Matthew Herper is a senior editor at Forbes
Medical device giant Medtronic sells $3.5 billion worth of spine surgery gear annually. But Stephen Oesterle, the cardiologist who directs the company’s medical strategy, hopes to make much of it obsolete.
He hopes to do for back surgery what device companies have already done for the heart: replace full-scale operations with simple, minimally invasive procedures that involve less cutting.
“One hundred years from now they’re going to dig people out of the grave say, ‘what were these people doing?'” Oesterle says about the current crop of spine procedures. “My goal at Medtronic before I retire is to morph our business into one which is not palliating end-stage disease but actually treating the progression of disease.”
Medtronic’s spine surgery business is dominated by a procedure called spinal fusion, in which two of the segments of the backbone, called vertebrae, are fused together using metal rods and cages, bone taken from elsewhere in the body, and protein drugs that stimulate bone growth. Each year, 460,000 patients undergo this procedure to alleviate severe back problems spinal fractures and torn cartilage. Competitors include Johnson & Johnson. Competitors include Johnson & Johnson and Synthes.
But the procedure costs $50,000 or more, takes weeks to heal, and is clouded by huge controversy over whether it is overused in patients with ordinary back pain who could do just as well with rehab. As many as 20% of spinal fusions are for ordinary low back pain and may not be supported by good evidence, says Derrick Sung, an analyst at Sanford C. Bernstein. He says that insurer United Healthcare is working to limit spine fusions, and that some hospitals may too, because the surgeries are so expensive and unproven. Medtronic spine device sales barely budged up 3% in the recently ended fiscal year.
Oesterle, 59, admits the back surgery field is “clouded by a lack of evidence,” even as he insists that fusion is effective for many patients. In the not-too-distant future, he thinks new minimally invasive technologies will the controversy obsolete. Overall, 2.7 million Americans get some kind of back surgery each year, while another 21 million people with back pain use nonsurgical treatments.
Back surgery is just starting to go through a revolution that cardiology underwent a decade ago, he says. As a doctor at Harvard’s Massachusetts General Hospital, Oesterle helped pioneer minimally-invasive technologies that can open clogged arteries with balloons, obviating the need in many cases for risky bypass surgery. At first the balloon procedure didn’t have solid proof of effectiveness, but the data were collected and it became standard treatment for heart attack patients. (During that time, Oesterle worked with the future research chiefs of Amgen and Novartis.)
Back surgery is more a craft than a science, with surgeons designing the tools that Medtronic commercializes and trying out techniques on a case-by-case basis. “These guys are like fine cabinetmakers,” he says. “It’s kind of a guild operation.” He hopes that technologies that make surgeries easier, more repeatable, and less invasive can change that.