Becker's ASC Review

22 EXECUTIVE BRIEFING 1 EXECUTIVE BRIEFING Over 400,000 spinal fusion surgeries are performed annually in the United States and as the population ages, that number is expected to rise. The goal of many spinal fusion surgeries is to reduce or eliminate pain as a result of degenerative disc disease. This is often done by removing the degenerated disc and then fusing the spine's vertebral bones above and below the disc to form a single, solid bone. A successful fusion can help reduce pain and enable patients to return to enjoying their lives. However, spinal fusion success rates vary from 70% to 90% and fluctuate depending on the patient's underlying condition and the surgical technique the surgeon uses. To learn more about the challenges affecting spinal fusions and innovation in the space, Becker's Healthcare spoke with neurosurgeon Sharad Rajpal, MD, Medical Director of the Advanced Spine Program at AdventHealth Avista in Louisville, Colorado and Valeska Schroeder, PhD, CEO of Cerapedics, a global commercial-stage orthopedics company. Spinal fusion's unique complexities A spine patient's journey can be long and difficult. Prior to considering surgery, most patients spend months, if not years, attempting to manage and alleviate their back pain before concluding that spinal fusion surgery presents the best long-term solution. As an experienced spine surgeon, Dr. Rajpal sees multiple challenges and complexities with spinal fusion procedures, including patient factors that can negatively impact bone growth. Every patient is different, and factors such as the patient's age, health, spinal condition and bone quality can impact the chance of a successful fusion. For example, patients with osteoporosis can have compromised bone healing, which puts them at increased risk of a non-union. Lifestyle factors, like obesity and smoking, and comorbidities such as diabetes, malnutrition and steroid use can also negatively impact the fusion process. As a result of these factors, spinal fusion surgery is becoming more difficult, with an increasing need for interventions to help overcome the biological challenges of bone growth for patients. "Our spinal fusion patients are not becoming less risky; they're becoming higher risk," Dr. Rajpal said. "We have not achieved a 100% fusion rate for any spinal fusion procedure yet. We still have failures and non-unions, so we need to be thoughtful about our biologics choices during these surgeries, especially in our higher-risk patients." An overlooked challenge Without a successful bone fusion, symptomatic motion can occur, and the longer it takes for the bones to fuse, the greater the risk of developing additional complications, like hardware failures, etc. There are more than 300 products in the bone graft space, but almost all are used to support healing, not to actively drive it. These widely used products have helped millions of patients, yet few activate bone repair. With increasing patient complexity, Dr. Rajpal stressed the importance of surgeons better understanding bone healing and adopting best practices, techniques and products to promote better, faster bone healing. "When we think about bone grafting options, surgeons want to use a product that can help address the fusion challenges that we constantly encounter in the OR ," Dr. Rajpal said. "This includes understanding the challenges that cause delayed and impaired bone fusions." Innovation drives better outcomes Over the past few decades, spinal fusion surgical techniques and hardware have advanced rapidly, but innovation in bone grafts has largely remained stagnant, with none proving to be superior to the patient's own bone or increasing fusion speed. From risk to recovery: New answers to spinal fusion's toughest problems

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