Vertiflex competitors

[bedrock]

I'm not currently trained/doing Vertiflex, but have recently come across a few patients who could benefit from it and likely to send them out. My spine surgeon is not interested in them either,

I've heard good things about Vertiflex from other physicians, but I also know that other companies make similar products so my question is this.

For patient too old/sick to have a lami, for LSS, is Vertiflex clearly the best device currently on the market? Anything else close it it?
(For this discussion lets pretend that MILD doesn't exist)

I want to ensure I send my patients to the right docs using the best devices for them.

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[Gnarvin]

I am not aware of any direct competitors in the interspinous spacer field. There certainly be some that I am just not aware of. However, there are a ton of new minimally invasive interspinous fusion devices coming out that basically clamp down on the spinous processes from the side and have some bone graft material that you use with them and work as a fusion device rather than an extension blocker like Vertiflex.

I am trained on one of the new interspinous fusion devices, however I am hesitant to start doing the cases. The indications for use for all of these interspinous fusion devices are incredibly vague such as "degenerative disc disease" or "spondylolisthesis." As pain physicians, we all know that just because someone has DDD or spondylolisthesis doesn't mean that those problems are causing their pain, and even if they are, a fusion isn't necessarily always the best treatment. Additionally, during pain fellowship I was never trained on identifying fusion candidates and performing fusions. It seems like the spine surgery field has been doing fewer and fewer fusions over the past 10-20 years so I am not sure why now all of a sudden pushing for fusions just because we have minimally invasive options is a good idea.

If these new interspinous fusion devices come out with studies showing they actually help more defined pain conditions and they come out with better patient selection criteria, then I will definitely be interested in using them more.

 

[Espn123]

I am not aware of any direct competitors in the interspinous spacer field. There certainly be some that I am just not aware of. However, there are a ton of new minimally invasive interspinous fusion devices coming out that basically clamp down on the spinous processes from the side and have some bone graft material that you use with them and work as a fusion device rather than an extension blocker like Vertiflex.

I am trained on one of the new interspinous fusion devices, however I am hesitant to start doing the cases. The indications for use for all of these interspinous fusion devices are incredibly vague such as "degenerative disc disease" or "spondylolisthesis." As pain physicians, we all know that just because someone has DDD or spondylolisthesis doesn't mean that those problems are causing their pain, and even if they are, a fusion isn't necessarily always the best treatment. Additionally, during pain fellowship I was never trained on identifying fusion candidates and performing fusions. It seems like the spine surgery field has been doing fewer and fewer fusions over the past 10-20 years so I am not sure why now all of a sudden pushing for fusions just because we have minimally invasive options is a good idea.

If these new interspinous fusion devices come out with studies showing they actually help more defined pain conditions and they come out with better patient selection criteria, then I will definitely be interested in using them more.

Spot on

 

[pmrmd]

The MIS fusions work when Vertiflex isn’t the best choice. Vertiflex is great for stenosis, no listhesis, with decent bone density. For patients with any kind of significant listhesis I go Minuteman, just like any surgeon would instrument that level.

 

[Gnarvin]

The MIS fusions work when Vertiflex isn’t the best choice. Vertiflex is great for stenosis, no listhesis, with decent bone density. For patients with any kind of significant listhesis I go Minuteman, just like any surgeon would instrument that level.

I don’t remember the minuteman indications for use including treating stenosis. Also, a surgeon would most likely do a lami and fuse that level rather than just fusing it.

If minuteman/Inspan/All the others come up with studies showing efficacy for treating stenosis in patients with spondylolisthesis/instability/etc then I will definitely be more apt to use them. Right now, I am not aware of any of them being approved for treating stenosis, though I could be wrong.

 

[Espn123]

I don’t remember the minuteman indications for use including treating stenosis. Also, a surgeon would most likely do a lami and fuse that level rather than just fusing it.

If minuteman/Inspan/All the others come up with studies showing efficacy for treating stenosis in patients with spondylolisthesis/instability/etc then I will definitely be more apt to use them. Right now, I am not aware of any of them being approved for treating stenosis, though I could be wrong.

You are correct

 

[pmrmd]

I don’t remember the minuteman indications for use including treating stenosis. Also, a surgeon would most likely do a lami and fuse that level rather than just fusing it.

If minuteman/Inspan/All the others come up with studies showing efficacy for treating stenosis in patients with spondylolisthesis/instability/etc then I will definitely be more apt to use them. Right now, I am not aware of any of them being approved for treating stenosis, though I could be wrong.

You get distraction with the implant.

 

[gazzer]

You get distraction with the implant.

What degree of stenosis? What % of patient's does it help and expected duration of relief? Complication types and rates? I'm interested in implementing in my practice, but unclear on how to answer these patient questions. Any tips?

 

[Gnarvin]

What degree of stenosis? What % of patient's does it help and expected duration of relief? Complication types and rates? I'm interested in implementing in my practice, but unclear on how to answer these patient questions. Any tips?

No one knows at this point. Unlike Vertiflex and MILD, there haven’t been any studies done with these interspinous fusion devices for stenosis.

 

[soccrwz]

Central canal: Mean expansion is 18-22% of spinal canal

Foraminal stenosis:Increase in area by 25%, and width by 40%

From some studies

 

[gazzer]

Central canal: Mean expansion is 18-22% of spinal canal

Foraminal stenosis:Increase in area by 25%, and width by 40%

From some studies

are you talking about vertiflex? minuteman? or some other interspinous process spacer device?

 

[Taus]

No one knows at this point. Unlike Vertiflex and MILD, there haven’t been any studies done with these interspinous fusion devices for stenosis.

From what I’ve seen locally..... now we’ve got pain docs fusing for axial pain, ddd, stable grade I listhesis. Great. Spine care goes back decades.

 

[Gnarvin]

From what I’ve seen locally..... now we’ve got pain docs fusing for axial pain, ddd, stable grade I listhesis. Great. Spine care goes back decades.

I agree 100%. Spine surgeons have been doing fewer and fewer fusions over the past 20 years, especially for the reasons you mentioned. Why now should we be doing more fusions just because we have minimally invasive options that pain docs can use? One of the most important concepts that I took away from fellowship was not to do a procedure just because I CAN, but deciding which procedures are appropriate for which patients. If something goes wrong with one of these procedures for whatever reason and there is a lawsuit involved, I think it would be tough to defend oneself as a pain physician with no training or experience identifying appropriate fusion patients. When I got trained on one of these devices, all they did was basically tell me the incredibly broad indications for use "DDD, spondylolisthesis, trauma, tumor." When I asked about more specific indications, patient identification specifics, and if they had any studies backing up the actual outcomes for pain with the device, I was met with silence.

 

[Orin]

Well when you've got a hammer...

 

[soccrwz]

I believe this is with stabilink

 

[BobBarker]

You need to start with Vflex first before trying minuteman and stabilink. They all work well. Minuteman and stabilink are indicated for ddd and spondylolisthesis (which every patient with stenosis has). I like all 3 devices and am faculty for all 3 as well.

 

[bedrock]

You need to start with Vflex first before trying minuteman and stabilink. They all work well. Minuteman and stabilink are indicated for ddd and spondylolisthesis (which every patient with stenosis has). I like all 3 devices and am faculty for all 3 as well.

No preference at all for one vs the other?
not necessarily with the procedure itself but with patient outcomes?

 

[drusso]

You need to start with Vflex first before trying minuteman and stabilink. They all work well. Minuteman and stabilink are indicated for ddd and spondylolisthesis (which every patient with stenosis has). I like all 3 devices and am faculty for all 3 as well.

Can you talk more about your specific experiences and indications and patient anecdotes?

 

[BobBarker]

Vflex works very well but isn’t comparable to the fusion spacers. It is much less invasive. But it is going to have some rotation, loss of decompression, subsidence. It is inevitable.
The fusion spacers are much more invasive. I use minuteman on morbidly obese and more medically fragile patients. I prefer stabilink for the more active patient or a thin patient that is more osteoportic. It certainly grabs onto the lamina. It can be removed easily where minuteman can not. I have done over 200 Vflex levels, much much less with both fusion spacers products combined. I have also trained on aurora zip several years ago.

 

[NJPAIN]

Vflex works very well but isn’t comparable to the fusion spacers. It is much less invasive. But it is going to have some rotation, loss of decompression, subsidence. It is inevitable.
The fusion spacers are much more invasive. I use minuteman on morbidly obese and more medically fragile patients. I prefer stabilink for the more active patient or a thin patient that is more osteoportic. It certainly grabs onto the lamina. It can be removed easily where minuteman can not. I have done over 200 Vflex levels, much much less with both fusion spacers products combined. I have also trained on aurora zip several years ago.

Why the choice of MinuteMan for morbidly obese and medically fragile?

 

[drusso]

From what I’ve seen locally..... now we’ve got pain docs fusing for axial pain, ddd, stable grade I listhesis. Great. Spine care goes back decades.

This is not the time nor place for data. I want to discuss personal experiences, anecdotes, and conjectures. Also, who has any idea about how MIS fusions will evolve the business model of pain and spine care?

 

[BobBarker]

You place a minuteman through a port. Basically the port takes care of all the extra dissection, retraction etc. it seems to be the same difficulty no matter the weight of the patient. They don’t bleed as much as the serial port placement gradually blunt dissects the pathway for you. It takes less surgery skill but better fluoroscopic skill. Some people struggle placing the k wire that far from lateral to medial and getting it through the spinous processes in the anterior aspect. It is less invasive than a posterior spacer. You don’t have to use cautery at all.

 

[bedrock]

You place a minuteman through a port. Basically the port takes care of all the extra dissection, retraction etc. it seems to be the same difficulty no matter the weight of the patient. They don’t bleed as much as the serial port placement gradually blunt dissects the pathway for you. It takes less surgery skill but better fluoroscopic skill. Some people struggle placing the k wire that far from lateral to medial and getting it through the spinous processes in the anterior aspect. It is less invasive than a posterior spacer. You don’t have to use cautery at all.

Vflex works very well but isn’t comparable to the fusion spacers. It is much less invasive. But it is going to have some rotation, loss of decompression, subsidence. It is inevitable.
The fusion spacers are much more invasive. I use minuteman on morbidly obese and more medically fragile patients. I prefer stabilink for the more active patient or a thin patient that is more osteoportic. It certainly grabs onto the lamina. It can be removed easily where minuteman can not. I have done over 200 Vflex levels, much much less with both fusion spacers products combined. I have also trained on aurora zip several years ago.

Thank you very much Bob. I certianly appreciate your perspective given your extensive experience with these devices.