new technology - combined disc / facet replacement
from Austin, Texas!
Austin is beautiful!
NASS is the largest spine congress and I understand
that there are 500 more registered attendees for
this meeting than there were last year in Seattle.
It seems like everyone is here. It's been 5 years
that I've been attending two to four conferences
/ year, and I'm learning more and more at each
one. It's interesting to see how the buzz changes...
motion preservation, biologics, navigation systems,
stem cells, nanotechnology, etc... I hope to post
more updates than I've been able to at past conferences.
These meetings are non-stop, but I'm committed
to sharing more of this amazing conference with
the patient community. As always, I'm only sharing
my perceptions of what I experience. Take everything
I say with a grain of salt. I hope that you enjoy
and learn from what I write. For the spine patients
reading here, I hope that information you gain
from me, GPN and
iSpine makes a positive contribution to your quest
for the best possible solitions to your pain and
Update style: Many posts here will
be out of sequence as it's tough to make the time
when running at this pace. While the posts will be
in chronological order based on what I'm writing
about, each post will be numbered and will include
the date and
time. Hopefully, this will make it easier for those
who'd like to keep up with this during the conference.
Let me know if this works for you!
Lending Library - check it out!!!
I've already snagged
extra copies of the program and abstract
for the lending library.
devices, procedures, etc... discussed on this
site are in various stages of development.
While some have been proven safe and efficacious,
are FDA approved and widely available; others
may be in a wide range of developmental stages.
Some are proven and are just waiting for FDA
approval of the manufacturing process, which
is expected very soon. Some are exciting ideas
that may prove to be very bad ideas; possibly
even harmful disasters. Some represent brilliant
ideas that may ultimately become life-saving
products while others will never make it to
the marketplace. Even for the great products,
development / testing / approval process may
take years or even decades. There is no guarantee
that any information presented here is correct.
Items discussed here may never be available
to the patient community. Medical decisions
should not be made based on information found
Lending Library - check it out!!!
have 2 copies of the program and abstract
book for the library.)
1 - Tuesday, October 23, 2007
at NASS... noon on Tuesday
was not sure I was coming to NASS until just
a few days
ago, but I have some really difficult cases
I'm working on. I can do so much more in person,
so spending these days surrounded by the world's
leading surgeons was too valuable an opportunity
to pass up. Will this conference be be worth the
thousands of dollars it costs me to attend? That
question was answered in my first 1/2 hour here.
Less than 5 minutes after I arrived, I bumped into
Luis Pimenta. He's a world class surgeon from Brazil
who's involved in so many new technologies. If you
keep up with spine, you see him mentioned in press
release after press release. Over the years I've
seen him presenting about the first this.. first
that... whether it's facet replacements, posterior
implantation of ADR, nucleus replacements, etc...
Dr. Pimenta is breaking new ground in spine arthroplasty
at an amazing rate. I was please to confirm his participation
in the 2008 International Spine Patient Symposium.
a minute later, I bumped into Michael Kropf.
He works at the L.A. Spine Institute with Rick
Delamarter and has helped me with some difficult
cases in the past. (He did a 2-level Dynesys
on an 84 year-old client of mine... now more
than a year post-op and doing great!) We reviewed
one of my more difficult clients and I believe
he'll be able to help. So if there had been any
question about whether or not coming here would
be worth it... I'm only 15 minutes in and any
been completely erased!
had lunch with Dr. Christopher Yeung. Since I
was recently in Phoenix with a client, we had
much to talk about. These sessions are really
helpful for me as I get candid discussions about
the new technologies. He and his dad (Dr. Tony
Yeung) are putting a state of the art, comprehensive
center. I'll be writing more about that soon.
hadn't signed up for the pre-meeting courses
(and they were checking badges), so I returned
to the hotel and put this web page together.
Heading to the opening recption, I was treated
to an amazing twilight full moon rise over the
beautiful Austin skyline. The warm breezes and
clear skies of Texas are wonderful. The air seems
to smell sweet
opening reception at the Hilton was great. I
wound up in an impromptu round-table discussion
that lasted over an hour with several leading
surgeons and industry reps for some technologies
I've been dealing with for my clients... specifically
Trans1 (Axialif Fusion) and biologic fusion enhancement
with growth factors, BMP, stem cells, etc.
2 - Wednesday, October 24, 2007
session - Presidential address - Richard
D. Guyer, MD
been seeing Rick
Guyer speak for 5 years now... always one of
the most enjoyable speakers, but has been limited
to the 'typical' presentation... more data...
more numbers. As the outgoing NASS president,
treatment of the challenges facing the medical
community and orthopedics industry was very interesting.
The challenges we'll face as we develop nanotechnology
for spinal cord repairs and start to head down
the road towards automated medicine will be difficult.
His overveiw of the new and emerging technoloties
was very interesting. He discussed an already
used system where people with medical records
on a system can go to (essentially) an ATM at
which they'll input symptoms, meds, etc, and
for ailments that can fit into standardized protocols,
they'll be dealt with in an automated fashion,
with prescriptions for tests and meds generated
by a computer program.
I got to spend some time with him and he's committed
to speak at the ISPS-II.
Association Between Waiting Time and Symptom
Reduction after Elective Surgical Lumbar
Discectomy (ESLD) - Jeffrey Quan, DC et.
grabbing a few minutes for this update as it hits so
close to home, with Diane's (my
wife) recent disc herniation and subsequent
discectomy. This study compared outcomes after
lumbar discectomies in comparing patients with
sciatica due to confirmed herniation. The cohort
included 391 patients. The "short" group
had a waiting time of less than 6 weeks for the
The "long" group were all waitlisted
for more than 6 weeks. The results were analyzed
format and also again with measured confounders
propensity scores (hopefully) improving the
quality of the data.
unadjusted analyses, long wait patients were
50% less likely than short-wait patients to report
improvement 6-months post-operatively."
association held after adjusting for propensity
scores, with long-wait patients
being 41% less likely
similar, but weaker deleterious effect of waiting
was observed when long-wait
as those waiting > 6 weeks."
3 - Thursday, October 25,
Session 1 - Cervical. BIG NEWS FOR PRO-DISC-C
During the morning
session, Dr. Dan Murrey from North Carolina and
Dr. Rick Delamarter from Southern California
both presented their center's data for ProDisc-C
follow-up. Dr. Murrey had 24 month data that
included 103 PD-c's and Dr. Delamarter's data
included 79 patients with 96 implants, including
14 2-level and 9 3-level patients. (Multi-levels
done under compassionate use exemptions.
There has been
much interest in the patient community regarding
the potential for heterotopic ossification. (Especially
since a European study showed, contrary to common
clinical experience, class II and III HO rates
of 49%). Out of 103 ProDisc-C's, Dr. Murrey reported
3 cases of HO. With 97 ProDisc-C implants by
4 surgeons, Dr. Delamarter was able to report
of HO. During the panel discussion, Dr. Delamarter
was asked to comment on the total lack of HO
in his center's cohort. He said that he could
not attribute it to any particular surgical technique,
but indicated that he does prescribe NSAIDS,
which inhibit bone growth, in post-op ProDisc-C
discussions ensued about the few revision surgeries.
Both surgeons had a few revisions of ADR to fusion
in dissatisfied patients for ongoing neck pain.
In those cases, the patients pain did not improve
after a technically successful fusion. They speculated
that there were undiagnosed pain generators not
addressed by ADR or fusion and that the results
would have been the same if they were fused first.
At the close of
his presentation, DR. Murrey announced the big
FDA has issued an approval letter for Pro-Disc-C. He
said, "The FDA has completed it's review
of the clinical data. ProDisc-C as demonstrated
safety and efficacy. The approval pricess is
not pending review of the manufacturing process,
product packaging, etc."
There was much
more interesting cervical ADR data presented
in other sessions... more later!
True Total Spine Motion Segment System
Thursday afternoon, I saw some new technology
that really piqued my interest. Disc
Motion Technologies has developed a new system
that solves many problems that limit options for
some patients. Many of us have facets that are too
severely degenerated to allow total disc replacement.
This new system is composed of 2 disc replacements
implants that can be implanted through a standard
PLIF (posterior lumbar interbody fusion) approach,
plus a total facet replacement. The disc portions
are like an current artificial disc, but cut in half.
This allows one segment to be inserted through each
side, eliminating the need for a larger access path
currently requred for ADR implantation. The problem
with the other PLIF total disc styles is that they
require removal of so much of the posterior column;
required stabilizing structures are removed. The
Disc Motion Tecnologies solution includes a facet
replacement system that is designed to complement
the kinematics of the total disc in front. It will
be interesting to see how this all unfolds: will
this only be for patiets with compromised facets?
The system was developed in the UK and we won't see
human implantations until next year... so this is
many years away from general availability. I was
glad to discover that technology after you discover
it, the solution seems so obvious... why didn't we
think of that before?
Day 4 - Friday, October
Transplantation: A new dimension in treatment
of degenerative spine disease
March, I posted articles about the WORLDS
FIRST DISC TRANSPLANT. Today,
I listened to a presentation of FIVE YEAR follow-up
data for 5 patients and 43 month follow-up for
13 cases. All operated levels underwent anterior
disc excision and transplantation of a fresh-frozen
endplate-disc-endplate composite harvested from
3 healthy female donors. (I guess healthy before
they died.) In all levels, evidence of good bony
union between the recipient's bone and the graft
endplates were observed at two months post-op.
graft migration, subsidence, or serological
suggestion of immuno-reaction was observed. There
was mild reduction of disc height at early post-op
follow-up and mild degenerative changes at the
final follow-up. However, all discs maintained
mobility. One patient needed posterior foraminotomy
for recurrent radiculopathy. That segment eventually
Day 5 - Saturday,
October 27, 2007
comment on the SAS blog on this