The second full day of the North American Spine Society (NASS) Annual Meeting featured a series of captivating debates on current controversies in spine care and surgery, spurred by the great discussion participants had at last year's version of the symposium. The discussion this year proved that NASS continues to be a great forum to bring top-of-mind controversial topics out into the open to generate meaningful discussions with respected surgeons and attendees. This year, the topics selected were those that continue to be at the forefront of our discussions on the spine industry?including a focus on the increasingly popular stand-alone anterior lumbar interbody fusion (ALIF) devices.

Industry wide, one spinal implant market trend that continues to be notable is the number of competitors that continue to join the stand-alone ALIF device market. The new generation of these products continues to be prominently featured by the growing number of companies offering these devices, with efforts to distinguish themselves with unique designs. During the discussion, Dr. Richard Guyer took the position that stand-alone ALIFs are a good solution for treating single-level disease of the lumbar spine. Dr. Guyer cited studies that demonstrated that in comparison to 360 degree fusion, re-operation rates for stand-alone ALIFs with intrinsic screw fixation compare favorably. Further, he argued that the cost of the procedures must be kept in mind and stand-alone ALIF procedures versus 360 degree fusions save about $12,000 of the overall procedure cost. From a clinical aspect, the use of these products has the advantage of lowering the risk of complications that may arise from approaching the spine posteriorly, particularly by decreasing the trauma on posterior anatomy.

On the other hand, Dr. Alexander Vaccaro provided his own short assessment of the industry that wasn?t quite as rosy. Dr. Vaccaro commented on the lack of long-term clinical studies for stand-alone ALIF devices, and noted how there are so many different designs that are being offered, at times criticizing certain designs. For example, he brought up an interesting point that the positioning a surgeon needs for screwing in some of these devices can be problematic depending on patient anatomy. Above all, the message Dr. Vaccaro tried to drive home was the fact that ultimately, to him, the design of these newer devices doesn?t intuitively make sense when considering the goals of fusion and stability. Of course, this position could be swayed with compelling long-term clinical data.

Nonetheless, interbody devices (IBDs) continue to be a growing segment within the spinal implant market. In Millennium Research Group's most recent US Markets for Spinal Implants 2012 report, stand-alone IBD fusion procedures will continue to grow at over 12% through 2016. With the growing number of stand-alone ALIF devices on the market, the vested interest these companies have in expanding the body of favorable clinical evidence continues to ramp up.

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