Kingsley Chin, MD, is a spine surgeon and entrepreneur.
He founded Kingsley Investment Company, the parent company of KICVentures, which aims to invest in physician leadership and technology development. Here, Dr. Chin discusses spine innovation and what to expect in the future.
Question: What do you see as the most disruptive forces in spine care today?
Dr. Kingsley Chin: The most disruptive force in spine care is patients beginning to reject fusion. I've already seen it happening in my practice. More patients are going to the internet to find information about their treatment, and studies have borne this out. Patients are not only able to read all about their treatment, but they're also able to visualize it through YouTube, which shows them a very graphic video of their surgery. They're also able to hear both good and bad testimonials online from people who had the surgery. The written information about fusion is also not that great, and this has been a problem for a long time.
The good news is we have gotten a lot better at fusing patients. We've also gotten better at the devices and biologics for fusion. You need the screws, rods, plates and interbodies, but you also need biologics. One of the major disruptive forces on the biologics side is bioactive glass. NanoFUSE Biologics, which is the only FDA-cleared combination of DBM and bioactive glass, is going to be a major player in this area.
The second part of this question is: 'If patients are rejecting fusions, what’s their alternative?' The trend is already on its way — patients want disc replacement. It’s intuitive, and that’s thanks in part to joint replacements of the knee, ankle, hip, elbow and shoulder. Patients are having these surgeries with great results, and they’re recognizing the value of joint replacements. A lot of patients that need spine surgery also have arthritis of their other joints, so when a patient has their hip or knee replaced, they begin to wonder, 'Why don’t I just replace the disc in my spine?'
As a spine surgeon, that’s going to be a difficult request to talk yourself around, but I think many of us do because we don’t have the best disc replacement on the market in the United States. Back in the early 1980s, Dr. Art Steffee came up with the idea of a viscoelastic disc replacement that would act just like a natural disc, but that was a very challenging thing to develop and perfect. Since he introduced his idea, many companies have come up with alternative options, including the typical ball-and-socket joint, where two metals are put together with a plastic in between them to give movement. But in 2001, AxioMed discovered a material that is made up of polyurethane and silicone, and they created a disc with a viscoelastic center that functions like a normal disc. The day that AxioMed releases the lumbar disc in the United States, I think you’ll see a dramatic change in the patients who will be aware of disc replacement as an option, and in the number of surgeons who know they have a total disc replacement that will work really well. I believe that will be a true disruption.
AxioMed is also planning to have an IDE study to look at the performance of the cervical disc. They are looking for protocol that will allow up to three levels and allow insertion next to an adjacent fusion — a protocol that was highly supported by Dr. Dan Riew who is a world leader in cervical spine surgery. I think the day that AxioMed receives clearance on the three-level and the indication for placing a disc next to a fusion is going to be even more disruptive than the lumbar version in the short-term. Imagine a day when you have both the cervical and lumbar AxioMed discs that behave perfectly as normal discs, and patients are now able to see that surgery being done and hear actual testimony from patients and surgeons. At that point, it’s going to be difficult to ask someone to choose having screws and rods in their neck and back, so I think the AxioMed Disc will create a huge amount of disruption.
The final part of this question is: 'Can you also replace the facets?' If you have a perfectly functioning disc in the front, can you replace the facets in the back? The answer is yes. We are now able to use the AxioMed technology to create a posterior, dynamic stabilization structure. We also see other options to develop that will allow us to stabilize the spine posteriorly to replace the facets and maintain motion. The ultimate disruption is to combine a disc in the front with a dynamic stabilizer in the back. This is not a new idea, it’s just we’re now pursuing it at KICVentures. We now have the material in the disc, and the ability to use that material posteriorly because we have a 15-year exclusive right to that material for the spine. Between combining the disc in the front with a dynamic stabilizer in the back, we reach 360 degrees, and a patient doesn’t have to be fused.
Q: What are the smartest investments you’ve made during your career? Where are you looking to invest in the future?
KC: In 2000 while I was a resident at Harvard, I saw that fixating the spine using a percutaneous pedicle screw was a great idea, so I sat down and started to draw a solution that I thought would be better than what the market currently had. Over time, I kept drawing it, and then I applied for the patent. In 2005, I made a very important decision to start an investment company called KIC (now KICVentures). I realized that it would be great for me as a physician to be able to make investments, and I wanted a holding company so that each time I made an investment, I would have a company to hold it. Our first investment was in the idea I had as a sketch from 2000, which we developed into a percutaneous pedicle screw called the MANTIS. I invested in the cost of developing it all the way to a prototype and then we had Zimmer Spine and Stryker Spine both make a bid for it. We went with Stryker, and that was a multimillion-dollar deal. It netted a hundred times return, so I have to believe that was a very smart investment.
My investment firm, KIC, allowed me to start focusing on being an investor, and since then, KIC has invested in medical companies and medical devices. We have acquired devices from surgeons and engineers, and we have brought those under the umbrella of our medical device company, SpineFrontier. We have also added AxioMed, a company with total disc replacement technology and NanoFUSE, an orthobiologic company.
KICVentures is currently investing in Mediconnects, a digital health software that provides an open platform to attract patients and caregivers to facilitate a direct-to-consumer marketing strategy. In the future, we are looking to partner with hospitals and surgery centers under our LESS Institute brand to leverage our technologies in and outside the U.S.A to form alliances with surgeons.
Q: What is the biggest change you’ve seen in your practice over the past year?
KC: The biggest change I’ve seen in my practice over the past few years is the movement to outpatient. In 2009, I did my first outpatient in spine fusion, and now I’m doing 100 percent spine surgery outpatient. We have published every year, probably an average of five papers, about our experience in outpatient. By identifying what patients’ criteria best fits, selecting the right risk profile, understanding the anesthesia, the fluid management, and even the concierge aspect of managing the patient and their expectations, we’ve gotten very comfortable doing outpatient surgeries. Since these patients go home and don’t stay in the hospital, we have pioneered using video-conferencing to closely follow them. We have a paper that we published on giving patients our cell phone number, and a paper on following patients with video-conferencing, and we’ve found it’s worked really well.
Now that we’ve fully vetted the experience of outpatient spine surgery (we also do outpatient orthopedic surgery, arthroscopies, ACL repairs, etc.) and published on it, we feel confident that nearly 80 to 90 percent of elective spine surgery can be done in an outpatient setting. Part of this is having the right patient selection, the right surgeon, the right techniques, a hospital that’s there in case of any emergencies, a surgery center that understands how to manage these patients and also a team that’s going to appropriately follow these patients by making sure that they have the right support system.
I think outpatient spine surgery is a great way for society to start looking at improving the patient experience. We need to look at the technologies and techniques that allow for more frequent outpatient spine and orthopedic surgery and then strategize on how to work with hospitals to make a system that’s more of a hybrid. I think over 41 percent of hospitals today have a co-venture with surgery centers. That’s a dramatic change from almost 100 percent of spine [and] orthopedics being done in the hospitals. The internet is also helping facilitate outpatient surgery as patients research different ways to be treated. They also have outpatient experiences in other specialties such as plastic surgery and ophthalmology.