Copy to clipboard 
Robert J. Rothrock, M.D., only ever wanted to be a neurosurgeon. A family event drove his focus on the specialty and his training and fellowships in minimally invasive and reconstruction spine surgery and spinal oncology. As Neurosurgical Director of Spinal Oncology at Baptist Health’s Miami Neuroscience Institute, he performs a mix of spine procedures, from degenerative to complicated infections to tumors.
The breadth of Dr. Rothrock’s practice exposes him to an array of technology and makes him keenly aware of room for product advancements. We met Dr. Rothrock through his use of Stryker’s Capri Expandable Corpectomy Cage, and asked for his thoughts on the state of spine implant technology.
Stryker’s Capri Expandable Corpectomy Cage System
We’ve edited his comments for clarity and brevity.
From a product trends perspective, what excites you most these days and why?
Dr. Rothrock: There’s been a huge push toward systems-based approaches, meaning navigation, robotics, enabling technologies. My opinions are not representative of thousands of other surgeons, but I care more about the actual stuff — what we use daily: instruments or interbody cages or screws.
As tried and true as pedicle screw fixation is, there are always ways to improve. Interbodies are getting increasingly sophisticated, meaning interbody cages for the lumbar spine, corpectomy cages and expandable cages.
One of the most amazing things about being a surgeon is that there’s so much available, especially in spine. When it comes to FDA-cleared hip implants, there are only a few. Knee implants, only a few. In the spine, there is a huge range.
When it comes to spine, I’m always wondering, where can we push things? Minimal access is one way. In 20 years, I’d love to see the field become even smaller than where we are now in terms of invasiveness.
What are some of the current benefits that you see with newer products?
Dr. Rothrock: I have the advantage of coming of age in a really exciting time in spine. When I speak with even the people who went through my training program 10 years ago, they didn’t train in lateral access surgery. It’s taken time, but lateral interbody fusion is hugely popular.
Let me give an example. I did an anterior lumbar fusion in a patient with a very calcified aorta. I had a phenomenal vascular surgeon at my hospital who could somewhat mobilize the aorta. Ten years ago, we might have been in a position where that was a no-go.
Now, interbody cages have two insertion points so that the inserter actually cannulates obliquely. Now, instead of this fist you have to shove in, you have this maneuverable shape and can come in from the side. Now you have this massive cage in a situation where you couldn’t 10 or 15 years ago.
That is down to something as trivial as where a screw is placed, where articulation is. Right? But that is something that’s manufactured. It had to be thought out. All of the instruments have to be prefabricated down to even the disc prep, the instruments that you’re removing discs with; these are all things that someone had to think of, develop and execute. So, it’s not always these big, sexy topics.
We were connected about Stryker’s Capri Cage. Do you have any specific insights on that implant?
Dr. Rothrock: I use a wide variety of instrumentation strategies, and not every case needs a corpectomy. The most critical thing with corpectomy is that you span as much end plate as possible for load sharing. Part of the caveat is you need something that goes in small and ends up bigger than it is, by definition.
The nice thing about Capri is its maneuverability and its oblique insertion points. You can maneuver it very well in small spaces. I do all my corpectomy work from a posterior approach. I’ve used it in a few different scenarios, including for infection for tumor.
In general, the reason that I use implants like Capri is that I use all titanium. Especially in infection scenarios, titanium has been demonstrated in multiple studies with pedicle screws or cages to be more bacteriostatic than using PEEK or other composites. The downside for tumor is that it creates more metallic artifact. But I care more about durability than artifact, usually.
What would you tell spine companies that seek to develop the next generation of technologies?
Dr. Rothrock: The best companies that do this have heavy surgeon involvement. Just speaking frankly, the idea of enabling technology sometimes feels like someone decided in a boardroom that it would be the new focus. If you talk with surgeons, that’s not always what we’re worried about. That little oblique fixation point on a cage matters much more than what color scheme you picked for a navigation system.
The best way forward is with partnership between surgeons and industry. It’s been made out to be adversarial in some forums because, unfortunately, people have abused the systems. This ecosystem is about cooperation, dialogue and engagement among tech companies, surgeons and hospital systems.
I think that the way forward is more minimal. I’m young, but the more I do, I see that less is more and that nature does it best. The more we mimic nature with everything we do, which means paying attention to spinal pelvic parameters, sagittal balance, preserving anatomy, that should be our goal in everything we do.
There are a lot of great new technologies that I’ve seen and integrated, that make me better and safer. And I think that’s the way forward. We learn from our mistakes. We push forward. We get better every day.
Robert J. Rothrock, M.D., only ever wanted to be a neurosurgeon. A family event drove his focus on the specialty and his training and fellowships in minimally invasive and reconstruction spine surgery and spinal oncology. As Neurosurgical Director of Spinal Oncology at Baptist Health’s Miami Neuroscience Institute, he performs a mix of spine...
Robert J. Rothrock, M.D., only ever wanted to be a neurosurgeon. A family event drove his focus on the specialty and his training and fellowships in minimally invasive and reconstruction spine surgery and spinal oncology. As Neurosurgical Director of Spinal Oncology at Baptist Health’s Miami Neuroscience Institute, he performs a mix of spine procedures, from degenerative to complicated infections to tumors.
The breadth of Dr. Rothrock’s practice exposes him to an array of technology and makes him keenly aware of room for product advancements. We met Dr. Rothrock through his use of Stryker’s Capri Expandable Corpectomy Cage, and asked for his thoughts on the state of spine implant technology.
Stryker’s Capri Expandable Corpectomy Cage System
We’ve edited his comments for clarity and brevity.
From a product trends perspective, what excites you most these days and why?
Dr. Rothrock: There’s been a huge push toward systems-based approaches, meaning navigation, robotics, enabling technologies. My opinions are not representative of thousands of other surgeons, but I care more about the actual stuff — what we use daily: instruments or interbody cages or screws.
As tried and true as pedicle screw fixation is, there are always ways to improve. Interbodies are getting increasingly sophisticated, meaning interbody cages for the lumbar spine, corpectomy cages and expandable cages.
One of the most amazing things about being a surgeon is that there’s so much available, especially in spine. When it comes to FDA-cleared hip implants, there are only a few. Knee implants, only a few. In the spine, there is a huge range.
When it comes to spine, I’m always wondering, where can we push things? Minimal access is one way. In 20 years, I’d love to see the field become even smaller than where we are now in terms of invasiveness.
What are some of the current benefits that you see with newer products?
Dr. Rothrock: I have the advantage of coming of age in a really exciting time in spine. When I speak with even the people who went through my training program 10 years ago, they didn’t train in lateral access surgery. It’s taken time, but lateral interbody fusion is hugely popular.
Let me give an example. I did an anterior lumbar fusion in a patient with a very calcified aorta. I had a phenomenal vascular surgeon at my hospital who could somewhat mobilize the aorta. Ten years ago, we might have been in a position where that was a no-go.
Now, interbody cages have two insertion points so that the inserter actually cannulates obliquely. Now, instead of this fist you have to shove in, you have this maneuverable shape and can come in from the side. Now you have this massive cage in a situation where you couldn’t 10 or 15 years ago.
That is down to something as trivial as where a screw is placed, where articulation is. Right? But that is something that’s manufactured. It had to be thought out. All of the instruments have to be prefabricated down to even the disc prep, the instruments that you’re removing discs with; these are all things that someone had to think of, develop and execute. So, it’s not always these big, sexy topics.
We were connected about Stryker’s Capri Cage. Do you have any specific insights on that implant?
Dr. Rothrock: I use a wide variety of instrumentation strategies, and not every case needs a corpectomy. The most critical thing with corpectomy is that you span as much end plate as possible for load sharing. Part of the caveat is you need something that goes in small and ends up bigger than it is, by definition.
The nice thing about Capri is its maneuverability and its oblique insertion points. You can maneuver it very well in small spaces. I do all my corpectomy work from a posterior approach. I’ve used it in a few different scenarios, including for infection for tumor.
In general, the reason that I use implants like Capri is that I use all titanium. Especially in infection scenarios, titanium has been demonstrated in multiple studies with pedicle screws or cages to be more bacteriostatic than using PEEK or other composites. The downside for tumor is that it creates more metallic artifact. But I care more about durability than artifact, usually.
What would you tell spine companies that seek to develop the next generation of technologies?
Dr. Rothrock: The best companies that do this have heavy surgeon involvement. Just speaking frankly, the idea of enabling technology sometimes feels like someone decided in a boardroom that it would be the new focus. If you talk with surgeons, that’s not always what we’re worried about. That little oblique fixation point on a cage matters much more than what color scheme you picked for a navigation system.
The best way forward is with partnership between surgeons and industry. It’s been made out to be adversarial in some forums because, unfortunately, people have abused the systems. This ecosystem is about cooperation, dialogue and engagement among tech companies, surgeons and hospital systems.
I think that the way forward is more minimal. I’m young, but the more I do, I see that less is more and that nature does it best. The more we mimic nature with everything we do, which means paying attention to spinal pelvic parameters, sagittal balance, preserving anatomy, that should be our goal in everything we do.
There are a lot of great new technologies that I’ve seen and integrated, that make me better and safer. And I think that’s the way forward. We learn from our mistakes. We push forward. We get better every day.
You are out of free articles for this month
Subscribe as a Guest for $0 and unlock a total of 5 articles per month.
You are out of five articles for this month
Subscribe as an Executive Member for access to unlimited articles, THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT and more.
CL
Carolyn LaWell is ORTHOWORLD's Chief Content Officer. She joined ORTHOWORLD in 2012 to oversee its editorial and industry education. She previously served in editor roles at B2B magazines and newspapers.
