I have SEEN it work beautifully with perc screws. Don't talk about things you know nothing about.

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  4. TSB - Thanks for saving me an Ambien.

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  5. If you can't get standard procedures approved because of lack of evidence based data, i.e.TLIF, what is the financial motivation for innovation? Unfortunately, that is the world we live in. It's becoming less about patient care and more about show me the money!

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  6. FDA, FDA, FDA. And after all these years still gaping holes in our understanding of the pathophysiological mechanisms that cause pain, scoliosis and all these other phenomena we treat at great cost. You cannot develop more effective treatment if you don't know what caused the problem in the first place. And FDA, FDA, FDA.

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  7. I think endoscopic has come a long way and is very interesting for micro discs and in the future boney work....oh wait.....the reimbursement is crap....another innovative product destroyed by our government. Innovation will be stopped because it adds cost to Obamacare. Look to Europe and Asia to blow by us in the next 10 years. I am going to Amsterdam for Spine Week to see all the products we will never have.

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    1. And smoke me some hash! No piss test at my company!

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    2. Yes...innovation has been killed by the lack of reimbursement for new, and more recently, established procedures. Who is going to invest $30M and 7 years into a PMA, knowing that the best they can hope for is about flat reimbursement relative to what is available now?

      So...what is left to the companies is to develop products by 510(k). To get one of those approved, you have to show FDA how your product is identical to some other product. Used to be, you could show them it performed the same function, but now it's degenerated down to even making comparison tables of sizes offered down to the millimeter. Stray outside that range, and NO APPROVAL FOR YOU! The best part is that your submissions are all reviewed either by 23-year old recent college grads, or 41-year old senior reviewers eyeing up their fat $200k a year government pension. The former will be clueless, the latter overworked and beyond caring, since he's trying to pad his hours in his last year to get a better pension base.

      This is what happens when we keep giving government more power to regulate.

      It will get worse before it gets better.

      Most of your job in the future will be pricing negotiations. It will be about as much fun as being a mortgage broker. Just less rewarding. On occasion, you may be allowed to get near an operating room...but since your stuff is identical to everybody else's stuff, and has been pretty much de-facto standardized by the regulatory process, it won't really matter. You won't be needed, since it's all the same. Most reps won't really know what their stuff is used for anymore, anyhow. What is the point in learning when all you're doing is negotiating pricing anyway?

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    3. Dude, relax. Meet me in Amsterdam.

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    4. Walk towards the red light!

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  8. Where did TSB go? We haven't seen an article from him in well over a month now. Not sure who's writing now but it's pretty easy to tell it's someone else. Not bashing, just curious why the change in authors. New TSB, care to illuminate?

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    1. This is definitely TSB...a month or so ago, not so much. TSB - you're writing is exquisite!

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  9. Signus had a major recall in germany !

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  10. Check this out. nuva isssues once again demonstrating a complete lack of accountability in my opinion.

    http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/detail.cfm?mdrfoi__id=2412912


    Alert your Docs and ORD's. They should be empowered to make appropriate QC/patient care decisions.

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    1. So what? Instruments don't have to be designed to be disassembled. As long as they are properly aerated and sterilization/cleaning validation has been performed, there is no need. In fact, there is a movement to not make instruments come apart, since there is a risk of them not being reassembled properly or pieces being lost.

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    2. There is a sterilization manager at a hospital in the DC area that is on a rampage to force new cleaning requirements for all the companies that do business in her hospital. She wrote that MAUDE report. It's not just NUVA that is getting this kind of heat for instruments that can be disassembled and cleaned from her and that hospital. This lady is also on all kinds of FDA committees related to this issue and they are finalizing the guidance document. Get ready for a longer product development timeline (time to market) due to even more regulations by the FDA.

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    3. Thanks for that information - it's funny how the FDA is always manipulated by those with the loudest voice, not the wisest voice. I wouldn't be surprised if the 0522 poster is the person who filed the complaint!

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    4. Would you want someone else’s sterile tissue debris in your body? Just sayin…

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    5. As long as it is sterile and as long as it meets FDA requirements, it shouldn't matter. The hospital can start telling us how to design our instruments when they start purchasing the sets instead of borrowing them for free.

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    6. 6:34 So I guess your moral compass has no ethics dial.

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    7. 8:31pm, do I need to define the word "sterile" for you? Apparently your mental compass has no common-sense dial.

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    8. Debating with a minion gets you nowhere.
      Signed,
      Mental Compass

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    9. Good one, 10:00AM. You lose, and I win!

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  11. Innovation is on the rise and doing well, look at TSON. Most on this blog lament the lack of innovation but simultaneously bash what's different because they fear it, don't understand it or don't respect it. I love the lack of innovation from most companies in this space because it means that the door is wide open. TSB alluded to the fact that most inhabitants of the spine world are not that bright, talented or visionary. They have been attracted to a gravy traing driven by over-utilization, poor patient selection criteria and dubious technologies and outcomes. Future innovation in spine will come from outside spine- biotech, personalized medicine, social media, health care IT, data monitoring and transmission.

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    1. and inventory tracking!

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  12. "Where Has All The Innovation Gone?"

    I thought this was going to be a TSB introspective piece.

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  13. Roger the "Dodger" and Paul the Teflon Man" better sleep with one eye open, they are coming...

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    1. Understand they are already there. Big Black Suburbans are frequently seen. A lot of questions and sequestered folks for "we can't talk about it" meetings. Can the hammer be dropping or just the setup for the unexplained fall?

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  14. Where are the McLeers of yesteryear?

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  15. 4:40 - You're dead on. The real MM sounds much different and never made so many grammatical errors...who is this imposter?

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  16. Most people on here that complain have no idea about how difficult it is to get a new concept out to market. Most of the time the new idea has to be refined and the process has to be repeated. All the while trying diligently not to fall into the IDE bucket. It takes capital, a good team and perseverance, not to mention a good concept. With the FDA blocking on one side and the lack of appropriate capital on the other it does not make for a good environment. It will take a great idea and great people to overcome the other two missing ingredients. This is a much tougher accomplishment than the casual spine rep or surgeon might think. I commend the individuals that are trying to bring new technologies to market. Try to not judge what you only have a small glimpse of.

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    1. Don't forget the nearly impossible task of gaining reimbursement for your new product adequate to cover the huge R&D up front costs, the ridiculous financial risk, and provide some type of reasonable return to the too rarely rewarded investor.

      TSB blamed the problem on a lack of innovators. Get serious, TSB! New products abounded when there was money in it, yet 99% of those "innovative products" were no better, or often worse, than the stuff already on the market (just more expensive). If you take a close look, the few surviving companies are still alive today (barely alive in many cases) have a significantly higher percentage of technologies that deserve to live. Hint -- the great ones won't be solving a problem that doesn't exist (i.e. "discogenic pain"), nor will they be addressing a problem that has already been basically solved (i.e. interspinous process distraction or vertebropasty). The great ones will be addressing an under-recognized, under-treated, or over-treated problem for patients. Common theme here -- look for products that truly solve a big PROBLEM for PATIENTS. Sheesh.

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  17. New ways to provide healthcare will be the innovation. The market will outmaneuver Obamacare. Medical tourism will grow and provide some solutions to access newer technologies.

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  18. Here, here...well said.

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  19. "Here, here...well said." I.E. Mar 9, 2012 08:04 AM

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  20. The real problem is that in the US, innovation = litigation. Look at Infuse, Charite, MOM hips. These were products with real promise, developed at great cost, and will now cost the companies billions more in the courtrooms of America.

    With the risks so great, its understandable that most companies stick to tried and true technology. We have become a nation that punishes undesired outcomes so brutally - fines, lawsuits, even criminal prosecution, that it should be clear why no one wants to innovate.

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  21. No innovation? You obviously haven't seen LANX new lateral system! Now that is going to be a game changer! Look out purple people eaters! We're coming to master this market!

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    1. that is so great! It's awesome that you will be able to master this market. Nothing like doing your first couple hundred cases on this with some new Surgeons! Just don't tell the Surgeons that you really have no clue on how to do the cases from a technical standpoint. Just do your best to stand in the corner and look approving at the c-arm images. "Sure Doc, that's exactly where you want that instrument!" If, the Surgeon actually does need help, you could always just pull out your technique guide and point to the pictures.

      I wish you the best in your endeavors.

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    2. I think you got trolled. No way that could have been sincere.

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    3. I saw Lanx's new lateral system a few days ago. The retractor is just a cheap looking knock-off of NuVasive's last generation retractor. Nothing special.

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    4. Hmm... Aren't lateral systems now all the same? Shame Lanx took all of Nuvasive's doctors, key sales reps, engineers, marketing directors, etc., etc., etc. Just as Nuva stole them from others in the industry but now Nuva is upset, albeit they have no non-compete's, which Nuva defended all the stealing originally......

      Get this. Nuva is old and tired with Alex's decree of no more stock options, except for executives.... Lanx is the new Nuva with stock options and an upside...

      Party Over. Stop complaining... Just a bunch of lawyers making money...

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    5. Lanx is the new Globus, not NuVasive.

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    6. 10:28pm, you comment makes no sense whatsoever. Are you a high school drop-out or what?

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  22. "We have met the enemy... and he is us"

    Sad but true. Spine is done. can anyone say < $2400.00 one level lumbar constructs? Already happening in some places. Like a slow leaking bicycle tire or the housing market, this market still has a couple of years to fully shakeout. Unfortunately, the ultimate survivors may look around and ask themselves- was it worth staying in this market?. RUN!!

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    1. Aww, poor little parasite sales rep. Can't keep jacking up prices so you can continue to be a non value added member of society. You've all been squeezing manufaturers for over a decade to lower cost while at the same time increasing your profit margins. Now it's coming back at you, and you can't hang. Go back to the used car lot, it's where you belong.

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  23. Yes, all ye doom and gloom snake charmers, please leave this industry. Take your negativity and hang dog faces and go sale insurance.
    Here's a history lesson. The Total Joint industry went through the same trends in the early 1990s that we are now seeing today. Continued pressure and entrance of "me too companies". Reduced average selling price due to hospital contracts, captivated pricing and hospital buying groups. Total joints also had their share of product failures in the forms of: DePuys Hylamer, Zimmer's Carbon Poly, Zimmer's nitride coated titanium implants, Howmedica's (now Stryker) heat treated/polished poly... And the list goes on.
    The Total Joint industry didn't collapse and the great reps of the 1990s are still working in a very lucrative and fulfilling industry.
    My point is this, mediocre reps and companies come and go. Great companies and reps adapt and overcome adversities and find ways to be of value to their customers.
    So yes, I'm hoping the weak will leave this industry so those who are the best stay and help pull this industry through the current era of problems and make it stronger to prepare for future success.

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    1. James there's a difference in total joints in that you have 5 players vs 100 ankle bitters (spine)driving "the bar" lower and lower to sell something....anything....pioneer in North Carolina...for ex)

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    2. My name is Steve so don't give credit to someone else. Who is Pioneer?

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    3. Pioneer biologics in NC? what are they doing?

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    4. In response to 10:33A
      Go to the AAOS website and look at the vendors listed for the recent meeting in San Fran.
      Excluding foriegn companies located in Asia or those without FDA clearance there are:
      116 companies selling competitive products ranging from Total Joints, trauma products, soft goods and biomaterials.
      68 of those companies sell total joints or trauma products alone.
      Those of us in the industry wish there were only 5 companies to compete against.

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    5. Great post 8:18.
      Future will follow Ortho- Ortho also dealt with the flooding of companies on the market, I remember counting about 100 or so.
      Consolidation will occur, and multilevel crossdivisional contracts will dominate the market.
      Dual contracting with compliance will be pushed through to save the hospital money and still alow reps to make a living and service these accounts.
      Cervical and straight forward lumbar cases will not need a rep in the room the entire time. One rep will be able to service multiple cases in a day without attending the entire case, this will become the norm(Less Reps needed). The ones who make it will be rewarded.
      The big three will dominate because of their massive and diverse portfolios(lets not kid ourselves: J&J 64 billion, Medtronic 12-14 billion, Stryker 8-10 billion in revenue). There is serious contracting power here regardless of what one thinks of the spine lines.
      The K2Ms, Globus, Nuvasive, Lanx, etc... will eventually round out the big three portfolios. These companies really have a refreshing spine line, however, I don't think they can make it due to hospitals taking away the surgeon's decision making power. Not to mention they have nothing besides spine.
      In the end: less companies, less reps, greater loyalty.

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    6. So riddle me this...
      If so much consolidation of total joint companies and cross-divisional contracts has occurred over the past 2 decades, why are there still 68 individual companies competing within this segment?
      There are 7 major players with full product lines in total joints - Stryker, Zimmer, DePuy, Richards, Biomet, Wright Medical and Exactech. There are another 61 niche players with a variable array of implants competing against the full line players.
      There are 9 major players with full product lines in spine - Medtronic, DePuy/Synthes, Stryker, NuVasive, Globus, Zimmer Spine, K2M, EBI (Biomet)and Alphatec. There are another 100 or so that again only have a piece here and there (cervical plates out the wazoo).
      How's the pull through been working for Zimmer or Biomet or even Medtronic (market share has steadily declined over the past 5 years)? NOT TO GOOD it would seem.
      While your statement is meant to show similarities between the total joint industry and where spine is and will be going tomorrow, let's call it for what it is. Your statement is nothing more than an attempt to scare those working for the smaller companies, or my guess, to try and persuade through fear anyone working for a large spine company to not leave. Lord knows the blood letting has been atrocious of the past 5 years. Because according to you, the large companies will gobble up all the small companies.
      By large, hospitals have not taken away the surgeon's decision making power with total joints which is a much more mature industry than spine. I would suggest a strong dose of true reflection instead of your not so subliminal message of fear.
      Synthes was a huge company but their size didn't protect them. At least don't be hypocritical and admit that a buyout can occur no matter how small or large the company happens to be.

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    7. And to add to your comment, 2:39pm, who would have ever thought that Medtronic would ever consider selling off its spine division? Whether it's true or not, just the simple fact that it is somewhat believable says a lot about how far the company has fallen.

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  24. Agree 8:18 am and you make a great case for the recon business. But i am not saying leave the industry, but it will be hard to convince me that spine will end up like joints. Everyone always wants to equate Spine to Recon. News Flash - it's not the same: 1) there were never > 100 joint companies. 2) there is actually engineering behind joints - a screw vs an articulating implant? Winner? Joints!! 3)Joints actually solve a patients need, whereas most spine procedures have a less than stellar success rate. 4) Reimbursement is not as volatile for Recon as for spine. God knows where it is going to end up with spine.

    Finally, patients recommend having a recon procedure to their friends in Del boca vista, phase II. Doesn't happen this way for spine..

    Remember this exchange when someone moves your cheese

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  25. 8:18....
    You are spot-on and I also am ready for the weak that constantly complain, bitch and belly-ache leave this industry and quit disgracing it with your lack of success and ignorance of what you are supposed to be selling!
    I for one am having more success now than ever in this industry and it is because I get up every morning, go to work, do my job, work hard and do what my customers ask of me and even more enjoy what I am doing. So pleeaaasssseeee, you morons complaining and spreading doom for this industry please go get another job! TSB, this includes you and your supposed esteem writers. LMAO you lazy bums!

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  26. 9:24 you are crazy if you don't think it's heading in a bad direction...Nothing wrong with be mad at working twice as hard for half the money....$2400 one level is bad...but considering how these nazi hospital hunger for more and more discounts every year with no floor!!!!!!! In sight!!!!!! When will the fing price cutting stop???? I don't want to do a 3 hour plif for 250 bucks.... But you go right ahead you go getter...and I completely agree with many of these posts on the govt and FDA fing everything up...look at our damn currency! We have lost more then half our purchasing power in the last ten years alone...Obama and his cronies like bernake(piece of crap) are printing away our futures!

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    1. Oh yea.. Good point. 3 joints before lunch vs a 1 level that hopefully finishes before 1pm

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    2. Most good joint guys have 2 rooms and can do 5-6 by noonish FYI... I had a guy 8 years ago that would do 7-8 and be done by 3pm 3 days a week and this is super common now vs 1-2 plifs plus most hospitals understand the drive through/total joint times and commit more and better turnover staff...while we wait an 1.5 hours at my hospital in btw cases...

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    3. I have a Neuro that gets two rooms and completes between 6 and 8 cases on those days. It is typically 3 to 4 cervicals, 1 lumbar fusion and 1 or 2 lumbar decompressions with bone graft. Usually a $35 - 40K day. Funny how's those who are not successful only see the negative and complain constantly.
      The thing is, there are at least two other competitive reps in my area that experience the same surgical volume in a single day. It's not magic.

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    4. Your missing the point. Three years ago you would have billed 55 to 60 k and a year from now you may be billing 20 k. It's not being being negative to see the market is under pressure.

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    5. 5:21 it's called luck you prick...come to my hospital and get 500 dollars for those plates you sell and turn your 40k day to16k...if you where in a mkt that lowers pricing yearly... And breaks 3 year contracts every 8-12 months wanting cheaper pricing you wouldn't be boasting.

      Delete
    6. 8:21pm, it isn't luck. If you have strong enough relationships with your docs (that's assuming that you have docs), they will go to bat for you when the hospital tries to strong-arm you into a new contract with greater discounts. Sure, sometimes you will still have to compromise with the hospital to keep everyone happy, but you won't have to do it every year. Another way to maintain your pricing is to work for a company that has technology that hasn't been completely commoditized. Of course, your run of the mill cervical plate is going to get hammered on pricing. There's about 150 of those things on the market, if not more.

      Delete
    7. Hey 8:21PM
      Good luck is worthless without the preparation to take advantage of it.

      My guess is you have never been well prepared to take advantage of opportunities that have come your way since you are so busy being bitter and wallowing in self-pity. I'm sure your cynical outlook has always been your biggest wall to climb.

      Delete
    8. You guys are both morons!!! Don't you get it? Different hospitals pay different. It's a damn fact that some guys do 1.3mill and would do 2.9mill in other hospitals. When you are prepared and bust your ass for pennies it gets old. Your dirt is your dirt. And the comments about pricing shows your ignorance...yes there are some scenarios where relationships help and some where you are SOL- and I have 2 neuros that are my best friends. Doesn't matter you ignorant pricks.

      Delete
    9. So you only work in one hospital or one system that has you by the short hairs.

      Who's the ignorant prick? ;)

      Delete
    10. LOL!! 7:26pm has two neurosurgeons as best friends! I can't even remember the last time that I actually classified my friends into groups like "best friends" and "super best friends for life". That's funny.

      Anyway, my advice to you, 7:26pm, is to get a new job outside of spine if you're really that sick of "busting your ass for pennies". The whole "life isn't fair" and the "world owes me high paying job because I have a degree in psychology" attitude doesn't work out too well in this biz. Sorry, kitten.

      Sincerely,
      Mr. Ignorant Prick

      Delete
    11. reminds me of my favorite Reggae tune...

      I smoked two joints before I smoked two joints, then i smoked two more....

      --friend of Ignorant Prick, jr.

      Delete
  27. Wenzel Spine and Mr. Jon Luedke are a joke. Don't trust this company or the integrity of the under qualified Luedke. Several distributors are not being paid full commissions and many have had surgeons taken from them and given to other distributors. It's just a matter of time before he gets canned and goes belly up.

    Cheers,

    ReplyDelete
    Replies
    1. I concur about Mr. Luedke. One day he works in marketing for Raymedica, then here he is Executive VP of Whatever. Not exactly the most experienced field manager I have ever worked with

      Delete
    2. Someone is actually that Ti VariLift? Ancient

      Delete
  28. Wenzel is worthless, lead by poor management and lack of integrity. Distributors who want to paid and have protected territories, stay clear!

    ReplyDelete
    Replies
    1. Enough Wenzel bashing, they are an irrelevant entity. Move on.

      Delete
    2. Anonymous character assassinations are cowardly. I'd like to see the moderator strike any post disparaging an individual's character unless it is not anonymous. It would be a fast easy way to make this a better forum.

      Delete
    3. Good idea Jon

      Delete
    4. Jon Jon .....how many distributors did you screw over today?

      Delete
  29. Globus Caliber, I heard is kicking some butt....I heard they also have some kyphoplasty system now...

    ReplyDelete
    Replies
    1. yeah..everyone wants in on kyphoplasty now, especially the docs. they cant wait!

      ps wonder how the globus distributors like having that not in their bags?

      Delete
    2. Unlike the SpineWave product, you still have to size. 2nd-rate product, at least it wasn't a Synthes ripoff for once.

      Delete
    3. First, you don't have to size. Second, how many footprints does spinewave have? Can shims be removed after being injected?

      Delete
    4. 7:20: different sizes mean thy have to size. What the hell is a shim? Learn your business knuclehead!

      Delete
  30. ZIMMER has 4 products launching in April all game changers!

    ReplyDelete
    Replies
    1. Zimmer is a joke. Game changer? Really!?! Most of their sales force can't sell their way out of a wet paper bag! It would really be a game changer if they fired the entire sales force and replaced it with an 800 number. That's game changing.

      Delete
    2. I work for Zimmer, are you sure we're launching 4 products in April? If so, what are they b/c that's news to me.

      Delete
    3. Oh PLEASE enlighten us of these GAME CHANGERS! bahhahahahwhahahawhahaha....

      The only game changing is HOW NOT TO RUN A SPINE DIVISION. PERIOD....

      Delete
    4. Zimmer gets the gold for ineptness, Stryker's silver. Who's bronze?

      Delete
  31. Hi TSB readers have Video for the DTRAX cervical system, clinical trial was done in the Philippines. DTRAX has a distribution site here, Please redirect your page to:
    http://spineblogger.blogspot.com/2011/08/dtrax-will-it-make-difference.html

    if your interested in viewing the video. Pardon about the language used but would be happy in translating it.

    ReplyDelete
    Replies
    1. Where is DTRAX manufactured?

      Enough said

      Delete
    2. If I am not mistaken DTRAX is made in the USA, they did conduct a clinical study here in the Philippines since DTRAX is not FDA approved in the US (I don't know the status now if it is FDA approved already). Surgery was done by Filipino doctors, under supervision of doctors in the US, the surgery was done using the visual guidance of Cardiac Cath Lab. at Manila Doctors Hospital, Two of the top Philippine Spine Doctors led the surgery.

      Delete
  32. DTRAX Posterior cervical spine surgery

    http://www.youtube.com/watch?v=ftTWiyioyw4
    http://www.youtube.com/watch?v=vFDjN4a28rQ
    http://www.youtube.com/watch?v=QfdNntJwcCA

    ReplyDelete
    Replies
    1. While it looks simple and straightforward, not sure folks are going to be entirely comfortable with a: apparently relying on indirect decompression in the cervical spine and b: potentially increasing kyphosis which could create issues at the neighboring segments. Please correct me if I'm mistaken, but that's the impression I get from looking at it.

      Delete
    2. Thanks for that insight, I'm not a doctor but this a good thought, as of now no new updates of those patients that have been implanted w/ the device. or may be guys from DTRAX just don't want us to know whats the status of those patients.

      Delete
  33. Thoughts on the Coflex product from Paradigm? Gaining some traction in my market. Any word when they are getting their PMA approval?

    ReplyDelete
    Replies
    1. Coflex is about five years late. It would have been grand!

      Delete
    2. Agreed. There is a ton of competition in this space and the big boys will dominate.

      Also there is a lot of question regarding efficacy of interspinous implants. Many surgeons don't think that they provide any real benefit.

      Delete
    3. supposedly coflex data is superior to pedicle screws and shows adjacent level revisions. that would attack interspinous fusion and all fusion for that matter.

      Delete
  34. Nuvasive is pulliung all their Precept sets from the market. What's going on? Heard the heads were pulling off the screw?

    ReplyDelete
    Replies
    1. 4:36pm,

      It would be pretty tough to pull the Precept system from the market when it hasn't even been officially launched yet. It's still in beta testing, and the screws are just fine.

      How's Lanx working out for ya'? Sounds like you're starting to get nervous Haha...

      Delete
    2. Actually the screws are not just fine. I am actually very good friends with the Nuvasive distributor in my area and he has had numerous issues with heads coming off the screws. I am not saying its happening all over the place but in my area it is indeed happening.

      Stones in glass house man, be careful.

      Delete
    3. Hey Mr. Purple Juice Chugger 7:09... Get this straight. The Precept went into "beta" launch... Yes that means MANY sets.

      OOOOOPPPPSSSSS.... The heads indeed are popping off... Get YOUR facts straight or are you just another peon in the field... yes u r. Going "Just Fine" huh? Well, lets see what the FDA will say about this one as the PPS head issues were just a close one now with this it should quantify a..... wait for it...... keep waiting...... oh hell... It is a RECALL!!!!

      You cannot justify pulling just certain sets to anyone but the DESIGN surgeons and no one else without a RECALL.... Damn. Those revenues were looking soooooo damn good too. Well... Sorry if MR. Kitty is out of the bag... Good you have a bunch of marketing guys running development now... I am sure Dennis and Russel and Pat will solve this head issue...

      Onward & Upward!

      Delete
    4. 10:12pm, the comments that you make on this site--even if you post as "anonymous"--can be tracked back to you with relative ease (your computer's IP address is sent to blogspot each time you comment). Your claims are false, and your intent is clearly to cause damage to NuVasive's brand and image. This is called "libel". Is your hatred for your former employer really worth being sued?

      Delete
    5. 10:12pm, do you honestly believe that the dozens of people involved in the development of the Precept system (engineers, product managers, surgeons, reps, etc...) would actually risk going to jail just to cover-up a potential design flaw discovered during beta testing? It's not like there are millions of patients walking around out there with these screws in their backs. If there was a problem with the screws, NuVasive would just recall the system and fix the problem. It's as simple as that.

      Delete
    6. You can always hide your IP address.

      Ref LulzSec

      Delete
    7. Millions of people with Nuva screws??? That's funny

      Delete
  35. What can anybody tell e abot SpineView and their motorized discectomey devices?

    ReplyDelete
    Replies
    1. It looks similar to Arthrocares Nucleoplasty and Stryker's dekompressor. It was a fad 8 years ago but the results were not great. The endoscopic product will probably be more promising.

      Delete
    2. They have a disc prep device that some of my docs love on their tlifs.

      Delete
    3. Mark Checci enough said! Bum!

      Delete
  36. 100+ comments and nothing innovative to list. Any thoughts on Growth Modulation or new Biologics?

    ReplyDelete
  37. Oh, I know... let me come on a blog that's in its death-spiral and post some info about the innovative products I'm developing so that Nuvasive or Globus can steal another device and try to make it their own. Sure, that's a good idea.

    Which company bought this blog from MM again? It must be one of the aforementioned. Are you really that short on good ideas that you want to ask an audience of mostly out of the loop sales people to share what little has been shared with them? Maybe the tool looking for high-margin biologics will help you out.

    ReplyDelete
  38. Can anyone share insight on Integra Spine or how they are perceived in the marketplace?

    ReplyDelete
    Replies
    1. Their Regional Manager in Chicago is flipping most of his and wife's relationships to the Koreans. Koreans are paying Lenny big $$$$ and it's way under managements radar screen.

      Go get'em Lenny...

      Delete
    2. I have a relationship with my neighbor I'd like to sell to the Koreans. Can I get big $$$$ for it?

      Delete
    3. Im so rone-ry...

      Kim Jong Il

      Delete
    4. I hear they are in a growth phase.

      Delete
  39. I think there are many such institutes which are carrying out research in order to fight against diseases. I'm sure there would be evolution in this field as well. minimally invasive spine surgery nj

    ReplyDelete
  40. The only people who honestly think that the FDA tightening restrictions on implants is a bad thing are those people who make their living off of the implants. If any of you were able to view the issue objectively you'd realize that for decades now the spine industry has been releasing questionable product after questionable product, charging billions of dollars to the American health system with little to no evidence that any of it is producing better clinical results.

    Products flare up when doctors become excited about them until after a few years patient outcomes are not improved, and they die off in popularity. Now the government is mandating that instead of the industry testing its products out on the public at large while charging out the nose for it, the implant manufacturers should be running limited clinical trials to determine if the therapy is actually beneficial.

    If you legitimately think you have a worthy new technology that will help patients, do the testing and prove it. Otherwise, you are just trying to make a buck selling very expensive snake oil, and you are hurting the country in the process.

    ReplyDelete
    Replies
    1. 9:48 -- Who, us? Naww...

      btw, check out my new biologic. Minimally manipulated tissue, so no FDA required. We tested it in 4 rats in Atlanta. Those little blobs near their spines. New bone. Promise. How about you stick this into your next few ACDF's & let's see how it goes, doc?

      Clinical trials are for suckers with high-risk stuff like cervical plates and PEEK cages. What would *we* do one of those for???

      mua-ha-ha.

      ps - dropped off some donuts for the staff. Cheerio.

      Delete
    2. Lemme guess...


      Osteocell Plus?

      OUTSTANDING BOGUS SALE! Way to go, Cheat Ya's ! You'll be long gone before the docs have to revise, eh? Mua-ha-ha!

      Delete
    3. I bet Osteocel has more peer reviewed white papers supporting its efficacy in fusion than whatever you are carrying 2:23...

      Delete
    4. Osteocel is smoke and mirrors. About those peer reviewed white papers..it's amazing how many of the authors are paid consultants for NUVA. Just amazaming! It's less processed allograft bone..dead tissue. They charge a ridiculous price for crap! Smoke and mirrors my purple friend.

      Delete
    5. Actually a lot of the best data is from Trinity (Blackstone), so those authors haven't gotten a dime from NuVasive. Quit talking out of your ass. And its not dead bone as its not terminally sterilized. Also, name a study where the investigators weren't compensated in some form. Look at Infuse, for god's sake.

      Delete
    6. .."more peer reviewed white papers...". ??? You can't be serious?

      Here's a good explanation : "Just to set the record straight, white papers are marketing publications that serve to explain the technology used in a product. Peer-reviewed publications are scientific articles that must be read and accepted by other scientists. "

      Nobody's peer reviewed those white papers... They are thrown out there by paid consultants... Usually lower than the lowest level of scientific evidence.
      Take them all with healthy scepticism.

      Delete
    7. ..." and its not dead bone as its not terminally sterilized...". Wow, again, serious?

      Some little purple trainee needs to back to training to learn more.

      My dog in the backyard is chewing on a rib bone he's had for a week- its not been terminally sterilized either. You think its not dead bone?

      ( you are confused by what is actually affected by sterilization techniques... Go back and ask your product manager...)

      Delete
    8. People have a hard time believing the science behind Osteocel because a lot of the processes used to develop it are proprietary and not disclosed to the public.

      Delete
    9. Exactly 100% wrong.

      The reason people in the know dont believe is because they DO understand the processes used to develop it. They are not diclosed to the public because they would reveal it to be what it is...
      a smoke and mirrors marketing gimmick sliding through current FDA loopholes. What level is the evidence, again?

      Hey, people like smoke and mirrors... Even docs go see David Copperfield. Human nature. Everyone wants to suspend reason and hope for something...anything.. that might work, and ignore inconsistencies. For a while until the next one.

      Delete
    10. You can say whatever you want 10:18pm. It doesn't make a difference to my docs. They would not continue to use Osteocel for more than two years now if it wasn't working. The fusion rates have been comparable to, if not better than, historical fusion rates with autograft. It achieves this without the complications associated with ICBG and Infuse.

      Delete
    11. To the original poster's point, sorry, but your faith is completely misplaced. The FDA is regulating the industry so much that doctors are relying on the FDA to decide if a product is safe and effective. Who better to make that decision, one government agency, or tens of thousands of specialists whose careers are ruined if they make a bad product decision? And manufacturers should worry that their products are safe and effective so they can a: sell them, b: protect their reputation, and c: avoid getting the hell sued out of them. (The latter of which is now impossible because if the FDA blessed it, that affords the manufacturer some protection.)

      To get what you want, which is lower prices, better outcomes, and more accountability, reduce the role of the FDA, hold manufacturers accountable for the products they sell and doctors accountable for what they choose to use, and make doctors professionally responsible for minimizing costs, as is now the trend. Amping up the role of the FDA is absolutely not the answer.

      Delete
  41. Where is the innovative blog or comments? Seems much like the industry a bunch of tired old recycled subjects, whining and insulting.

    ReplyDelete
  42. Any thoughts on today's OIG Advisory Opinion regarding GPOs?

    ReplyDelete
    Replies
    1. Please provide a link to the story. Can't find anything about it.

      Delete
    2. http://oig.hhs.gov/fraud/docs/advisoryopinions/2012/AdvOpn12-01.pdf

      Delete
    3. Any idea who this might be?

      Delete
    4. The only thing I like about this, is that POD's are going to be obsolete...If the savings that hospitals are supposedly going to reap, ultimately reach the consumer, that would be great, but I doubt that would happen. All of the savings will be ciphened off by the hospitals, who will pay the docs, and by the insurance companies, as they lower reimbursement due to the knowledge that hospitals are getting better pricing. I hate the idea that the government, via regulation and not legislation, is involved. I guess they sort of have to be, but this ruling looks like it will have no benefit to the patient, or consumer. If the Federal Government were really interested in lowering the cost of healthcare, they would allow arrangements like this, and deregulate the insurance industry and rely on consumer demand to force these savings to benefit the consumer. If the insurance companies had to compete for your business, these types of arrangements would ultimately drive prices down, as insurance companies would see this as an opportunity to attract new customers via lower rates. Too bad our Regulator in Chief and his minions only care about control, and despise the free market.

      Delete
    5. Oops, I meant "siphoned." Had to get that in there before the spelling police arrived...

      Delete
    6. Sounds like Cedars in Los Angeles. They are working on some sort of GPO with a few hospitals.

      Delete
  43. US IP law requires disclosure to secure limited monopoly rights.

    The manufacturing process for Osteocel was disclosed in adequate detail in the Osiris/NUVA patents to establish process patent infringement on behalf of Trinity/MTF.

    The results of the infringement case are public record previously discussed on this board, and all granted patents are public record you can search, download, and (maybe even) read.

    ReplyDelete
  44. Pharma Reps, exciting new opportunities!! Synpuy

    ReplyDelete
  45. What about nucleus replacement and annular repair?

    ReplyDelete
  46. TSB you suck. No new posts in 10 days. This blog sucks.

    ReplyDelete
    Replies
    1. start your own you whiny dipshit.

      Delete
  47. I have heard several spine surgeons swear up and down about Amedica's ceramic spacers. They claim to achieve bone attachment... If that is true, why hasn't this ceramic technology become more prominent in the marketplace?

    ReplyDelete
    Replies
    1. Because their board of directors has raised and blown $150 million, and never brought in a top-flight management team. All retreads and castoffs. Next question?

      Delete
  48. Getting back to innovation, anyone seen Medtronic's new reducers and VCM system? Damn good!

    ReplyDelete
    Replies
    1. It's a joke. Just a knock off of K2M crickets and derotation system that has been around for years. And Medtronic's gear isn't nearly as effective at direct vertebral rotation or manipulation.

      Delete
    2. Is Medtronic still around? Didn't Kyphon gobble them up?

      Delete
    3. K2M, Glbous, NuVasive all have the ability to derotate and reduce. Medtronic's VCM system is not anything new or innovative, just another deformity system. Although, it is nice to see a deformity system being developed by Surgeons who actually see a lot of Pedaetric or Adolescent Deformity (Unlike Globus). If I was to develop a deformity system Larry Lenke is most definitely who I would talk to. He is a stud. Ol' X-Ray eyes!

      Delete
    4. Pedaetric = Paediatric

      Delete
  49. My surgeon likes to use the Medtronic MIS system. Which competitive system out there most resembles the MDT system?

    ReplyDelete
  50. K2M Serengeti. Simple, easy, limited fluoro and limited assholes in the sales force. Except the VP. He's about as smart and dynamic as a box of rocks! A dial tone has more to offer.

    ReplyDelete
    Replies
    1. What about Spineart MIS system?

      Delete
    2. Call up ol' Trent, he'll fix you right up. Give you a free butterfly tie-tac to boot.

      Delete
    3. The SpineArt system is actually innovative. I am amazed no one created a K-wireless before they did.

      Delete
    4. Integra Spine has an innovative MIS system. Surgeons that do many MIS cases seem to like it.

      Delete
  51. You must be referring to the new AVP on the East Coast.

    ReplyDelete
    Replies
    1. You mean half the East Coast. The other half refused to work for him.

      Delete
  52. I think he is speaking about Brad Coy, AVP Central

    ReplyDelete
  53. I'm amazed at how many times I see Brad Coy's name on this sight, he must have pissed off someone pretty damn good.

    ReplyDelete
  54. SpineArt is about as innovative as this blog has become. Uncle. I cry uncle.

    ReplyDelete
  55. This blog is like the spine market, a decaying corpse.

    ReplyDelete
  56. In the past few months this whole site has turned into a steaming pile. I would get more education on life reading my girlfriend's People Magazine. Or US Weekly, Natl Enquirer, etc. in the grocery store line.

    Pile.

    ReplyDelete
    Replies
    1. Then do not read it idiot

      Delete
  57. How about someone innovate a new blog?

    ReplyDelete
  58. Amybody known of an odointoid screw system besides Aesculap that is available to distributors.

    ReplyDelete
  59. Apparently the innovation has gone the same place as creativity on this blog....

    ReplyDelete
  60. Looking for Odontoid/Dens screw system besides Aesculap that is available for distributors to carry. Can anybody help?

    ReplyDelete
    Replies
    1. hmm would a small, partially threaded, cannulated facet screw work?

      Delete
    2. I'm not the original poster, but I think the key would be the angled retractor blades in the set. Otherwise a lot of screw options have been published for the technique. One big screw vs two small, lag vs non-lagging, cannulated vs non, etc. I imagine most docs are using one, cannulated lag screw, but I don't know.

      Delete
  61. Let's start a new blog. Anyone hear that Medtronic Spine is having layoffs? We work hard for the company and now we are facing this. They need to start with the Kyphon rep in Oklahoma who was on 2 payrolls at the same time with his managers approval. Whats up with that?

    ReplyDelete
    Replies
    1. If you are a strong rep leave before they can you or crush your commission rates. The big companies are going towards pharma reps over the next 5 years.

      Delete
    2. Other way around. If you are a strong rep stay, keep working hard, and see what the future holds for you. If you're good, the other options elsewhere don't go away, but chances are the people who know you best will open new better opportunities for you. This isn't the teachers union where tenure dictates who gets the rewards. This business is a meritocracy, and if you're good, you've got the power.

      Delete
    3. A positive post. Spoken by someone who seems to get it but very reminiscent of a leadership 101 book. Probably a trainer.
      The problem is not the solid rep, it is the poor leadership. I have watched so much talent leave in the past 5 years and mostly due to the horrible leadership. The company has been on a loosing track and continues to "donate share". The culture of entitlement is prolific. You mention this is not the teachers union and tenure does not exist. I beg to differ. The ranks are flush with tenured, but compliant, managers with little to no value and clearly no leadership. The real leaders spoke up and then they were gone. Once healthy and passionate conference calls became silent. Those who did not comply were disloyal. What that leaves is a loosing culture. A team of squatters well versed in survival and self preservation. Keep your head down low and don't take chances.
      Your lively hood in these hands is a dangerous place to be whether you're the solid rep or not you will find that they do not have your back, especially when you need them the most. There is no more developing of people. You're fighting the two front battle, in the field and in your own home.
      This is a meritocracy and if you're good, you do have the power. So use it to your advantage while you still can and find somewhere were they will appreciate you and you can make a difference. MDT has made their choice and set the course for the future. Think pharma. If your good then you don't have to put up with it and that will leave all the rest.

      Delete
  62. 4:57. Fair enough, but you're speaking about MDT specifically, and I was speaking about going through transitions or layoffs at a big company in general.

    ReplyDelete