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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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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
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Spine Gainsharing Through the Looking Glass
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Orthopedic Incubators: Where Little Ideas Grow Up
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Staking a BIG Claim
Alphatec, the company whose IPO collapse served as an object lesson for all medical device companies, has nearly completed its turnaround. The key? New management and new technology. Exhibit A: OsseoFix™—with it Alphatec stakes a claim to the next big spinal implant market.

Wright Adds PROFEMUR® Stem Designs and Less-Invasive Surgical Technique
By Elizabeth Hofheinz, MEd, MPH
February 8, 2008

If there were an ortho-catwalk, Wright Medical would be shaking its hips. New from Wright in ’08 is a cemented modular neck hip implant (the company’s first), a wedged stem for revision hip replacement, as well as a new technique for total hip arthroplasty.

The first implant, known as the PROFEMUR® Xm Hip Stem, features a highly polished stem with a dual taper for cement engagement and implant rotational stability. With this, says Wright, stem insertion is simplified and surgeons have a new level of flexibility in addressing any number of patient anatomies. Wright indicates that it is the pioneer of modular neck implants and offers a broad spectrum of modular necks and modular neck stem philosophies backed by over 20 years of clinical results.

Also receiving attention is the PROFEMUR®Z Revision Hip Stem, which features a wedged stem for revision hip replacement surgeries. This implant is a longer version of the currently available PROFEMUR® Z Stem, which is Wright's most widely used primary hip stem. Because the PROFEMUR® Z Revision Stem uses the same instrumentation and surgical technique as the PROFEMUR® Z Primary Stem, the Revision Stem will provide many surgeon customers with ease of conversion during hip revision surgeries. Wright envisions that the PROFEMUR® Z Revision Stem will be useful in many revision scenarios, specifically revisions of loose stems with severe proximal and distal bone loss.

As for technique, the SUPERCAP™ for total hip arthroplasty was developed by Stephen S. Murphy, M.D., of New England Baptist Hospital in Boston. The goal of this approach is to safely perform total hip arthroplasty while minimizing the effects on the surrounding soft tissues. According to Wright, a unique feature of the SUPERCAP® approach is that it does not require surgical dislocation of the hip during the procedure, resulting in maximum preservation of the surrounding soft tissue. The fact that it is performed through a single incision is something that the company thinks may help reduce patient recovery times for a quicker return to everyday life.

As Dr. Murphy explained in the news release, "The soft tissues surrounding the hip are critical for function, strength, and stability. The more respectful we are of the soft tissues during surgery, the better the prospects for both short- and long-term outcomes."

Added Patrick Fisher, Wright’s Senior Director of Ortho Recon Marketing, "Wright continues to focus on total hip replacement innovations which allow physicians to never compromise patient outcomes. In addition, Wright takes great pride in its 'first to market' product launches. The SUPERCAP™ technique, in which surgeons never surgically dislocate the hip, and our unique PROFEMUR® Xm cemented modular neck femoral stem are two more innovations that keep Wright one step ahead of the competition."

 

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