Wednesday, April 18, 2012

Tell Me Something Good

As Rufus and Chaka Khan once sang;

You ain't got no kind of feeling inside
I got something that will sure 'nuff set your stuff on fire
You refuse to put anything before your pride
I got something that will knock all your pride aside

Tell me something good, tell me, tell me.....................

TSB thought it would be interesting to table a forum whereby all of our readers can contribute their knowledge and expertise in response to our famous commentator whom continues to bad mouth TSB and this blog.  Let's just call it something creative like, well, The Spine Technology Summit. You don't have to fill out any forms, or pay an entry fee, nor do you have to wear a monkey suit and sit through a mediocre dinner listening to the state of the union.  As for our famous commentator, well, let's just say that for someone that criticizes TSB, this dude never logs off of this site. Could it be an addiction to their predilection as to where they get their news?  So after attending AANS, what is it that is so innovative?  Don't tell TSB, tell our readers something good. Tell them what is so great about this industry? 

In order to brighten up our famous commentators day, let's take a serious look at the state of our industry.  Based on Biomets and DePuy's recent earning reports, spine is down. Even the analysts with their crystal balls, are modifying their forecasts. Why? Because the industry is a microcosm of a greater phenomenon. As markets get saturated with more products that really aren't improving the outcomes for patients, we have commoditized ourselves to near death in terms of real growth. The industry has become its own adversary.  TSB knows someone will blame the POTUS for the current state of affairs in healthcare. But what products are making a difference, and what company is separating itself from the rest of the pack?  I would venture to say not one company can claim the throne, unless one looks at pure marketshare.  If that's how we measure success, then Medtronic is the hands down winner.  The reality is that this is a tremendous business to be in considering the angst surrounding capped pricing. The margins are still north of 60% and that's taking general sales and administrative costs into account. So why aren't we that great anymore.

The industry and its leaders have become one-dimensional. What have any of your so-called leaders done to provide you with a competitive advantage in the field? NADA. Spare the reader how innovative your company is. Without consulting agreements, a majority of you would be out on the street selling copiers. The art of the deal, is the deal itself. The fact that you have to pay surgeons to use your product tells you how the industry's wounds are self-inflicted. We talk about nefarious dealing in international markets, yet we really aren't that different. We just do a better job of hiding it. How do you run a successful company when you have multiple interests outside the company? Name one CEO today, that is innovative and thought provoking? Dvorak? Paul? Lukianov? Orsinger? Vater? Binder? This industry spends too much time worrying about the analysts and the Street.  Don't believe it.  Remember how nervous John Brown and Dave Simpson use to get when the analysts were coming to the  booth at NASS or AAOS? Maybe it's time that the industry return to the basics, or maybe, the industry is too far gone? Territories have been cut. Downsizing has occurred. Some companies are so top heavy in management that they spend more time in meetings, than they do actually doing something constructive. Engineering can't coexist with sales and marketing, and sales and marketing can't get the necessary tools to get the job done because everyone is worried about cutting corners so that they can provide the shareholders with an acceptable return on investment.  Ever try to increase sales without the necessary tools?  You can't make beef wellington out of BS.

The markets will eventually stabilize themselves. The result will be less money for everyone, meaning   middle management, sales, and even surgeons. Because in the larger picture, you are the bottom of the pyramid whether you like it or not. Until people realize that its 2012 and not 2007 nothing will change.  So old wise one, tell our readers what is so great about this industry and what does the future hold?

78 comments:

  1. ok first off, you do nothing but focus on what is bad in the world of the business and how it effects "us" all. Like we are the chosen few? We, meaning "us" (well most of us) chose to be in this business. If we don't like the way things are shaping up or headed, we need to maybe think about a career change. Something more honorable, like say, selling vacuums door to door? Or better yet, for those of you that are direct reps and can't stand to see the lose of your benefits, Starbucks is always looking for a few bright Super Stars. Until then, shut up and do the job that we are paid pretty well to do. Yes, its no longer 2007 its 2012 (so you got something right for once). Times have changed, so has the sales rep.
    You seem to only take notice of how "we or us" are effected instead of how a lot of the this bullshit technology, as you like to think it maybe, has helped many of people improve their lives and some of it may have even saved their lives. Wasn't this supposed to be about helping the patient? Or was it about how we have all suffered from the down turn of this business and the economy? Gee inlighten me O so enlighted one TSB?
    You blow smoke up in the air trying to be the "Old' Wise One" but you sound more like the ones you write about...a broke down, beaten, washed up ex executive that just "couldn't take it anymore".
    So why your sitting there trying to come up with some cleaver come back or some stupid lyric to overshadow your shallow mind and insecurities, I am off to make a sales call. See TSB, some of us still enjoy waking up to the challenge of this business.

    PS...yes I do log on to this “blog” or hot air balloon you call a blog is that the daily funnies just aren't has cleaver and entertaining as you!

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    Replies
    1. Easy Aristotle!

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    2. Commodus: Rise. Rise.
      Commodus: Your fame is well deserved, Spaniard. I don't think there's ever been a gladiator to match you. As for this young man, he insists you are Hector reborn. Or was it Hercules? Why doesn't the hero reveal himself and tell us all your real name? You do have a name.

      Maximus: My name is Gladiator.

      Commodus: How dare you show your back to me! Slave, you will remove your helmet and tell me your name.

      Delete
  2. 10:13 TSB follower with a question, where's all the good news. Aren't you bitching like TSB. C'mon give us the good news.

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  3. The good news is most of you wont be in this business in the next 2-4 years!

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  4. What was great in this industry, providing innovative solutions for people with real back problems, lies more than 20 years behind us. What the spine industry has evolved into is an arrogant, cynical and amoral machine that is only interested in generating as much money as possible, and where the patient him or herself is of absolutely no import except as a source of (insurance) money. In another 20 years the industry will be back at where it started, only operating on those who really stand to benefit. By that time 80% plus of the present participants will be bankrupt or gone.

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  5. What I love about being a 1099 spine rep:

    -Eating what I kill

    -Freedom to carry other lines (beyond my main company) and leverage relationships
    Lucky and fortunate to work with customers who are good surgeons and actually good people. Not everyone has butterfingers and not everyone is on the take!

    -Freedom to pursue ventures that are completely unrelated to spine (but productive ventures that do not include golf, fishing or sleeping in).

    -Using tax strategies (not available to 1040 employees) to build wealth by protecting more of my hard earned money from the government.


    What I am and what I choose to be:

    -I was in school during the cage rage. Since I wasn’t there, I don’t lament the “good old days.”

    -I’m unencumbered by the “sense of entitlement” many of my older colleagues and competitors have.

    -I value and internalize the lessons and advice my older, experienced and accomplished colleagues share with me.

    -Most of my products are commodities…I am not!

    -Most of our corporate chieftains are useless tools. Thankfully my customers don’t even know their names.

    -Sometimes my surgeons forget the name of my cervical plate or bone void filler. They never forget my name.

    -I didn’t flunk out of medical school. I never even thought about becoming a doctor. No inferiority complex here.

    -I study history. Bubbles and business cycles are not things you should first learn about when they’re hitting you in the face.

    -I play defense and offense. I’m an offensive player always looking for ways to exploit fat, lazy defensive minded reps. This means you, “Mr. One Doc Rep” who pulls himself off the golf course twice a week to “observe” a couple big lumbar fusions.

    -My colleagues and customers can talk about my honesty and integrity because I don’t need to.


    There is no seniority and no golden parachutes in our world. Getting older doesn’t make you more valuable or enhance your job security. Working harder every day to be more valuable makes you more valuable.

    ReplyDelete
    Replies
    1. 10:13 here....dude you hit it all right on the head!! Simply well said my friend! Maybe if TSB and some of his "followers" took notice they too we be singing the same story. But they don't and are just going to be sad, feedup, broke down wannabe's.

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    2. I wannabe me, not you. Vote for Romney, go to church carry a gun and watch porn now that's the dream

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    3. I resemble this remark.

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  6. Looked at Integras products this week, weak at best I am looking for additional products for my line any suggestions?

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  7. People who believe and internalize the negativity of this blog will not be successful. Spine is still a great and exciting business (for the independents!). While the industry negativists are wallowing in self-pity over their perceived direction of spine, the real men (and women) are earning the business every day.

    If you don’t like spine, get the hell out of it! Make room for the next generation who don’t have your misplaced feelings of entitlement. I, for one, love spine and there is nothing else I’d rather be doing, despite the lame chorus of naysayers. Sure total joints or general ortho might have less drama, but I would die of boredom.

    ReplyDelete
    Replies
    1. Hey Deepak Chopra the body is the mind's battleground. Go smoke some hookah and things will be alright. The only reason you don't die of boredom is because of this blog.

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  8. If you don’t like spine get out of it!

    If you don’t like PODs, POCs, DOPs, COPs, get out of it!

    If you don’t like entitled docs, get out of it!

    If you don’t like small companies with inexperience, get out of it!

    If you don’t like big companies with arrogance, get out of it!

    If you don’t like the “direction of the industry,” get the fuck out of it!

    Stop making everyone else miserable and move your waste of a life in another direction. I would suggest:
    -The janitorial arts
    -The food service industry
    -The government services administration

    ReplyDelete
  9. Just read the post where's the negativity? You fellas are thin skinned.

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    Replies
    1. you must be a Stryker Rep! God help us all.

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  10. Best Innovation? 13 comments and no answer.

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  11. The innovation is not the implants but how they are delivered. Reduced trays and brand new sterile bar-coded implants that are never reprossesed is the future. This makes the reps and hospitals job easier while reducing cost which is what our customers want. SpineArt is currently the only company to offer everything sterile. If a patient was given a choice to recieve new implants or implants that have been contaminated and cleaned over and over again they will choose new everytime. If you don't believe me watch Depuy try to replace reps with sterile implants and vending machines in the next 3-5 years. It's the only value that can be offered to hospitals as the products are commodities.

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    Replies
    1. Not true, other companies provide everything sterile... Especially those (like spine art) that were founded outside the US.

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    2. Sterile packaging is not innovative. Its a marketing tool at this point and may be required in the future. But it didn't involve any R and D, engineers, surgeon advisors etc. I personally think its a good move and could reduce inventory costs in the long run, but its not innovation.

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  12. How exactly does that work in a bg scli case? Is a surgeon supposed to wait for each screw while someone hits the candy machine?

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    Replies
    1. I agree, and that is why i don't see the machine working out. I do think sterile implants are going to be the stanard just like it is in joints. Any company that is already doing it is years ahead of their competition.

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    2. what is the cost to package each screw, locking cap, rod and peek spacer? With the asp getting lower every year, what is the up side to do this? Please tell me

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    3. Less trays equals lower COGS. Less shipping, inventory management, smaller distribution center....the savings far outweigh the costs to package everything.

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    4. Don't forget assurance of sterility, lot traceability and lowered costs due to only needing to process the instruments, not the implants.

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  13. I think the CEO of LDR deserves credit for being innovative and thought provoking. The blade technology they have introduced is both innovative and has challenged the notion that a product has to be screw based to be effective or legitimate in the spine universe. Kudos to him for going outside the norm of "me-too" products and instead take a risk and challenge the status quo.

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    Replies
    1. Those blades have increased my corpectomy business! Gimmick concept that's led to horrible revisions in the cervical and lumbar spine. Hardly innovative.

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    2. It's unfortunate that people use this blogs to try to create a false perceptions about their competition. I would wager that this technology has affected your business and that is the reason you spew poison. Regardless of your comments, this technology has changed the way many great surgeons treat their patients. That is the definition of innovation.

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    3. Not just surgeons, but "great" surgeons. Gimme a break. Its most successful with lazy surgeons. Its very easy to put the blades in and I'm betting they are still billing for the instrumentation as they would a plate. Biomechanically, it doesn't stack up to a plate or any of the screw based integrated devices, except the ones with only 2 screws.

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  14. Yeah - I wish we had bought them when we had the chance.

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  15. Finally someone actually answered the question, where is the innovation. Whether you agree with the commentator or not, 4:49 ACTUALLY READ THE POST, unlike our friend from the West Coast who does not offer anything, but bitches about TSB because he got spanked for doing some inappropriate things, but then they would never talk about that would they?

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    Replies
    1. now look who is calling the kettle black!

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    2. How many times has TSB asked, where's the innovation? If you read the post you would understand that, rather than shooting the messenger. As Elton John once said, "don't shoot me I'm just the piano player." What TSB is pointing out is that someone actually read the blog rather than bitched. So where's the innovation if everything is so great?

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    3. Easy MM, you're crossing the line. You are close to identifying a reader that you obviously don't care for. I know you can see IP addresses, but how do you know who's posting what? And do you have proof that your responding to who you think you're responding to and do you have proof that they did something wrong or are you just spreading rumors like most of your readers?

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    4. 4:23 great point! He does has access to EVERYONE'S IP address and has made several refferances that I am for N. Cali and have been in some sort of BS hand slapping problem. He is right, I live in N. Cali but the hand slapping...WTF? He is way off base there man! Sounds like the only one that needs some hand slapping is....????

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  16. Products that are intriguing: Globus caliber, LDR cages,Medtronic cortical technique. Also like PEEK expandable corpectomy cages, allograft based products that might get some play with Infuse decreasing. Most important, Navigation! Who will win this battle? brain labs? MDT? Stryker? Someone else?

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    Replies
    1. Medtronic cortical technique?

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  17. Biomet Spine has the Trivium Deformity System that is pretty darn slick. Trans1 Latteral cage and access instrumentation provides the surgeon with great visualization. MSD Atlantis Dynamic cervical plating system is slick and easy to use. Just a few....

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  18. Good products are the key to getting in the door with surgeons. Then if you build a relationship after they start using your most innovative product, hopefully you can farm more business. So question:
    What is with all the Lanx news lately? Yes, I understand they signed Dr. C from Buffalo, but I dont know what all the fuss is about. No one uses Lanx in my area, but after researching their products, I can't understand why all the fuss... I did hear they are paying 25-45% commission but to me that just means they are a short term thinking company with "me-too" products. I could be wrong, hence the post. Please enlighten me!

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  19. Diffusion of innovations...

    TSB Rules!

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  20. Don't tell TSB, tell our readers something good. Tell them what is so great about this industry?

    Globus is going Public!! isn't that great news?!?!?

    ReplyDelete
    Replies
    1. I hear they may have to pull the offering due to lack of demand. Anyone else hear that?

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  21. Note to sports fans:


    Dwight Howard's season is over. His chances to help Team USA win another Olympic gold are likely done, too.

    Orlando's All-Star center told ESPN.com he will have season-ending back surgery.

    Friday's operation in Los Angeles to repair a herniated disk also will keep him from playing in the Olympics in London, Howard's agent, Dan Fegan, told ESPN.com.

    My question is who is his surgeon in LA?

    Heal up Howard. I've met him and he is a solid guy!

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  22. MM you are correct. Will Annulex be used to close up the annulus?

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  23. I think you are witnessing a cyclical event here in this industry. Similar to the trading patterns of an individual stock. Whether its up or down you have to ask yourself is it a good stock to invest in and the answer is ... YES. Margins are good, demand is consistent, and on a global scale the industry continues to grow. So why the lack of innovation? During a correction we're tightening the belt. This is a time to make the older products better. Wildcat programs are simply shelved. Once the tightening stops or is met with continuous resistance than we will begin to see the new innovative product rise. Yes, vending machines with implants will happen, reps will always be in the OR regardless, robotic surgery will make a comeback and lateral surgery is here to stay. What's new in this industry? These vampire consultants who work with hospital systems to kill pricing to levels that are simply ridiculous. Their only compensation is based on what they save plus whatever other administrative costs they demand. Talk about knocking the wind out of innovation and new tech. These guys are putting an immediate halt to not only innovation but more inventory of next generation products that are good products. This madness has to stop. If you see these RFP's in your area just refuse it. We have to band together on this. They come in, damage a relationship and then leave. For what a few points? Madness.

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  24. When the hell is Spinewave going out of business? Staxx has more issues and much of their business around here is from surgeon consultants.

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    Replies
    1. Which area are you refering to?

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  25. What are the issues?

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    Replies
    1. LoGuidice, Traurig, and Skinner ?

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  26. What about CoAlign? Product looks interesting. Could it be better than Caliber?

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    Replies
    1. I have used them side by side and CoAlign is only offered as a banana tlif type cage whereas Caliber can be used in a PLIF approach; so, CoAlign certainly has its option limitations.
      The expansion mechanism in Caliber feels more solid than the CoAlign expansion; that ramp mechanism is one of the more impressive new 'simple' innovations out in this industry right now.

      Delete
  27. What are the issues at S-Wave??

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  28. It's kind of hard to refuse an RFP. If you are lucky enough to have the business at any given hospital, you can bet that someone w/ nothing to lose will undercut you just to get in. If you don't match their lowball offers, the hospital positions you as the bad guy tothe MD's. That's when you find out who your friends are, or aren't, as the case may be. It's like a race to the bottom. And the winner is... Not you !

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  29. Has anyone removed a failed axialif without using the same approach? Has anyone successfully cut that screw and performed an ALIF?

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    Replies
    1. We have revised the ass rocket. However, not by taking the screw out or cutting the screw. The surgeon did a PLF with instrumentation. The risk of trying to take it out was too high in order to get an interbody fusion. That's what the surgeon felt.

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  30. Innovation is "the creation of better or more effective products, processes, services, technologies, or ideas that are accepted by markets, governments, and society. Innovation differs from invention in that innovation refers to the use of a new idea or method, whereas invention refers more directly to the creation of the idea or method itself."

    Call it "me-too" but any company that improves upon a concept (e.g., handling, cost, manufacturing processes, delivery processes, customer service processes, etc.) in a way that results in an increased market share for that product has, by definition, been INNOVATIVE.

    Furthermore, COMPETITION is the engine that drives the train called INNOVATION.

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  31. Stop hating on SineWave just because they're good! I distribute them and we're lighting it up. Ease of use, solid instruments, and definitely not 'me too'. I even get paid less from them than my other lines because SW has great door openers. Also, solid mgmt won't try to steal your relationships with bs consulting deals.

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    Replies
    1. 7:42. Who handles the West Coast for them, specificaly California?

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  32. How do you like Sniper? Do you lead with that?

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  33. Anyone know anything about Surgline and Thomas Toland? Orthoflash had a blip about them this morning.

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  34. Whatever happened to Coflex F and Coflex? Must not be doing well because nobody is talking about these two products. Has Paradigm Spine changed their sales mangement or their strategy?

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    Replies
    1. Paradigm has no strategy.

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  35. 7:11,
    Yes I lead w sniper for ease of use, staxx for tlif, and new staxx lateral rocks.

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    Replies
    1. got a contact name and number for the Area Manager for them in the West Coast?? Would love to chat with them about the Spinewave line.

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  36. Dunno call SW direct

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  37. I need a locking dynamic cervical plate that compares to Zimmer/Abbott ACT-CER II plate. Anything out there similar? How does Rhausler compare? Need something a distributor can carry. Any suggestions?

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  38. What's great about this industry is companies like NuVasive can rise up and lead the path of real innovation for the past ten years. They are thought leaders and solution providers. There is no other company that has had such a substantial and significant impact as this company in recent history. Neural monitoring, minimal disruption procedures, pioneer of the lateral procedure, etc. Who else has made such an impact that there are so many copycats? Who had procedural integrated neural monitoring prior? Who truly developed lateral? Who truly used conventional methods to change the way we think about and do surgery. All of the other companies feed off of the low hanging fruit. NuVasive and those like it, the small few, should be awarded for their daring will to raise the bar! Thank you NuVasive!! Thank you Alex, Keith and Pat. Onward and upward!

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    Replies
    1. They definitely pioneered lateral and deserve credit for it. But to be considered a top tier company, they will have to have a core product line that is competitive, and they do not. Lateral will only take you so far. And if you spend all your cash on marketing, new buildings, exec bonuses, broadway plays and former presidents as speakers, then you won't have cash to keep the products coming.

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    2. NuVO a pioneer? You for to be kidding me. Its only within the last 2 years that they finally got an acdf plating system and some allograft. Yes, I agree they "innovated" the lateral approach, but heck, even a dog finds a bone once in awhile. They have spent way to much $$ and focus on crap rather than making a substantial contribution to the market. And you 6:57 say they innovated Neural Monitoring? Hell half the reps that started "applying" the crap to the patient's body in the OR weerre kicked out because they had no idea what they were doing. Sounds like Terry Rich writing this crap to me!

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    3. NUVA started with neural monitoring and allograft...you know nothing! They have had a cervical plate for over 6 years. You know nothing. From stem to stern they have a competitive solution in every aspect...you know nothing!

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    4. I know nuuu nuuu nuuu...nothing NuVo...drinking to much purple Kool Aid my friend.

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    5. You're damn right because it's the only damn refreshing drink around here that quenches one's thirst. I suggest you pour yourself a cup!

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  39. Hallelujah! PS: That's the name of my next B'way Play.

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