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During his OMTEC 2014 Keynote, Robert S. Bray, Jr., M.D., charged spine companies to make improvements in the following areas. He spoke from nearly four decades of experience as a neurological spine surgeon and as the CEO and Founding Director of DISC Sports & Spine and Co-Founder and Inventor at RSB Spine.
Retractors
“People came out with tubes for minimally invasive retractors; we don’t work through tubes. Tubes are designed for endoscopes, where you turn them in circles and put them inside a closed joint like a knee or a shoulder. In spine, we don’t work through a round hole; it actually limits your view up and down. I don’t use it. Many people don’t. We need a retractor that allows minimally invasive approaches, that fits the pathway and maximizes our visual view.”
3D Navigational Systems
“Tons and tons of money spent; needs to be rethought. The problem is in registration. Registration changes. When you do a CAT scan, you take it as your baseline. When you flip the patient onto a frame, you change the entire position of their spine—it doesn’t match the CAT scan anymore. You have to register it to one point, and then you put an implant in and you move point A from point B, L4 moves from L5. Unless you reregister every single segment every single time, every screw is going to miss.
“They would be very useful if they actually worked efficiently and remapped constantly as we worked.”
Biologics
“We need the Holy Grail. If you’re in the biologics business, figure this one out. It has to be nonimmunogenic, so it can’t evoke immunologic reactions. It has to be solid scaffolding, so we can use it as a structural device.
“PEEK doesn’t heal. Stainless doesn’t heal. Titanium doesn’t heal. Bone heals, when you generate new bone. The surface area of the bone has to be great enough, but the scaffold that lies in place, if it’s not going to be bioabsorbable or incorporated, needs to be small enough that you get enough bone to actually work. The biologic has to be both osteoinductive and osteoconductive, and ultimately should be machinable. Ultimately we’ll get to 3-D laser printers, and we can print out and customize that space. They’re doing it for crowns.
“The bottom line is, well-researched. Not bought and paid data, but real research, real long-term outcomes, real disclosure complications. We are very much looking for the Holy Grail in biologics, and it is a huge market when it gets there.”
Artificial discs
“We don’t need motion; we need true motion, and we need controlled motion. When you put in a disc, it should move less than a normal disc. You don’t put a device in that moves normally or has more than normal motion; you put in a device that controls motion. You don’t put in a device that creates too much motion that creates pain. We need true motion; we need impact absorption. Metal on metal does not have impact absorption; discs were made to bounce. And, back to the same thing, it needs to be an easy to use implant and not a complication.”
During his OMTEC 2014 Keynote, Robert S. Bray, Jr., M.D., charged spine companies to make improvements in the following areas. He spoke from nearly four decades of experience as a neurological spine surgeon and as the CEO and Founding Director of DISC Sports & Spine and Co-Founder and Inventor at RSB Spine.
Retractors“People came...
During his OMTEC 2014 Keynote, Robert S. Bray, Jr., M.D., charged spine companies to make improvements in the following areas. He spoke from nearly four decades of experience as a neurological spine surgeon and as the CEO and Founding Director of DISC Sports & Spine and Co-Founder and Inventor at RSB Spine.
Retractors
“People came out with tubes for minimally invasive retractors; we don’t work through tubes. Tubes are designed for endoscopes, where you turn them in circles and put them inside a closed joint like a knee or a shoulder. In spine, we don’t work through a round hole; it actually limits your view up and down. I don’t use it. Many people don’t. We need a retractor that allows minimally invasive approaches, that fits the pathway and maximizes our visual view.”
3D Navigational Systems
“Tons and tons of money spent; needs to be rethought. The problem is in registration. Registration changes. When you do a CAT scan, you take it as your baseline. When you flip the patient onto a frame, you change the entire position of their spine—it doesn’t match the CAT scan anymore. You have to register it to one point, and then you put an implant in and you move point A from point B, L4 moves from L5. Unless you reregister every single segment every single time, every screw is going to miss.
“They would be very useful if they actually worked efficiently and remapped constantly as we worked.”
Biologics
“We need the Holy Grail. If you’re in the biologics business, figure this one out. It has to be nonimmunogenic, so it can’t evoke immunologic reactions. It has to be solid scaffolding, so we can use it as a structural device.
“PEEK doesn’t heal. Stainless doesn’t heal. Titanium doesn’t heal. Bone heals, when you generate new bone. The surface area of the bone has to be great enough, but the scaffold that lies in place, if it’s not going to be bioabsorbable or incorporated, needs to be small enough that you get enough bone to actually work. The biologic has to be both osteoinductive and osteoconductive, and ultimately should be machinable. Ultimately we’ll get to 3-D laser printers, and we can print out and customize that space. They’re doing it for crowns.
“The bottom line is, well-researched. Not bought and paid data, but real research, real long-term outcomes, real disclosure complications. We are very much looking for the Holy Grail in biologics, and it is a huge market when it gets there.”
Artificial discs
“We don’t need motion; we need true motion, and we need controlled motion. When you put in a disc, it should move less than a normal disc. You don’t put a device in that moves normally or has more than normal motion; you put in a device that controls motion. You don’t put in a device that creates too much motion that creates pain. We need true motion; we need impact absorption. Metal on metal does not have impact absorption; discs were made to bounce. And, back to the same thing, it needs to be an easy to use implant and not a complication.”
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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.
