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June 3, 2008

For Immediate Release

Spine Surgery Steadily Adopting Minimally Invasive Procedures (MedMarket Diligence Report)

Foothill Ranch, CA -- The development of imaging systems like fluoroscopy, sophisticated endoscopes and a wide range of surgical instruments that facilitate minimally invasive surgery are combining with the persistent demand for less invasive, less traumatic procedures to drive the growth of minimally invasive spine surgery.  Products, technologies and trends in minimally invasive surgery are detailed in the worldwide spine surgery report from MedMarket Diligence.

A traditional, “open” surgical spine procedure typically involves the surgeon making a long incision, from either an anterior or posterior approach, dissecting and retracting layers of tissue as needed to provide both visualization and access to the affected area. For many kinds of operations—instrumented spinal fusion the most notable—open procedures remain the norm due to the demands of positioning, attaching, and configuring fixation devices. A higher rate of patient postoperative complications and a longer recuperative time period are thought to result from many open procedures, however. These findings have helped to drive the development of minimally invasive techniques—and instrumentation—for certain kinds of operations; in the near future, new minimally invasive technologies and techniques will likely change the approach to operations currently performed with traditional means.

 Traditional ("Open") Spinal Surgery Procedures

Name of Procedure

Clinical Indications to Perform Procedure

Anterior Cervical Discectomy and Fusion (ACDF)

An intervertebral disc in the cervical spine bulges or herniates, exerting pressure on an adjacent nerve root. Procedure also used to remove tumors, osteophytes, or vertebral fracture fragments from the spinal canal.

Anterior Lumbar Interbody Fusion (ALIF)

Herniated intervertebral disc in the lumbar spine.

Cervical Corpectomy

Narrowing of the cervical spinal canal due to growth of bone spurs or the ligament behind the vertebral bodies, where an anterior cervical discectomy does not address the entire area of neural compression.

Cervical Foraminotomy

Space through which a spinal nerve root branches off from the cervical spinal canal is too narrow, exerting pressure on the root

Cervical Laminoplasty

Cervical spinal canal is painfully restrictive due to injury or disease.

Decompressive Lumbar Laminectomy

Abnormal bone spurs or rough intervertebral disc edges exert pressure on spinal nerve roots or the cauda equina, a nerve root bundle at the end of the spinal cord.

Interbody Fusion with Cages

Performed to remove a damaged intervertebral disc and fuse the vertebrae above and below the disc space.

Posterior Lumbar Interbody Fusion (PLIF)

Herniated intervertebral disc in the lumbar spine.

Spinal Fusion

Indicated in a variety of instances to unite two or more bony segments so that they grow together

Posterolateral Gutter Spine Fusion

Indicated in a variety of instances to unite two or more bony segments so that they grow together. This approach has a high level of success due to the rich vascular network present in the posterolateral spinal region.

Transforaminal Lumbar Interbody Fusion (TLIF)

Performed to remove a damaged intervertebral disc and fuse the vertebrae above and below the disc space.

Source: MedMarket Diligence, LLC

Minimally Invasive Procedures

While patient concerns remain a significant driver in the development of minimally invasive techniques, technological advances in surgical instrumentation have transformed the theoretical to the practical. Advanced fluoroscopy, or x-ray imaging during surgery, has markedly improved the accuracy of incisions made and hardware placed. A variety of endoscopes, camera-tipped wands, can be inserted through small incisions and provide the surgeon with excellent visualization of the operative site. New surgical instruments were developed to work in tandem with endoscopes. The past several years have brought numerous innovations to spine surgery. These innovations include the development of imaging systems that interpret anatomical data for three-dimensional display; the use of lasers, ultrasonic frequencies, and high-pressure water jets remove tissue; and new monitoring devices that help the surgeon to optimally position instrumentation as well as to warn of potentially damaging neural contact during a procedure. Spine operations that lend themselves particularly well to minimally invasive approaches are intervertebral disc decompressions and discectomies. Progress has been made in adapting certain kinds of spinal fusion procedures to a minimally invasive approach, and certain forms of scoliosis of the thoracic spine have been treated with minimally invasive surgery.

MIS has many enthusiastic supporters. However, caution needs to be exercised, as even though a technique is less traumatic, if the rate of successful spinal fusion is much lower, then there is really not an advantage. Also, it has yet to be demonstrated that minimally invasive spine fusion systems actually cause better outcomes than some other surgical techniques used in the traditional open approach.

Increasingly, minimally invasive techniques are becoming the preferred method for autologous bone graft procedures. Traditional procedures involve the surgeon making a 3- to 5-inch incision to harvest bone from the patient’s hip area, and some studies have shown that complications arise in nearly a third (31%) of these patients. These studies also show that about 27% of patients still feel pain in the hip area up to two years after the surgery.

Minimally Invasive Spinal Surgery Procedures

Name of Procedure

Goal of Procedure

Vertebroplasty

Performed to treat fractured or collapsed vertebra

Kyphoplasty

Performed to lessen or eliminate pain due to an osteoporotic compression fracture of the vertebra

Microscopic Discectomy

Performed to relieve pressure on spinal  nerve roots caused by a ruptured intervertebral disc

Disc Decompression

Performed to remove extruded portions of an uncontained herniated disc or to remove nuclear disc material causing a bulge in a contained herniation. Decompressing the disc relieves pressure on adjacent nerve roots.

Endoscopic Scoliosis Surgery

Performed to correct abnormal lateral curvature; this is an alternate procedure for certain forms of scoliosis appearing in the thoracic spine

Source: MedMarket Diligence, LLC

 

The MedMarket Diligence report #M510 is a detailed market and technology assessment and forecast of the products and technologies in the management of diseases and disorders of the spine. The report describes diseases and disorders of the spine, encompassing congenital disorders, inflammatory and infectious diseases; degenerative diseases; herniations, stenoses, myelopathies and other "mechanical" disorders of the spine; spinal trauma; tumors of the spine; and others. The report characterizes the patient populations, their current clinical management, and trends in clinical management as new techniques and technologies are expected to be developed and emerge. The report details the currently available products and technologies, and manufacturer offerings. The report details products and technologies under development and markets for each in spine surgery. The report provides a current and forecast assessment of the worldwide markets for these technologies, with geographic segmentation by U.S. & Canada, European Union (detailing France, United Kingdom, Germany, Italy and Spain), Japan and Rest of World. The report provides emphasis on the market impact of new technologies through the coming decade, profiling nealry 100 active companies in this industry, with comprehensive detail on key companies, providing data on their current products, current market position and products under development.  

For additional information, see this link or contact Patrick Driscoll, 949-859-3401. The report may also be purchased online.

About MedMarket Diligence
MedMarket Diligence provides tactical decision-making solutions on medical technology to the medical products and investment industries. The company publishes the MedMarkets newsletter, a monthly analysis of the market implications of new medical technologies, dedicated Reports on technology markets and the Medtech Startups Database.