Other Articles

Biologics for Spine: Where We Are Now
Dr. Jeffrey Wang, Chief of the UCLA Spine Service and Director of the UCLA Spine Surgery Fellowship, discusses the exciting happenings in spine biologics, including growth factors, the use of different genes, and injecting stem cells into the disc. And then there are the challenges, namely the disc environment and the funding environment.

Physician Medicare Payments: Grandma vs. Docs
The fight over Medicare physician payments in Congress has been reduced to a fight over limited public dollars between Grandma and her physician. Is this a prelude to how public health care policy will be decided in the future? Read about the tussle here.

Spine Niche! Opportunity in the Spinal Deformity Market
Given the myriad of start-up companies pursuing the same patients, product differentiation and solutions for specific target markets could be the key in the future. Using the PearlDiver Patient Records Database we estimate procedure volumes for posterior fusion as a treatment for scoliosis—followed by the results of a study identifying complications associated with instrumented posterior thoracic fusion in treating scoliosis.

AAOS Political Action Committee
Active players in the orthopedic field know the importance of the AAOS Political Action Committee (PAC). On the cusp of hot topics affecting physicians and patients, the AAOS PAC works diligently to provide data to members of Congress and improve the present and future of orthopedics.

Who ARE These Guys?
Every 60 seconds or so a surgeon tears the cover off an Integra LifeSciences package. Quietly, this company has become the seventh largest medical implant manufacturer serving orthopedic surgeons in the world. Where to now? Would you believe $1 billion in two years? How about $2 billion by 2015?

Redemption in a Mechanism of Failure: The TOPS™ Story
Impliant’s TOPS™ System had a “squeaker” in its clinical study. After a voluntary suspension of the study by the company and finding the mechanism of failure, the FDA has approved a resumption of the study. What insider lessons were learned? Class starts here.

Who is Numero Uno in the PearlDiver Database!! Are You Surprised?
The answer may surprise you. Is it sore backs, aching hips, sore knees, fingers? PearlDiver details 3.8 million spine related complaints—complete with demographic information and charging information. But that’s not #1. PearlDiver also lists 3.5 million large joint complaints. Sorry, still not #1. What could the most common orthopedic complaint possibly be? To get the surprising answer…read on.

What the Knees Need: Baby Boomers and Their Options
Knee patients often show up at the doctor’s office with recurrent mechanical symptoms. It is up to the orthopedist, says Dr. Giles R. Scuderi, Director and orthopedic surgeon with the Insall, Scott & Kelly Institute in Manhattan, to thoroughly assess the patient and then determine if nonoperative treatment will do, or if the person needs a unicompartmental or total knee procedure.

Physician: Report Thyself
The government says its healthcare anti-fraud efforts are working and it wants to encourage physicians to self-report possible fraud. How well did the government do in 2007 and what about those deferred-prosecution deals with undisclosed evidence? Read about it here.

Revising the Statistics
The word that orthopedic patients least want to hear is “revision.” Who, in the universe of large joint patients, do we expect to see on the receiving end of this news? If you guessed “the elderly” you would have been wrong. The reality of who is hearing “revision” may come as a surprise. Read what we found when probing PearlDiver’s database.

Where Is Ben Now? Trends in Venture Capital
What is being funded by VCs and why? First of all, spine is having to share the spotlight, says Gary Stevenson, Managing Partner at MB Venture Partners, LLC. Here Stevenson outlines what constitutes an attractive investment…he also highlights issues that are affecting the distribution of VC funding.

The Hounds of Wall Street
Conventional wisdom on Wall Street is that ArthroCare is in a bare-knuckle fight to the finish with short sellers. Which leaves us with the dominating question: If ArthroCare is essentially a “lame duck” growth stock, then why are sales, earnings, and the stock price contradicting the short seller’s dire predictions and even outperforming consensus analyst forecasts? We have the answer.

The Era of “Tell Me Right Now” Dawns at FDA
The FDA wants the next phase of post-market oversight to change from self reporting to proactive surveillance. How? Through the Sentinel Initiative. Read what it means to device manufacturers here.

The Day After Tomorrow: Complication Rates and Instrumentation Trends in Posterior Lumbar Fusion
Could PearlDiver be the Nostradamus of spinal instrumentation? This most commonly performed surgery on the lumbar region of the spine increases fusion rates and improves spinal stability—but what about complications? Using PearlDiver’s database we find the answers. Are you ready for some quatrains about what happens next?

You Try It. No You Try It First: New Technology Adoption
What are the forces working for and against new technology adoption? Youth versus age, risk taking versus conservatism, and the economic realities of the day, says Dr. Rick Guyer, President of the Texas Back Institute.

Cheaper, Thinner, Faster, Stronger
In this, the second of our series of three articles on innovation, we tackle the question: How do you measure medical technology innovation? While difficult, measuring innovation is NOT impossible. Why? Well to start, and in the immortal words of Supreme Court Justice Potter Stewart, “We know it when we see it.”

SAS Crosses the Rubicon in Miami Beach
The SAS 8th Annual Global Symposium in Miami Beach may have crossed the Rubicon. How? Read about the Society’s opportunities for growth and collaboration as its new President lays out a vision for the future.

“I was drawn to orthopedic trauma, in part, due to the excitement and inspiring outcome of challenging spine cases and by my attraction to the tool/instrument centered nature of spine surgery,” says Dr. Thomas J. Errico, chief of the Division of Spine Service and associate professor of Orthopedic and Neurologic Surgery at New York University Medical Center (NYUMC). While there were certainly trials associated with becoming a surgeon and spine specialist, Dr. Errico could have ended up experiencing a very different set of trials indeed.

A “Jersey boy,” Dr. Errico says that when his older brother went into medicine, his family decided that young Thomas should become a lawyer because he had the gift of gab. However, fate intervened.

“My brother moved back from Georgetown with all his medical books in tow,” says Dr. Errico. “I was only 12 years old, but while taking biology, I had gotten hooked. It wasn’t the frogs that captivated me—it was the beautiful intricacies of how things worked. Between my introduction to the study of living things, dissecting frogs and having access to my older brother’s medical texts, I worked up my enthusiasm from amphibians to human beings.”

Several years later, he would be expressing this love for science and medicine in Italian. “Once I graduated from Rutgers University, although I had done well, entrance to medical school was more highly competitive than in past years. The system was changing to accommodate more women and minorities, so there was tough competition everywhere. A friend had gone to Italy the year before for medical school and suggested that I investigate this as a possibility. I researched several schools and found that the University of Bologna was an excellent institution and a good fit. I began my studies there in 1972 at the age of 20. I had graduated from high school at the age of 16 and so was fairly young to be entering medical school. It was also rather intimidating to have all my classes in Italian. I panicked immediately and started taking three Italian courses a day. Fortunately, many of the scientific words were based in Latin, so a lot of the vocabulary in English was virtually the same. At first, reading a page took an entire hour, but soon that was reduced to 45 minutes. Before I knew it, I was reading comfortably in Italian.”

Although enriched by his Italian medical school experience, Thomas Errico still had thoughts of returning home during his studies. “There are two entry points to medical school in the U.S., the first year and the beginning of the third. I studied for Part I of the U.S. National Board Exams, did well, and decided to transfer home to the University of Medicine and Dentistry in Newark, New Jersey. At one point, I supported myself as a framing carpenter for homes and carried my tools in my car trunk. One day, my brother, now an OB-GYN, asked me to help him with a project. He took a look in my trunk and said, ‘You should become an orthopedic surgeon.’ A light bulb went on.”

Dr. Errico’s blossoming interest in the orthopedic world would eventually lead him to the place where it all began. “I got one of the premier orthopedic rotations in medical school—spine surgery. Even as I watched a Harrington rod procedure, I had not yet decided on a career in spine. I did like the observable, ‘speedy’ results, however. Some people with a medical degree are happy with keeping something in check, but I prefer the immediate gratification of orthopedic surgery. In my senior year of medical school, I decided I wanted an exciting elective and at that point was still trying to decide between general surgery and orthopedics. Bellevue Hospital, the location of clinical instruction for NYU School of Medicine, was the oldest hospital in the country and the first department of orthopedics in the country. I was thrilled when they offered me a trauma elective in November 1977. Gunshot wounds, car accidents, people who had jumped off of buildings ... we saw it all. The Trauma Service worked closely with the Orthopedic Trauma Service, so I was thrust into working with orthopedic surgeons. This was such a fulfilling experience that I asked for and received a one-month extension in orthopedics and made my decision to commit to the field.”

Continues Dr. Errico, “During this time, Dr. Theodore Waugh, then chairman of the Orthopaedic Surgery Department, was my mentor. He handed me a significant amount of responsibility and helped foster my interest in spine. His trust in my judgment developed my confidence level. I was fortunate to be the chief resident for two years and to spend a year of that position at Bellevue. I had just started my chiefship when a 16-year-old boy with a spine fracture and bilateral paralysis of the legs came into the ER. Dr. Gordon Engler, another mentor and spine surgeon, did a middle-of-the-night procedure on the boy, used Harrington rods, and corrected the fracture. When this young boy woke up, he could move his feet. I was astounded and knew that spine was my new, permanent love.”

The feeling was mutual as spine offers began to come calling. “While attending a course in orthopedic surgery at the Hospital for Joint Diseases in 1982, I attended a lecture given by Dr. John Kostuik, then of Ontario, Canada, and now chief of the Spine Division at Johns Hopkins, Baltimore. Dr. Kostuik offered me a spine fellowship at the University of Toronto, which I undertook from 1983-1984. Soon after I secured my fellowship, my residency chairman said, ‘We could use another spine surgeon here at NYUMC.’ It was a relief to know that I would be going to a familiar and esteemed program following my fellowship.”

Dr. Errico would be studying, both in Canada and later “across the pond,” an aspect of spine surgery that captured his imagination and defined much of the direction of his career. “One of the things that led me into orthopedics was a fascination with the instrumentation. Spine surgery in the early 1980s did not involve a lot of instrumentation. I was ‘Euro-friendly’ and knew that across the Atlantic people were doing interesting work with instrumentation. So I packed my bags and spent some time learning from the Europeans. In particular, I had become interested in Roy-Camille plates and screws and at one point had the great opportunity to meet him. Dr. Roy-Camille had developed one of the first pedicle screw systems and posterior cervical plate systems. Dr. Kostuik was also an innovator in spinal instruments, and, in fact, some of my early papers were on his instrumentation. Through these experiences, I learned that my ultimate goal would be to expand the use of instruments in spinal surgery. To this end, I engaged in spine fracture research and published a textbook on spine trauma in 1990, which demonstrated the different kinds of instrumentation techniques that were emerging from the field.”

In the 90’s, Dr. Errico began to explore the potential crossover between orthopedics and neurosurgery. “I soon became interested in metastatic tumors of the spine by working with the Neurosurgery Service at NYUMC. Although this was unusual in those days, because the departments were competitors, I developed a close working relationship with Dr. Paul Cooper, a neurosurgeon. It was one of the most satisfying professional relationships I’ve ever had. We did innovative and interesting surgical procedures for more than 10 years, which resulted in a number of research papers on metastatic disease of the spine and on papers of other pathologic spinal conditions. Interestingly, we found that surgeons could be intimidated by an anterior approach to the spine. Because of my training with Dr. Kostuik, however, who was a master of this approach, I brought to NYUMC an enthusiasm and expertise in anterior approaches. We even applied these techniques to tumors, which was unique. Some surgeons were cautious at first, saying that these patients were old and frail and could not handle an anterior approach. But I knew we could do it safely—and we did. Now the trend is posterior, of course, due to better techniques and instrumentation options.”

When asked about his most memorable day at work, Dr. Errico recalls a day unforgettable for all Americans: September 11, 2001. “I was operating at the Hospital for Joint Diseases [HJD], which in 1996 had merged its orthopedic department with NYUMC’s department. I had been chief of Spine at NYUMC, and after the integration of the two departments, became chief of the Spine Service at both institutions. I divided my surgery schedule between HJD and NYUMC. HJD was located on 17th Street and Second Avenue, which was closer to the World Trade Center than NYUMC, situated between 34th and 30th Streets. I was operating that morning, doing an anterior/posterior case on a young girl. I was just about to scrub for the anterior aspect when an orderly told me, ‘A plane just flew into the World Trade Center.’ My first reaction was to think that it was probably a Cessna or some other small plane. I saw everyone beginning to scramble, however, and we learned quickly that every hospital was canceling elective surgeries. The unfolding crises downtown and potential threats to the city and the country soon were apparent. My patient was already open, so I had to finish this operation. It required a great deal of focus, perhaps the most I recall having to muster. Maybe because I had started my career there, I knew I had to get to Bellevue, our major trauma receiving center, as soon as possible.”

Continues Dr. Errico, “As I left the Hospital for Joint Diseases, I saw a man being escorted into the hospital, bleeding from his hands and covered with a white dust that looked like talcum powder. I looked into his eyes and saw this dazed look. The ambulances that had brought these minor casualties were also covered with this white dust, while the rest of the street was clean. When I got to Bellevue, there was a line of people three blocks long. When I asked what it was for, someone responded, ‘We’re all waiting to give blood.’ I reported to Dr. Noel Testa, the chief at Bellevue for Orthopedic Services. Essentially, however, nothing was happening. There were more doctors per square foot in that hospital than imaginable, as everyone had heard about the tragedy and rushed in. We were all geared up for injuries, but there were few. The little trauma we did see came from people being on the periphery of Ground Zero. The entire day was a bizarre and unsettling experience.”

Whether in a national emergency or a ‘How are you today, Mr. Jones?’ situation, Dr. Errico brings all his years of travel, study, and research to the needs of the patient. “I think my patients would be surprised to learn that when I render them care, when I suggest something for a particular person, that there is an incredible network of preparation that has gone into my decision making. From my orthopedic residency training to my fellowship in Canada, and more, I have focused on acquiring the best information and skills for my patients. Attending spine meetings and interacting with surgeons from all over the world, reading scientific literature, searching for evidence in the literature, working with doctors I admire ... all go into forming an expert opinion that is individualized to each patient. This is true for most spine surgeons I know.”

Says Dr. Errico, past president of the North American Spine Society, “If there was a story to tell about my time as an orthopedist, it’s that I came to this institution, NYUMC, more than 25 years ago, became involved in a small spine service, and watched the evolution of the relationship between the NYU School of Medicine/NYU Medical Center and The Hospital for Joint Diseases. We are now a huge institution with more than 100 orthopedic faculty members, sixteen of whom are full-time spine specialists, with four spine fellows per year, rotating residents and the wonderful Dr. Joseph Zuckerman as chairman of Orthopedic Surgery. We do several thousand spine operations per year.”

From an ocean of commitments to an ocean of calm. “When I need a change of pace, my wife and I take our three children and head for the sea. We have a fantastic time deep-sea fishing for tuna and white marlin, among other things.”

Dr. Thomas Errico ... in spine veritas.