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Procedure of the Month

This is the case of a 68 year-old male suffering from severe back pain for 3 months. Patient failed conservative treatment with high doses of analgesics. MRI was performed, as shown in Figure 1 below. This T2-weighted image clearly revealed evidence of acute fracture with bone marrow edema at the L1 level. Which choice do you think best describes the patient's treatment options (click on the x-ray below to take the multiple choice/guess test)?

Figure 1: Preoperative T2-weighted sagittal MRI showed evidence of bone marrow edema indicative of acute fracture at the L1 level (arrow).

Case review and x-rays courtesy of
Dr. Bassem A Georgy.
Interventional Radiologist Valley Radiology Consultants Assistant Clinical Professor University of California, San Diego

SPONSORED BY:


Procedure of the Month Sponsored by DePuy Spine, Inc.


 

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Using DNA to Predict Scoliosis
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New Capital, New Science for Cartilage Repair
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Should I Become a Physician-Employee?
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Outrageous Whistleblower Lawsuit Challenged
Spine surgeons sued by whistleblowers in Boston are fighting back. Their lawyer is outraged and says the claimants are just shopping an old and settled case to another judge. Is this the proverbial lipstick on a pig? Find out.

Medical Education Under the Microscope – Is It Up to Today’s Challenges?
Where is the line drawn between what medical schools, residencies, and professors should provide to students and what doctors-in-training should reach for themselves? Here are the results of interviews with three senior surgeons, who opine on things such as attitudes, how people learn, and the possible effects on the field.

The Underlying Meaning of Zimmer’s Purchase of Abbott Spine
From the price paid to the timing, this transaction held an underlying meaning for the entire spinal implant industry. Zimmer, the $4.2 billion (revenue) diversified orthopedic company is now #5 in spine. More to come?

Resurging Lumbar and Cervical Total Disc Replacement Markets! New PearlDiver Estimates
Rumors of the TDA market’s demise were premature. Increasingly positive long term patient data is at the core of a resurging lumbar and cervical TDR market. Senior analyst Matt Menze tackles the TDA market and interviews one of the fathers of TDR, Dr. Scott Blumenthal from the Texas Back Institute. Where is this market actually heading? We think to the $2 billion range by 2015. All details here.

Six Days in June – Biomet and Zimmer Battle for Distributors in Kentucky
Documents filed recently in a Kentucky lawsuit pull the curtain back on an epic battle between Biomet and Zimmer. For six fevered days in June 2007, Biomet CEO Jeff Binder and founder Dane Miller went into the trenches to save one of their own. For all the details, read on.

Multicenter Clinical Trials: Do They Get the Respect They Deserve?
They’re not fast or sexy, but they are critical…large trials, that is. With multiple sites and principal investigators who donate their time, large trials are more complex—and normally yield more actionable data—than smaller, quicker studies. But large trials don’t always get the respect they deserve. And, says at least one physician-researcher, this could affect the future of the field.

Patent Wars: Medtronic Attacks NuVasive
MSD’s lawsuit came amid a period of declining spinal implant market share – from a peak of 60% in late 1998 (just prior to being acquired by Medtronic) to, we estimate, 36% currently – and a growing sense that MSD’s reign as the king of spine was coming to a close. What’s really behind Medtronic’s attack on its former senior exec? Read on.

Spine Gainsharing Through the Looking Glass
The feds have issued their first opinion allowing a spine gainsharing proposal. In Alice in Wonderland style, Through-the-Looking-Glass logic, they said the proposal was improper but would not impose sanctions. Who is the author of such a plan and what’s her secret? Read here.

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Orthopedic Incubators: Where Little Ideas Grow Up
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Staking a BIG Claim
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Frost & Sullivan Shines Light on Raymedica
By Elizabeth Hofheinz, MEd, MPH
April 24, 2008

Feelin’ hot, hot, hot! Frost & Sullivan has named Raymedica, LLC, as winner of the 2008 Frost & Sullivan Hot Investment Opportunity Award. Raymedica is involved in the development of a nucleus replacement technology aimed at preserving the motion of the spine and is a pioneer in the field of Nucleus Arthroplasty™. The company’s technology replaces only the diseased nucleus in the early stages.

In the news release, Frost & Sullivan Senior Research Analyst Sheetal Rajani said, "The company's technology addresses DDD [degenerative disc disease] through the replacement of the disc nuclei with a prosthetic device to restore and maintain height and spine motion. It uniquely addresses the category of patients who fall in the gap of being under-treated by a discectomy but over-treated by more invasive spine surgery."

Commercially available in the E.U. and Asia, the prosthetic disc nuclei have been implanted in over 5,000 patients worldwide. The company's two product platforms are PDN-SOLO® and HydraFlex™ Nucleus Arthroplasty System™ (NAS™) technology.

The prosthetic disc nuclei are composed of an inert hydrogel core encased in an inelastic, woven polyethylene jacket. Once implanted, the device absorbs fluid and expands within the disc space, thus maintaining height. The HydraFlex NAS is the fourth iteration of the company's proprietary technology, featuring improved designs such as a more contoured implant shape for a better fit, a larger footprint, and softer core.

As indicated by the company, in 2006, the 24-month preliminary results of a multi-center study conducted on 75 patients revealed that the PDN-SOLO showed an improvement both in terms of the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) scores—validated measurements to gauge the effectiveness of spinal treatment.

Thus far, Raymedica has received approximately $60 million in financing, primarily from Viscogliosi Brothers, LLC.

 

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