Trends and Developments Shaping the Future of Spine: Q&A With Ben Shappley of Amedica Corp.Written by Rob Kurtz | June 14, 2010
Ben Shappley is president, CEO and director of Amedica Corp., an orthopedic implant company focused on using silicon nitride ceramic technologies to develop spine and total joint implants. Mr. Shappley has more than 26 years of orthopedic and neurosurgical implant experience with management and senior management responsibilities.
Q: What kind of growth are you anticipating in spine over the next few years?
Ben Shappley: I still think we're going to see double digit growth in spine and I think we're going to continue to see that in the short- and medium-term time periods. The major reason is the older population keeps presenting with baby boomers. As we move forward, I think the trend of patients presenting with low back problems will continue and increase.
Q: What do you see as a major issue facing spine in the long-term?
BS: In the longer term, dealing with spinal fusion and degenerative disease, both of the cervical spine and lower back, I think we may see some issues dealing with outcomes. I think that the days of large failed back syndrome cases as a result of failed fusion may be somewhat limited because of pressures from the likes of Medicare, Medicaid or the UnitedHealthcare and Blue Cross Blue Shields. These are very expensive surgeries and I think the pseudarthrosis rate, the failed spine rate is certainly higher in low back applications than it is in any other area of orthopedics. And I think the industry needs to pay particular attention to that. The high failure rate could mean we need to diagnose low back problems better. CT scans, X-rays, MRIs, they're important and are, of course, fairly effective, but to date we don't really have anything to report on the physiology of the low back.
When we look at other areas of medicine, we do a patient history, we do patient exam, we do an anatomy study and we do a physiology study. In dealing with the lower back, we do patient history, we do MRIs, we do CT scans, we do physical exams but we don't get any real significant reports on muscle and nerve activity. I think we need to be a little bit more sophisticated down the road in diagnosing low back issues specifically pointed towards physiology.
Q: What are some of the major trends currently influencing the direction of spine?
BS: Materials, outcomes and costs. I think we will see minimally invasive techniques to spinal applications become more popular. Same with percutaneous procedures, such as percutaneous facet fixation, which is done through a small cannula that can buy a patient years of pain relief before you have to do a full interbody fusion. I also think you'll see more minimally invasive techniques that deal with stenosis and other issues that may not require a complete laminectomy. We need to start thinking as an industry about minimally invasive percutaneous approaches. The smaller the wound, the quicker the recovery, the less rehab time that the patient's not at work, the less drugs that the patient has to take over a period of time — the [demand for these approaches and outcomes] will continue, particularly for the treatment of those patients facing more government pressure from Medicare, Medicaid and workers' comp, and then throughout healthcare in general. We also need to be particularly careful and sensitive to costs of spine surgeries as, in my opinion, it will become a greater issue going forward.
Q: Your company, Amedica, focuses on using silicon nitride for implants. Can you touch on why you're using this material?
BS: Our technology is focused on advanced bioactive material (silicon nitride) for interbody spacers, vertebral body replacements and cages. Currently the market primarily uses a plastic material called PEEK, which is a polymer, and bone does not grow onto and into plastic. Implant materials that are more biologically kind to lend themselves to interbody fusions, such as silicon nitride, which has a bioactive surface and a very strong ceramic material, should yield a better outcome.
Learn more about Amedica.
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