The first week of the Castellvi Spine Conference is in the books. The topic of motion preservation in spine surgery was discussed in length, led by presentations from experts with decades of experience using and studying motion preservation technology. The discussion was led by me and Stephen Hochschuler, M.D., and the session moderator, William Welch, M.D. Unfortunately, Larry Khoo, M.D., was unable to present due to evacuations caused by the fires in Southern California.
Virtual Castellvi Spine Conference Week 1 Recap
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#castellvi#artificialdisc#interlaminarstabilization#motionpreservation
The evening start with a presentation by William Welch, M.D., Medical Director of the Spine Center and Department Chair of Neurosurgery at Pennsylvania Hospital. Dr. Welch provided an update on motion preservation technology by diving into the history of the technology, and discussing what concerns still need to be addressed going forward. When asked what the primary goal of motion preservation devices should be, the meeting attendees were evenly split between preservation or re-establishment of normal motion and unloading of the disc, facet joints and prevention of abnormal load distribution.
The next presentation, facet replacement technology, was provided by Scott Webb, D.O., from Florida Spine Institute in Clearwater, Florida. Dr. Webb focused his talk on the TOPS [total posterior spine system] facet replacement system, its slow progress through regulatory hurdles, its predecessors, such as the TFAS [Total Facet Arthroplasty System], and the repeated transfer of intellectual property for the technology. Globus Medical, Inc. owns the TFAS and ACADIA Facet Replacement System (AFRS) after its acquisition of Facet Solutions in 2011.
Reginald Davis, M.D. from the BioSpine Institute in Tampa, Florida, then presented on one of the latest trends in motion preservation technology, interlaminar stabilization (ILS). Devices, such as the coflex®, now sold by Surgalign Holdings, Inc., and Limiflex, from Empirical Spine, are ideally suited to address those patients where decompression alone is not sufficient, but fusion is overkill for their condition. The devices provide enough stabilization to prevent further progression of spondylolisthesis and avoid many of the perioperative risk associated with more invasive fusion procedures. Dr. Davis pointed out that disability and pain improvements are maintained to at least five years after surgery suggesting that these devices do more than just delay the need for fusion. He also presented data comparing decompression alone to decompression with an ILS device that showed improved function in walking distance.
The evening concluded after a discussion among panelists that touched on a number of concerns in the field such as the role of ambulatory surgery centers (ASCs) in different regions of the U.S. and the adoption of lumbar disc replacement. Most panelists agreed that it has been held up by reimbursement issues.
Next week, the discussion will focus on stem cell and regenerative therapies for spine pathologies. Stephen Hochschuler, M.D. and I will be joined by the session’s moderator Ira Fedder, M.D.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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