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.

Dr. Daniel Berry, chair of the orthopedics department at the Mayo Clinic, enjoys the myriad responsibilities that come with his position. He takes particular pleasure in seeing a glint in the eyes of the young residents and fellows he trains ... he knows that means their minds are opening.

And Dr. Berry likes open minds. Born in Oregon to an English teacher mother and a pediatrician father, Daniel Berry traveled the world with his parents. “My father spent time as a doctor with the Peace Corps,” says Dr. Berry. “We lived in Bombay, India for two years, where I learned a perspective on the developing world I never would have had. This experience fostered a love of travel and other cultures, and, most importantly, taught me to have an open mind.”

Years later, armed with an inquisitive outlook, Daniel Berry went to college at Dartmouth, then Harvard Medical School. “For years I thought about pursuing a career as a scientist because I enjoyed the prospect of discovery. I was studying biochemistry. In the end, however, medicine was more alluring because I thought it had the most direct positive effect on people’s lives. I wanted to be able to ensure I was making a difference on a regular basis.”

With its concrete, often immediate feedback, orthopedics fit the bill. Says Dr. Berry, “I enjoyed a lot of different fields in medicine. I chose orthopedics because of the diversity of surgical challenges, the immediate effects, and its reconstructive aspect. My longstanding interest in woodworking meant that I enjoyed building things. I could tell that orthopedics would give me a sense of building things up as opposed to cutting them out. Last, but not least, I really enjoy the kind of people who do orthopedics.”

Stimulated by the environment, Dr. Berry remained at Harvard for his orthopedic residency. “During my residency, I was influenced by Dr. William Harris, a father of modern hip surgery. He was extremely dedicated to learning about the hip and the science of orthopedics. More than anyone, he demonstrated the value of having a complete commitment to a subject. Dr. Harris was always more passionate than anyone else in the room. It became obvious to me that the biggest decision I would have to make during residency was whether or not to subspecialize. My decisionmaking process led me to hips and knees because of the reconstructive elements and because it was a field that was moving forward rapidly with a lot of technological innovations and technical challenges. During this time, Drs. Richard Scott and Tom Thornhill were instrumental in helping me make this decision and refine my clinical skills. Critical to my residency experience was Dr. Clement Sledge, then chair of the orthopedics department at Brigham and Women’s Hospital. Dr. Sledge was an extremely bright man who was very interested in seeing younger doctors achieve success. An amazing man, he could walk into a room with a Harvard professor he was treating and speak to that person in detail on their specialty. If it was an economics professor, they might delve into international trade or resource allocation—a political science professor would be engaged in a discussion on such-and-such issue within that field. You can imagine the rapport he developed with these patients. As for me, perhaps the most important thing he did was arrange for me to do a fellowship in Europe. Dr. Sledge recognized the value of cultivating a broad perspective; I was inspired by his energy and by my past cross-cultural experiences. I elected to spend six months in Europe doing a fellowship. This time in Paris and Switzerland was one of the most enlightening and enjoyable experiences of my career.”

Continues Dr. Berry, “A highlight of my fellowship training was working with the remarkable Dr. Maurice Meuller, a forward-thinking physician who had the vision to see how what was happening now could be translated to the future of orthopedics. Dr. Meuller was meticulous about preoperative planning and had a deep understanding of orthopedic surgery and the people who practice it. He taught me that if you want orthopedic surgeons to listen to you, you have to interest them first. This wisdom also applied to the realm of publishing in scientific journals. ‘Grab your reader,’ he would state emphatically. His instruction to ‘always have a few brief sentences telling the reader why your work is relevant and interesting’ has stayed with me to this day.”

Settling back into the rhythm of life in America, Dr. Berry then entered a one-year fellowship at the Mayo Clinic and has been there ever since. “I was recruited by Dr. Bernie Morrey, then chair of orthopedics at Mayo. I had not planned to stay in the Midwest, but the environment in the Mayo Clinic Orthopedic Surgery Department is so unique and compelling that I’ve never wanted to leave. The clinical environment is stimulating and the professional atmosphere is collegial. Through the years, Dr. Morrey continued to be a mentor and friend. When I was named chair of the department, he let me know what to expect. He has been and continues to be particularly helpful in teaching me how to navigate the complex waters involved in chairing a major orthopedic surgery department.”

Complex waters are also found in the relationship between clinical orthopedics and the orthopedic industry. Says Dr. Berry, “One of the hallmarks of orthopedics is that it is a forward-thinking field. We lead with innovations, something that is usually great for our patients. This tends to set us apart from some surgical specialties that have stagnated. Innovation flourishes within a dynamic industry. The negative side is that industry goals and our goals as doctors are not always the same. The reality is that industry has a responsibility to their stockholders, so sometimes they have a different perspective than surgeons. One of these is the issue of how new technology should be introduced. It must be introduced responsibly, with careful testing and follow up of the technology after introduction to ensure it continues to function correctly. Many orthopedic innovations have a long timeline, so even many years later there should be postmarket surveillance conducted. The other issue here is how rapidly new technology should be introduced. As surgeons we may feel that’s it prudent to go slowly. Industry, on the other hand, doesn’t always see it that way.”

Living the forward-thinking ethos, those at the Mayo Clinic have developed a resource that any orthopedic program would envy. States Dr. Berry, “At Mayo we have a registry of all joint replacements done here. As you can imagine, this is an enormous help to us. Much of my clinical research work is studying the factors that go into successful joint replacement, so I use the registry on a regular basis. One recent project involves the diameter of the femoral head. We were able to demonstrate something conclusively that had long been suspected but not proven: larger diameter heads are more stable than smaller heads and dislocate less. This is important because new technology allows use of a bigger head without too much wear. We also recently published an article where we looked at the long term follow up of 1000 knee replacements and examined what caused some of them to fail. We found that even though everyone has been focused on the possibility of mechanical failure, for the first 15 years after the inception of modern knee replacement, the more common problems were infections or fractures. We need a renewed effort to address these issues.”

When not doing research or working with patients, Dr. Berry enjoys the teaching aspects of an academic orthopedic surgery practice. “We have 50 orthopedic residents at Mayo, as well as two or three joint replacement fellows every year. Our goal is that they become the best surgeons and clinicians they can be. Personally, I want them to gain the knowledge of our specialty necessary to be excellent orthopedists. Also, I attempt to inculcate the discipline and the detail of clinical practice that helps them avoid problems. For example, I stress to the residents that they should spend a significant amount of time planning what they are going to need in surgery. Specifically, I tell them to plan for all eventualities. It’s also very exciting to watch residents and fellows go towards academic medicine and follow a question they are interested in. I find it quite satisfying to assist them with publishing and presenting their results. And then there’s the glint in their eyes.”

Putting a glint in Dr. Berry’s eyes is his young family. “My daughter is 10 and my son is eight. We spend a lot of time outdoors, backpacking, and hiking. When on my own, I have a great time fly-fishing and skiing.”

Dr. Daniel Berry ... sharing his clinical curiosity and furthering the field with his measured, detailed approach.