Becker's Spine Review

21 Executive Briefing The product also beats other graft materials in terms of handling characteristics, whether it's used in posterior cervical, lumbar or thoracic spine surgeries, according to Dr. Allen. "The polymer used to make it malleable also makes it moldable," he said, "and its ability to stick down to the facets, transverse processes and lamina is truly impressive and unlike any demineralized bone matrix or other graft material I have used." More effective, but at what cost? Outcomes and handling characteristics are two vital considerations when introducing a new product. But as prices for lumbar spinal fusions soar, costs are at the top of surgeons' minds. Today, estimates for the price of a lumbar spinal fusion range from $60,000 to $110,000 per procedure, according to SpinalCord. com, an injury resource center. In part because of non-unions, spinal fusion costs an estimated $118,945 per quality-adjusted life year gained, an April 2015 study by Nashville, Tenn.-based Vanderbilt University Medical Center researchers found. MagnetOs represent a cost-effective option for spine fusions, according to Dr. Poelstra. Not only does MagnetOs' promote solid bone formation to help surgeons avoid costly non-unions, but it also doesn't use added cells or growth factors that come at a price. "Based on the evidence we have about the product, I know that it's extremely effective and that I most likely don't have to use anything that is more expensive in the operating room," he said. "If you look at all of the products that have growth factors in them or are cell-based, they're usually three to four times as expensive as MagnetOs." Moreover, Kuros' cost-effective option has worked "extremely well" inside of a cage for patients with immunologic diseases such as rheumatoid arthritis or severe psoriatic arthritis, as well as older patients whose healing processes might not be as successful, Dr. Poelstra said. For these cases, Dr. Poelstra combines a small amount of local autograft with MagnetOs putty, resulting in a "tremendous buildup of bone" and more predictable bone growth than he's achieved with bone morphogenetic protein products. Plus, he doesn't have to fill the entire interbody fusion cage with MagnetOs. Dr. Allen has also used MagnetOs in some of his toughest cases, including one where a patient referred from an outside hospital presented with a large seroma surrounded by what seemed to be a shell of early bone after rhBMP-2use. Concerned about the difficult fusion environment, bony eburnation and soft tissue surfaces with an avascular appearance, Dr. Allen performed a pedicle subtraction osteotomy at L3 and revision fusion with a small amount of autograft and MagnetOs, filling in areas with cancellous chips and demineralized bone matrix. At eight months after the surgery, the patient's implants are stable, his alignment is maintained, and radiographs and CT scans indicate he's making mature bone in areas not previously fused at about six and a half months. "He is significantly better functionally, increasing his daily walking and has markedly improved pain scores," Dr. Allen said. Over a decade of work coming to fruition The MagnetOs technology that creates the kinds of outcomes Dr. Allen described is not derived from brand-new science. Kuros Biosciences has spent more than a decade refining its bone repair technologies and the surface science of orthobiologics. Continuous efforts to mimic the best features of biologically robust autograft bone has led to the creation of MagnetOs as it is today. In February 2017, the FDA approved Kuros' MagnetOs granules, and in August of that year, the MagnetOs putty received clearance. Dr. Poelstra introduced MagnetOs into his practice as soon as it got the FDA's green light. Though Kuros hasn't yet pursued an osteoinductive indication in the U.S., MagnetOs' ability to promote bone formation — even in soft tissues — without added cells or growth factors gained the product an osteoinductive indication in Europe. Drs. Poelstra and Allen agreed that MagnetOs' osteoinductive abilities are clear. Wherever it's used, the advantage of MagnetOs' ability to make bone endogenously, cost-effectively and without added cells or growth factors boils down to one thing: patient outcomes. "This architecture is unlike conventional and most current bone synthetic bone grafts," Dr. Allen said. "Having the ability to locally apply this type of graft material, alter the local inflammatory environment after surgery in favor of bone healing and repair, and do that based on the graft applied is an exciting potential opportunity to improve fusion rates in our patients." Disclaimer: The views, opinions and positions expressed by surgeons in this article are those of the surgeon alone and do not represent those of Kuros Biosciences. Please refer to the product instructions for use for a full list of indications, contraindications, warnings, and precautions. Kuros Biosciences aims to deliver decreased complications, advanced functional rehabilitation and to eliminate non-unions for spine surgeons and their patients. Their flagship product, MagnetOs bone graft, has an advanced submicron surface topography that leads to the formation of bone, rather than scar tissue, following implantation. Within their pipeline is an investigational drug/biologic combination product candidate consisting of a fibrin-based healing matrix with a targeted bone growth factor (truncated parathyroid hormone (PTH) analog). Visit www.kurosbio.com for additional information on Kuros Biosciences, its people, science and product pipeline.

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