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This course will review the current knowledge base and challenges of motion technologies. The strengths and weakness of the available evidence will also be reviewed. Attendees will be provided with a firm understanding of state-of-the-art scientific techniques. Clinical and basic science presentations will be offered on cervical and lumbar disc replacement, posterior dynamic stabilization and facet replacement. Case study presentations will conclude the activity.

This course includes videotaped podium presentations in conjunction with audio and slides.  A post-course evaluation will be given to help reinforce your knowledge.

This course was originally presented to a live audience at the NASS 25th Annual Meeting in Orlando, FL, on October 5, 2010, and has been adapted for online presentation.

Course Chairmen:
Avinash G. Patwardhan, PhD

Faculty:
Reginald Davis, MD
Adam R. Deitz, MD
Walter Eisner
Paul A. Glazer, MD
Richard D. Guyer, MD
Robert M. Havey
Greg Lambrecht
Carl Lauryssen, MD
Isador H. Lieberman, MD, FRCSC
Alex Lukianov
Paul McAfee, MD, MBA
George Miz, MD
Frank M. Phillips, MD
Luiz Pimenta, MD, PhD
William R. Sears, MD
Alexander R. Vaccaro, MD, PhD
Nicholas D. Wharton

Learning Objectives
Upon completion of this course, participants should be able to:

• Comprehend the current status of clinical research pertaining to these new technologies.
• Assess study design and the benefits and limitations of current clinical and basic research.
• Appreciate the current challenges of motion technologies.
• Recognize the current payer status of each type of motion preservation class and specific devices.
 

Agenda: 

• Introduction (Patwardhan)
• Analysis Techniques for In Vivo & Ex Vivo Studies: Existing and innovative techniques for kinematic analyses for clinical and laboratory studies along with their benefits and limitations.
  o  Radiographic Image Analysis Technology for Motion Assessments (Wharton)
  o Measuring Motion Quality for Diagnostic/Outcome Assessments (Deitz)
  o Patient/Specimen Specific Modeling for Kinematic Assessment (Havey)
• Motion Preservation: Clinical Experience: Focus on clinical experience with new devices and/or approaches that address challenges of existing technology.
  o Difficulties of TDR Adoption in the US 10 Years Later (Guyer)
  o Lumbar TDR (Sears)
  o Cervical TDR (Phillips)
• Point/Counterpoint
  o Rationale for Posterior Dynamic Stabilization (McAfee)
  o Posterior Pedicle Based Motion Sparing: Technology over Reason? (Vaccaro)
  o Complications in Motion Technologies (Pimenta)
• Case Study Presentations
• New Developments in Motion Technology: Short presentations from surgeons on latest technology.
  o Future Designs of Cervical TDR (Lauryssen)
  o Do We Need Alternate Articulations for Lumbar TDR? (Lieberman)
  o Replacement of the Functional Spinal Unit: The Ultimate Frontier? (Davis)
  o Injectable Nucleus Replacement: Can These Work? (Glazer)
• The Changing Economics of Motion Preservation Surgery and New Technology: A multi-factorial analysis of how different stakeholders measure the value of innovative spine technology.
  o A Year in Spine: Current Regulatory and Legal Developments and Reimbursement Challenges (Eisner)
  o Challenges of Commercializing New Technology in Today’s Environment (Lambrecht)
  o Defining the Value of New Technologies: Industry Perspective (Lukianov)

Continuing Medical Education (CME) Information
This activity has been planned and implemented in accordance with the Essential Areas and Standards of the Accreditation Council for Continuing Medical Education (ACCME). The North American Spine Society is accredited by the ACCME to provide continuing medical education for physicians and takes responsibility for the content, quality and scientific integrity of this CME activity.

The North American Spine Society designates this enduring material for a maximum of 4.75 AMA PRA Category 1 Credit(s)^TM.

Physicians should only claim credit commensurate with the extent of their participation in the activity. The American Medical Association has determined that physicians not licensed in the US to participate in this CME activity are eligible for AMA PRA Category 1 Credits™.

This course was released on 4/15/2011, and is available for purchase through 4/14/2014.

Appropriate Audience
Orthopaedic surgeons, neurosurgeons, physiatrists and all other physicians and allied health professional involved in spine care.

Conflict of Interest Disclosure
All faculty members provided estimated dollar amounts per the NASS Disclosure Policy through the NASS online disclosure module. NASS staff then translated that information into dollar ranges for purposes of this index, as well as for presentation at the live course. These ranges are as follows:

• None: Existing relationship but no remuneration in prior calendar year
• Level A: $100 to $1000
• Level B: $1,001 to $10,000
• Level C: $10,001 to $25,000
• Level D: $25,001 to $50,000
• Level E: $50,001 to $100,000
• Level F: $100,001 to $500,000
• Level G: $500,001 to $1M
• Level H: $1,000,001 to $2.5M
• Level I: Greater than $2.5M

Davis, Reginald J.: Royalties: Zimmer Spine (E); Consulting: Zimmer Spine (C), Paradigm Spine (D), Scient'x (B); Trips/Travel: Zimmer Spine (B), Scient'x (B); Scientific Advisory Board: Zimmer Spine (Consulting disclosed), Anulex (25,000 options, B).

Deitz, Adam: Stock Ownership: Ortho Kinematics (Founder, CEO, 5% ownership); Board of Directors: Ortho Kinematics (Stock ownership disclosed); Other Office: Ortho Kinematics (Stock ownership disclosed).

Eisner, Walter: Nothing to Disclose.

Glazer, Paul A.: Royalties: Biomet (F); Stock Ownership: Promethean Surgical Devices (250,000 shares); Speaking and/or teaching arrangements: Medtronic (B).

Guyer, Richard D.: Royalties: DePuy (B), K2M (B), Alphatec (None); Stock Ownership: Spinal Motion (190,000 shares, <1%); Private Investments: Spinal Ventures I and II (200,000 shares, 5%), Anulex (10,000 shares, <1%); Consulting: DePuy (B), Alphatec (A); Speaking and/or teaching arrangements: Synthes (C); Scientific Advisory Board: K2M (B), Flexuspine (Stock options), Spinal Kinetics (Stock options), Applied Spinal Technologies (Stock options); Fellowship Support: DePuy Spine (D, Paid directly to institution/employer), Synthes/AO Spine (D, Paid directly to institution/employer).

Havey, Robert M.: Nothing to Disclose.

Lambrecht, Greg: Other office: Intrinsic Therapeutics, Inc. (Employee).

Lauryssen, Carl: Not available at time of publication.

Lieberman, Isador H.: Royalties: Stryker (C), Mazor Surgical (None), Merlot OrthopediX (None), Axiomed Spine Corp (None); Consulting: Synthes Spine (B), Mazor Surgical (C); Speaking and/or teaching arrangements: Trans1 (B); Board of Directors: Merlot OrthopediX (32% ownership); Scientific Advisory Board: Axiomed Spine Corp (B); Fellowship Support: Baxano Spine (D, Paid directly to institution/employer).

Lukianov, Alex: Other office: NuVasive (Chairman/CEO).

McAfee, Paul C.: Royalties: Globus Medical (F); Stock Ownership: Breakaway Imaging- Medtronic (1,000,000 shares, 50%); Private Investments: Globus Medical (1,000,000 shares, 50%), Cervitech (500 shares, 5%); Consulting: Abbott Pharmaceutical (F); Speaking and/or teaching arrangements: Pioneer Surgical (F); Trips/Travel: DePuy Spine (G); Board of Directors: Disc Motion Technology (F); Scientific Advisory Board: SpineMedica (D); Other Office: Bonovo (F); Endowments: Impliant (E); Fellowship Support: Globus Medical (E).

Miz, George S.: Royalties: K2M (C); Stock Ownership: K2M (25,000 shares, 0.1%); Consulting: K2M (B), Stryker Spine (C); Trips/Travel: Stryker Spine (B); Scientific Advisory Board: K2M (C); Research Support (Staff/Materials): Stryker Spine (C).

Patwardhan, Avinash G.: Consulting: Aesculap (B), Spinal Kinetics (Scientific Advisory Board), AxioMed (Scientific Advisory Board), Simpirica Spine (B), Ortho Kinematics (Scientific Advisory Board), Alphatec (B); Scientific Advisory Board: Spinal Kinetics (Stock ownership), AxioMed (Stock ownership), Ortho Kinematics (Stock ownership).

Phillips, Frank M.: Royalties: Nuvasive (F), DePuy Spine (F); Stock Ownership: Nuvasive (<1%), Flexuspine (<1%), Axiomed (<1%), Crosstrees (<1%), Baxano (<1%), Spinal Motion (<1%), Spinal Kinetics (<1%), Facet Solutions (<1%); Private Investments: K2M (<1%), BioAssets (<1%), Angstrom (<1%); Consulting: Kyphon (D); Scientific Advisory Board: Flexuspine (Amount not disclosed), Crosstrees (Amount not disclosed), Spinal Kinetics (Amount not disclosed), Facet Solutions (Amount not disclosed).

Pimenta, Luiz: Consulting: NuVasive (Imaging costs and provision of devices); Other: Apatech, Pioneer, Globus Medical, Impliant (Imaging costs and provision of devices).

Sears, William: Royalties: Medtronic (F); Consulting: Medtronic (D); Speaking and/or Teaching Arrangements: Medtronic (C); Trips/Travel: Medtronic (B); Research Support (Investigator Salary) Medtronic (C); Research Support (Staff and/or Materials): Medtronic (D); Grants: Medtronic (C).

Vaccaro, Alexander R.: Royalties: DePuy Spine (F), Biomet Spine (F), Globus (F), Medtronic (F), K2M (C), Aesculap (B); Stock Ownership: K2M (50,000 shares), Cytonics (Unknown), Disc Motion Technology (Unknown), Zygoloc (Unknown), Progressive Spinal Technology (Unknown), Computational Biodynamics (Unknown), Stout Medical (D), Bonovo Orthopaedics (100,000 shares), Electrocure (Unknown), Vertiflex (30,000 shares), Flagship Surgical (Unknown), In Vivo (Unknown), PearlDiver (Unknown), Small Bone Innovations (30,000 shares), Neucore (22,000 shares), Crosscurrent (125,000 shares), Vertilink (1,535 shares), Orthovita (10,000 shares), Syndicom (2,750 shares), Biomerix (25,000 shares), Spinemark (82,000 shares), Paradigm Spine (146,875 shares), Spinology (28,750 shares), Vertebron (184,984 shares), Replication Medica (15,250 shares), Breakaway Imaging (100,000 shares), Crosstree Medical (41,667 shares), Globus (60,000 shares); Consulting: DePuy Spine (D), Osteotech (None), Orthofix (B), Vertiflex (A), Vertebron (B), Stryker Biotech (C), Stryker Spine (F), K2M (B), Medtronic (D), AO Spine (B); Other Office: North American Spine Society Annual Meeting Program Committee (None); Research Support: Staff and/or materials: AO Spine (D), Medtronic (E).

Wharton, Nicholas D.: Nothing to Disclose.

Disclosures are current as of November 1, 2010.

Technical Requirements
The following hardware/software specifications must be met or exceeded to complete this course:

• Web browser and internet connection
• Computer equipped with audio output (speakers or headphones)
• Printer (to print PDF handout)
• Internet Explorer 7 or higher
• Adobe reader 7 or higher
• Microsoft Silverlight (if you do not have the program on your computer, you will be prompted to install it)
• Disable pop-ups

Disclaimer
The material presented is made available by the North American Spine Society for educational purposes only. The material is not intended to represent the only, nor necessarily the best, method or procedure appropriate for the medical situations discussed; rather, it is intended to present an approach, view, statement or opinion of the faculty, which may be helpful to others who face similar situations. NASS disclaims any and all liability for injury or other damages to any individual attending the meeting and for all claims which may arise out of the use of the techniques demonstrated therein by such individuals, whether these claims shall be asserted by physicians or any other person.