Glass Houses of Cards

by James Cavuoto, editor

By now, most professionals in the neuromodulation industry have become aware of some of the negative news reports and journal articles calling into question the value of spinal cord stimulation for treating back pain. The SCS industry has fought back on a number of fronts and continues to offer product enhancements and sponsor clinical trials that can produce the scientific evidence necessary to convince patients, payers, and regulators that the therapy is effective and appropriate.

When it comes to treating pain, neuromodulation is just one approach available to clinicians and their patients. As we know well, pharmaceutical interventions, notably opioid medications, have been widely used and have left a trail of dissatisfied patients and societal problems in their wake. Still another approach involves spinal surgery, including spinal fusion surgery. This type of intervention helps some patients but leaves others with more pain.

A recent article in New York magazine calls into question the effectiveness of fusion surgery, pointing out that many studies have doubted its efficacy in treating back pain caused by degeneration, and that the number of revision operations for spine surgery is higher than those of other orthopedic surgeries.

The article also reported that U.S. orthopedic surgeons receive the most amount of money out of all specialties and rates of spine surgery are higher here than in any other developed country in the world. One key source for the magazine article was Eugene Carragee, former director of the Stanford Spine Center and editor-in-chief of The Spine Journal. Carragee believes that much of the growth in the spinal fusion market was driven by profit motive on the part of surgeons and device vendors in the $14 billion orthopedic market.

While the article doe not mention SCS as an alternative therapy for chronic back pain, it does discuss the indication failed back surgery syndrome (some have argued for renaming that condition into something less negative). As it turns out, FBSS is one of the leading indications driving SCS sales.

So how should the SCS industry react to attacks like this article on the orthopedic device industry? On the one hand, if more patients were aware that SCS is a viable alternative to spinal fusion, this might help drive neuromodulation revenues. On the other hand, if FBSS cases were to dry up, would that have a negative impact on SCS sales? And more to the point, would the general public tend to regard all surgically implanted devices more negatively if they were to read articles like this?

The question of whether the orthopedic device industry is a friend or foe of the SCS industry took a decided turn toward the former earlier this year when the North American Neuromodulation Society forged a collaboration with the North American Spine Society and two other organizations.

It remains to be seen whether and to what extend orthopedic surgeons will refer their pain patients over to SCS implanters, or vice versa for that matter. But if the goal is to deliver the most appropriate pain therapy to each patient, revenue be damned, then this has to be seen as a positive development.

In the end, the best way to ensure the long-term health of any segment of the healthcare industry is probably not by engaging in a smackdown with other segments, but by motivating clinicians to do what’s right for the patient.