North American Spine Society, 2006 Annual Meeting

[mmglobal]

I'm looking forward to tomorrow. This will be my 3rd NASS meeting. This is the largest spine congress there is and there is always a ton of new info.

Click here for the final program.

I should be able to provide a copy of the proceedings for the iSpine lending library.

I'm planning on blogging the conference on the GPN site.

If there is any technology that someone wants particular info about, please post here and I'll see if I can get it for you.

More tomorrow!

Mark

[Jim M2]

Mark,

Here's some questions.
What are possible end-game scenarios for a post-ADR patient who has significant facet pain? Will the pain stay forever? Will the facets wear down to bone on bone and then fuse?

Jim

[mmglobal]

Jim, there was some discussion about using interspineous spacers (specifically coflex) to open facets. There is also some consideration for Dynesys to open posterior elements and restrict motion. These configurations have been done in a handful of cases. The good thing about the posterior systems is that the collateral damage is small and revising to fusion is simple. However, there is discussion about fusing failed ADR, getting good fusion and still not getting relief. This would tend to indicate that the problem has always been inability to diagnose the pain generator. The speculation is that even with successful fusion as the first surgery, the patient would not have gotten better. When asked about this situation at the complications poster session yesterday afternoon, Dr. Bertagnoli indicated that if there are not clear indications for fusion, he would still consider fusing the failed ADR patient as a last-ditch effort, but only after casting the patient, INCLUDING ONE leg. This immobilizes the lumbar spine. If this substantially reduces the pain, that gives more confidence that the fusion will help.

I'd be surprised if the facets will fuse spontaneously on their own in the presence of a highly mobile segment. I'll ask.

Mark

[Jim M2]

Mark,

A body cast? Dr. B is very innovative. The fact that one leg needs to be casted to immobilize the lumbar has meaning to me. That part of my pain that's motion dependent is highest when the legs are moving apart, for example when walking. The longer the stride, the higher the pain. The pain is always on the back-foot side of the spine. What I mean is, if the right foot is behind me, the right side of the L5S1 level spine gets sharp pain.

It would seem unlikely for the facets to self-fuse. Dr. Zeegers told me at the GPN seminar ('05 in Fountain Valley) that fused ADRs weren't very successful because even with backside fixation the level isn't immobilized enough to eliminate the pain. I'm grasping at straws trying to imagine how this plays out long term. Usually the body finds a fix but it takes a long long time.

That is an awesome post you made. It is the last word on the state of this problem. I hope others find their way to ispine soon.

Many thanks,
Jim

[fortitudine]

Since NASS includes all spine surgeons, I would think it a better indicator of thelevel of acceptance of ADR than the SAS conference. Did you get any impression of whether the general spine surgeon population was warming up to ADR? Was there more positive response compared to previous NASS conferences?

[mmglobal]

Fortitudine,

It's been very interesting watching this unfold. My first spine surgeon's conference was AAMISMS (American Academy of Minimially Invasive Spinal Medicine and Surgery - see http://www.aamisms.com/) in December of 2002. This is where I met Dr. Bertagnoli and Dr. Yeung. At this conference, I became something of a curiosity... a real live ADR patient. Almost none of the attendees knew anything about ADR... very few believed in the technology.

I've been to all 4 SAS (Spine Arthroplasty Society - all about motion preservation) meetings and 3 NASS (North American Spine Society - all about spine... the largest spine congress) meetings since then. It's been interesting watching the attitudes of the medical community change.
The patients have seen it in their interactions with thier doctors:

• 2002: I've not heard of disc replacement, but it can't be good.
• 2003: I've heard of disc replacement, but I won't even consider it until it's been FDA approved for 5 years.
• 2004: Yes it looks promising, but it's still not proven.
• 2005: I'm trying to get training, but they are scheduling 10 months out.
• 2006: I've been trained and have done a few cases, but the insurance companies still aren't paying.

As your question indicates, there is a difference between SAS and NASS. SAS has been attended by the medical community and portions of the industry that embraces motion preservation. The early SAS meetings were pretty outrageous Rah-Rah events. Many articles were written in orthopedics industry newsletters about how 'salesy' they were. As the years have unfolded, more and more balanced data has been presented. The doctors who presented early successes with unbridled enthusiasm, have been tempered by their real-world experiences.

In the first years, there was a big difference... now it's much less apparent. There are fewer motion preservation naysayers at NASS than there were a few years ago. The rah-rah ADR enthusasim of SAS's past is toned down. There is a HUGE overlap in the presentations... with many of the same papers presented at both conferences.

Both are excellent congresses with a ton of good info. There is much to complain about as well. Much of the data that is presented has less to do with science and medicine than it does with marketing. It's very difficult to separate the useful info from the marketing spin. The acceptance of data that clears the 'published in peer-reviewed journals' bar, must be reviewed with a very critical eye. Just because it's published in the NASS journal does not mean that it's useful in our decision making process. It certainly may well be... but the fact that it's here doesn't make it so.

Mark

[letteski]

Fortitudine, great question and thanks Mark for your insight on how the Doctors are moving with spine technology. As for choosing a spine specialist I would want someone that takes the extra step and keeps up on the latest technology, attends advents like this, and even better if they are a presenter. Did I read somewhere that you ran into Dr Delamarter. During my first interview with him he said I was asking questions that were being asked by other doctors at doctor’s conference. I got my information from reading forums like this. I was able to talk the talk with one of the top docs. Thanks for all your great info Mark and most of all for I-Spine

[chasswen]

looks like we need the spamer banned.
chuck