Becker's Spine Review

29 DEVICES & IMPLANTS The spine devices with the most potential By Anuja Vaidya F our spine surgeons discussed the devices and techniques that will have a significant effect on patient care. Question: What devices currently on the market do you think have the most potential to improve spine care? Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Ange- les: I believe arthroplasty remains an important adjunct in care. ey have their place, and when not over-used and [only] used in reasonable situations, are very valuable. It allows patients to theo- retically delay or perhaps avoid further surgery. e newer expandable lateral lumbar cages are very exciting and make it easier to get sagittal balance in certain cases and will likely result in fewer and fewer flat backs. Robots will find their place and can really improve accuracy — in theory — but we should not forget that humans are still, and fallibly so, running them. Intraoperative imag- ing and guidance have improved by leaps and bounds, and certain lightweight and super-exciting technologies have come to the fore to spare everyone in the room from the normally prodigious amounts of radiation. Alden Milam, MD. Spine Surgeon at Or- thoCarolina (Charlotte, N.C.): Hopeful- ly, patient-specific 3D printing, which has already started, will grow in its applica- tion. e idea of implants tailored for the nuance of patient anatomy, bone density and/or goals of surgery (such as sagittal or coronal correction) is exciting as a new frontier for spinal implants. Issada ongtrangan, MD. Orthopedic Spine and Neurosurgeon at Minimally Invasive Spine (Phoenix): In my opinion, minimally inva- sive via endoscopic approaches will gain more popularity in the next five to 10 years, similar to the tubular-based retractor in the past 15 to 20 years [where] more and more evidence has shown excellent patient outcomes and superior-to-traditional technique. Endoscope brings the minimally invasive spine surgery to the next level and can be uti- lized in almost all aspects of cervical and lumbar spine pathologies. I also predict that robotic and navigation-based surgery will prove their value in [the] spine arena, and it could replace 2D images such as fluo- roscopic C-arm in the future. 3D-printed devices and advancement in surface technologies will also enhance fusion outcomes. Jason M. Cuéllar, MD, PhD. Assistant Professor in the Department of Orthopaedic Surgery at Cedars-Sinai Medical Center (Los Ange- les): Artificial disc replacement is currently gaining in popularity and has the greatest potential to improve spine care across the globe as its utilization becomes more popular and its indications expand. ere are currently two devices available for use in the United States for the lumbar spine (ActivL and ProDisc-L) and seven devices for use in the cervical spine (Prestige-LP, Prestige ST, ProDisc-C, Secure-C, MobiC, Bryan and PCM). ere are several currently in the pipeline for ap- proval, and the much-awaited M6 cervical implant from Orthofix has gained FDA approval for single-level use and will be available for use this summer starting in select sites. e Prestige-LP from Medtronic and MobiC from LDR / Zimmer Biomet currently have FDA approval for two-level use. n DOJ charges 24 in $1.2B+ medical device kickback scheme — 5 insights By Eric Oliver T he Department of Justice charged 24 individuals in connection with a massive kickback scheme that resulted in more than $1.2 billion in losses. What you should know: 1. The DOJ charged defendants across the U.S. They al- legedly all participated in a kickback scheme concerning medically unnecessary durable medical equipment braces. The defendants include executives in telemedicine compa- nies, owners of durable medical equipment companies and three licensed medical professionals. 2. The defendants allegedly used an international call center that advertised to Medicare beneficiaries. Through the call centers they attempted to get the patients to receive DME medical braces at little or no cost, regardless of need. 3. The defendants would then allegedly pay kickbacks to telemedicine companies, who paid kickbacks to physicians to receive prescriptions for the braces. The call center would sell the prescriptions to the brace companies, who then billed Medicare. 4. The alleged operation caused more than $1 billion in loss- es, $1.7 billion in claims and $900 million in payments. 5. The FBI and HHS' Office of Inspector General led the in- vestigation. n

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