Recent Updates:
Disc Transplantation: A new dimension in treatment of DDD!
Exciting new technology - combined disc / facet replacement system!
Thursday Cervical Session - BIG PRODISC-C NEWS!!!
Greetings from Austin, Texas!
October 23, 2007

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 disability.


Mark Mintzer

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!
iSpine Lending Library - check it out!!!
I've already snagged extra copies of the program and abstract book available for the lending library.

Technology Disclaimer
The 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 here.

iSpine Lending Library - check it out!!!
(I have 2 copies of the program and abstract book for the library.)

Day 1 - Tuesday, October 23, 2007
Arriving at NASS... noon on Tuesday
post #2, 10/24/07, 22:00

I 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.

Just 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 doubts have been completely erased!

I 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 spine treatment center. I'll be writing more about that soon.

I 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

The 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.

Day 2 - Wednesday, October 24, 2007
Opening session - Presidential address - Richard D. Guyer, MD
#3 10/25/0700:30

I've 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.

Later, I got to spend some time with him and he's committed to speak at the ISPS-II.

The Association Between Waiting Time and Symptom Reduction after Elective Surgical Lumbar Discectomy (ESLD) - Jeffrey Quan, DC et. al.
#1 10/23/07
I'm 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 surgery. The "long" group were all waitlisted for more than 6 weeks. The results were analyzed in 'unadjusted' format and also again with measured confounders propensity scores (hopefully) improving the quality of the data.
  • "In unadjusted analyses, long wait patients were 50% less likely than short-wait patients to report improvement 6-months post-operatively."
  • "The association held after adjusting for propensity scores, with long-wait patients being 41% less likely to improve"
  • "A similar, but weaker deleterious effect of waiting was observed when long-wait patients were defined as those waiting > 6 weeks."

Day 3 - Thursday, October 25, 2007

Concurrent Session 1 - Cervical. BIG NEWS FOR PRO-DISC-C
#4 10/25/07 17:00

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 ZERO cases 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 patients.

More interesting 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 news... The 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!

First True Total Spine Motion Segment System
#5 10/26/07 0:30

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 26, 2007

Disc Transplantation: A new dimension in treatment of degenerative spine disease

In 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. No 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 fused..

Day 5 - Saturday, October 27, 2007


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