Becker's Spine Review

33 DEVICES & IMPLANTS Spine technologies that failed to live up to their hype: 5 surgeons weigh in By Alan Condon M arketing has the tendency to get in front of the science in many areas of orthopedics, which can result in suboptimal patient outcomes and significant steps back for the technology. Five surgeons discuss spine technologies they believe do not live up to their hype. Question: What spine technology do you think promised more than it delivered? Brian Gantwerker, MD. e Craniospinal Center of Los Angeles: Hype is always a dif- ficult thing to see past. Spinal technologies that I think were less than stellar are the in- tervertebral distraction devices that became popular about two years ago. A slew of these devices were put into patients with the prom- ise of relief from spinal stenosis. I have at least two spinous process fractures from these de- vices and have taken out at least one. I sin- cerely hope these devices will be retooled or removed from circulation altogether. Alok Sharan, MD. NJ Spine and Wellness (East Brunswick, N.J.): I believe the robot promised more than it delivered in spine surgery. In other fields of medicine, such as gynecology and urology, there have been tremendous advancements in the use of ro- botic surgery. Initially, the spine community thought the same successes in those fields would apply to spine surgery. Due to a vari- ety of reasons (capital costs, workflow issues, etc.), we have not seen a tremendous leap in adoption in robotic spine surgery. e challenging part of the healthcare indus- try is that every disease process is different. What works in cardiac care may not work in urology, etc. Because healthcare is not a true system, such as the military, lessons learned in one field of medicine do not apply directly to another field. Christian Zimmerman, MD. Saint Alphon- sus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): e PEEK rod sys- tem, touted by many companies, failed to alleviate the adjacent level failure phenome- na that so many of us anticipated and cared for in our careers. e five-year run (or so it seemed) saw mitigation of pain issues be- cause of lessened surgical intervention but saw returns for the additional surgeries years later for related symptoms of failure or per- sistence. Although the fracture rate of the rods was rare, this also became a concern in the older populace. As interest waned, the healthcare industry, applicable economics and the evolution of forward-thinking spinal care remedied this issue with eventual phase- outs by most corporations. Michael Goldsmith, MD. e Centers for Advanced Orthopaedics (Bethesda, Md.): Interspinous and interlaminar devices were widely considered innovative technologies that could address spinal stenosis and were initially seen as less invasive options to spi- nal fusion or laminectomy. However, the results of these techniques in practice have not always delivered on the promise of ad- dressing symptoms of neurogenic pain. Spine surgeons — and the healthcare industry in general — can learn that we must still abide by the basic principles of decompression, and stabilization when necessary, to achieve our patients' goals. Ehsan Jazini, MD. Virginia Spine Institute (Reston): While laser technology promis- es precision in our ability to address spinal problems in the vast majority of the cases, it has failed to do this safely. Laser technol- ogy poses a risk due to the thermal collateral damage it imposes on the surrounding struc- tures. Although laser technology has been used successfully in many industries, it has failed to live up to its hype for spine surgery and has little utility in our field. With the ad- vancement in motion-preserving techniques, robotics and ultrasonic technologies, we can more effectively address structural spine con- ditions while preserving motion which laser technology can't successfully address.. n Royal Philips expands AR spine surgery system globally By Carly Behm R oyal Philips' ClarifEye augmented reality system for spine surgery debuted in Spain and Oman, the company said Dec. 1. Surgeons at Sant Joan de Déu Barcelona Children's Hospital used the system with a 12-year-old patient who had congenital spondylolisthesis. ClarifEye was also used in a procedure at the Armed Forces Hospital in Muscat, Oman, for a 51-year-old patient with multilevel degenerative lumbar stenosis. ClarifEye was introduced in February and is CE marked. It combines 2D and 3D visualizations with 3D augmented reality, using a low X-ray dose. It's integrated with the Philips Azurion image-guided therapy platform. ClarifEye has also been adopted in Germany, Sweden, Switzerland and France. n

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