The expandable interbody implant
In 2005 as i was ambling around a spine meeting in Chicago I happened to come across an individual placing what looked like a small bag of crushed bone into a fractured body of one of the thoracic vertebraes. As he utilised the fluroscopic C to guide his every move the flashbulbs all went off at once in my inquisitive head as I suddenly reaslied that this technlogy could be used to place interbody devices in to the degenerated disc spaces between the vertebral bodies to augment the process of fusion. The device was called optimesh and was manufatured by a compnay called Spineology. Regardless of the fact the device was off label for interbody placement it is a well accepted practice in modern medicine that 80% of all drugs and devices are used clinically in off label fashions.
I returned to New Jersey the following week and commnenced the process of organsing a case in which one of the field reps would attend the surgical center at which I worked as I plannned to perform a case on a 45 year old man with single level disc disease that had failed all other forms of conservative therapy.The procedure would be performed for the first time anywhere in the world on an outpatient basis and would be associated with minimal blood loss, muscle or bone destruction and a rapid post operative recovery that allowd the patient to be discharged home the same day. The case went well and the patient did well.
This ws an incredibly pivotal moment in the field of spine as it took away a case traditionally performed in the hospital and performed it safely and effectively in an ambulatory surgical setting. This was made possible by many factors which included the following:
1. Less blood loss
2. Less post operative pain
3. Less tissue dissection
4. The introduction of a post operative caudal injection to manage pain
5. Th utilisation of minimal incisions
Subsequent to the successful deployment of thousands of these implants several other large device companies developed their own versions of the innovative implants which could be inserted via the transforaminal route into the empty disc space and then expanded once in place. The days of wide open aggressive back dissections were coming to an end and at last spine surgery was moving into the 21st century, thanks to a sequence of thoughts and events that commenced in 2004 in New Jersey. Who would have guessed ?
