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Surgeon’s job with new surface technologies: Provide contact bone, achieve stable motion segments
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LOS ANGELES — From the surgeon’s perspective, host bone, biologic factors and implants are key considerations when it comes to new surface materials used in spine surgery, according to a presenter at the North American Spine Society Annual Meeting, here.
“We need that large contact surface area,” Jean-Jacques Abitbol, MD, said when he discussed the optimal fusion setting for implant materials with new surface characteristics. “If we do not have that exposed cancellous bone, nothing is going to heal. It is just not going to heal. We need a stable motion segment.”
In addition, an ideal device surface and a bone extender are needed for optimal spine fusion conditions, he said.
However, the problems that spine surgeons face are not primarily related to obtaining the large contact surface area that is called for with the various competitive surface technologies in the pipeline, according to Abitbol. Such bone contact area is readily obtainable with anterior lumbar interbody fusion and lateral lumbar interbody fusion procedures.
“That’s not the problem,” Abitbol said.
The problem lies with the transforaminal lumbar interbody fusions, 20% of which are now done through a minimally invasive approach that typically has a limited exposure.
“Regardless of what [companies] offer us in the devices, if we cannot deliver a contact surface, we are not going to get a fusion,” he said.
“We have to work, especially from the posterior aspect. Expose the surfaces. That is critically important because even if you have a ‘secret sauce,’ you are not going to get a fusion. So, in conclusion, smooth surfaces likely behave as spacers with little or no osseointegration. New surfaces show progress. Porous devices need a surface boost, and we need more science and clinical data. As to which surface is best? I don’t know, and we are going to get more science coming out shortly that will help us out and I believe that we’ll get a whole menu. We’ll be able to choose, as a surgeon, to best fit our patients,” Abitbol said. – by Susan M. Rapp
Reference:
Abitbol J-J. It’s what’s on the surface that matters: The surgeon/clinical perspective on implant surface biotechnologies. Presented at: North American Spine Society Annual Meeting; Sept. 26-29, 2018; Los Angeles.
Disclosure: Abitbol reports he was on the scientific advisory board of Nanovis and Vertera Spine, prior to its sale NuVasive, and did work on nanoprojects with Richard D. Guyer, MD.