Guess Who's Back, Back Again — TSB's Back, Tell a Friend Spine Nation:

Spine Nation: TSB is back!!!!!!!!!!!!!!!!! Come here......... just a little bit closer to the screen......... a little bit closer......... that's it......... I can see you. You're sitting in your car in the hospital parking lot between cases, scrolling on your phone, aren't you? Or maybe you're at the airport bar heading to some regional sales meeting where your VP is going to show you a pie chart that took him three days to color and tell you that quota is going up 30% because "the market is rebounding." I know. I've missed you too. Don't believe it? TSB will send you a copy of the emails. The inbox hasn't stopped since the day the lights went off. So where has The Spine Blogger been? Let's just say TSB took the longest sabbatical since Moses wandered the desert, except Moses had a destination. TSB has been watching. Listening. Traveling. Sitting in hotel lobbies at NASS, standing in the back of ballrooms at Becker's, nursing a bourbon at industry dinners where CEO's still think nobody's paying attention to the nonsense coming out of their mouths. Fellow bloggers, twelve years is a long time. Twelve years ago, TSB warned you about PODs, and you said it was a phase. TSB warned you about surgeon kickbacks, and the DOJ said "thank you for the tip." TSB told you that "me too" companies with a PEEK cage and a prayer were going to get steamrolled, and now half of them are landfill and the other half were acquired for pennies on the dollar by private equity vultures looking to flip them in 36 months. As the great Mark Twain once said, "the reports of my death have been greatly exaggerated." Unlike half the companies TSB used to write about, the blog still has a pulse. But here's the thing, Spine Nation. TSB isn't coming back alone. After years of self-serving puff pieces and sycophantic press coverage that passes for "journalism" in this industry, TSB has decided to align with a publication that actually has the stones to print the truth. Effective immediately, The Spine Blogger will be working alongside Orthopedics This Week. Yes, that OTW. The same OTW that tried to unmask TSB back in 2011. The same OTW that Robin Young built into the one publication in this space that the suits actually feared seeing in their inbox on Monday morning. Irony? C'est moi. But as the great Winston Churchill once said, "you have enemies? Good. That means you've stood up for something." TSB and OTW have stood for the same thing all along: the truth, however inconvenient, however uncomfortable, however much it makes the PR departments at the legacy companies reach for the Tums. We just took different roads to get here. Now we're on the same one. And fellow bloggers, that road is about to get very, very interesting. Because let TSB tell you what he's seen while sitting in the shadows for twelve years, and it's enough to make your head spin faster than a Globus robot placing a pedicle screw. The industry TSB left in 2014 had four or five big players, a hundred ankle biters, and a Wild West ethos that made Wall Street look like a church social. The industry TSB is walking back into? Globus swallowed NuVasive whole and then ate Nevro for dessert. Q4 sales of $826 million, breathing down the Evil Empire's neck for the number one spot. Medtronic just got FDA clearance for Stealth AXiS, their new robot-meets-AI-meets-navigation system, because apparently one billion dollars for Mazor wasn't enough, now they need the machine to think for itself. Stryker. Yes, Stryker. Sold its US spinal implant business to the V Brothers. The Viscogliosi Brothers now own a spine company. If you've been reading this blog since 2009, you just spit out your coffee. VB Spine launched on April Fool's Day 2025 (and no, TSB is not making that up) and has since acquired a manufacturing plant in France, an AR navigation system, and a robotic platform. They're assembling Frankenstein's monster from spare parts and ambition, and the bolts on the neck are still showing. Meanwhile, ATEC is projecting $890 million for 2026 and just unveiled a robotic platform called Valence. Pat Miles turned a company that couldn't integrate Scient'x into the industry's most compelling growth story. As TSB always said, funny what happens when you put the right people at the helm instead of recycling the same failed executives from the Warsaw talent pool. And what about the things that haven't changed? Word on the Street is that the Lown Institute found 200,000 unnecessary back surgeries billed to Medicare over three years. $1.9 billion in taxpayer money, one unnecessary fusion every eight minutes. The DOJ is still chasing kickback schemes. Dr. Kingsley Chin and his SpineFrontier saga dragged on for seven years before the Anti-Kickback charges were dismissed and he pled to a false statement. Innovasis paid $12 million to settle allegations of paying off seventeen surgeons. Seventeen! The names change. The dollar amounts change. The underlying pathology, and TSB uses that word deliberately, does not. As the great Pete Townshend once sang, "meet the new boss, same as the old boss." But here's what IS new. The entire industry is migrating to ambulatory surgery centers like refugees fleeing a burning building. CMS is pulling 285 musculoskeletal codes off the inpatient-only list. Robots are no longer a novelty, they're a prerequisite. AI is planning your surgeries. Endoscopy is going mainstream. And every company from Memphis to Minneapolis is trying to build a "closed-loop ecosystem" that locks surgeons in tighter than a set of polyaxial screws in a L4-S1 construct. The game has changed, fellow bloggers. The players have changed. The money has changed. But the fundamental questions that TSB has been asking since February 7, 2009 remain the same: Are patients being served or being used? Are surgeons making decisions based on clinical judgment or consulting agreements? Are companies innovating for outcomes or innovating for Wall Street? And is anyone, anyone, willing to tell the truth about it? TSB is. OTW is. And together, we're going to hold this industry's feet to the fire the way we always have. With facts, with analysis, with a healthy dose of sarcasm, and with the occasional Steely Dan lyric to remind you that the more things change in spine, the more they stay the same. So to the CEO's reading this on your Bloomberg terminal: TSB sees you. To the sales reps reading this in the hospital parking lot between cases: TSB is still fighting for you. To the surgeons who do the right thing every day, who operate because the patient needs it, not because the quarterly number needs it: TSB respects you. And to the ones who don't? Well, as the great Eminem once said (and yes, fellow bloggers, TSB's musical taste has expanded during the sabbatical): "Guess who's back, back again, TSB's back, tell a friend. Now everybody report to the blog floor, To the blog floor, to the blog floor. The Spine Blogger's created a monster, 'Cause nobody wants to see the truth no more, They want screws, they want cages, they want more, Well if you want the truth, this is what I'll give ya: A little bit of me mixed with some hard data." The lights are back on, Spine Nation. OTW and TSB. Strap yourself in and enjoy the ride. The fun is about to begin. Do svidaniya... but not for long. TSB