Has spine become a fashion industry?
The spine industry moves so fast that there is no time for clinical studies. Since there is no time for clinicals, there is no feedback loop for outcomes. The way to sell more devices is to add new features.
This is understandable. Suppose a spine company performed a 5-year RCT (randomized control trial) for a specific IB fusion product with a specific coating. Once the study was finally published, that specific IB product would no longer be for sale. The market has moved on. Five years later, surgeons are now interested in newer “shinny objects”.
In the consumer fashion industry, this is a well known cycle. The cycle lasts for a few months. There are four parts of the clothing fashion cycle:
- the Rise,
- the Peak,
- the Decline,
- and the Abandonment.
In the spine device industry, there is also a known cycle. The cycle lasts for a few years. There are four parts of the spine feature cycle:
- the Interest,
- the Max Adoption,
- the Loss of Interest,
- and the Abandonment (moving on to something newer).
A spine fashion could be a new material combo (eg: PEEK/Ti), a new coating (eg: nano Ti), a new surgical approach (eg: OLIF), a new MIS expandable cage, a new patient-specific 3D-printed cage, a new robot, and so on.
The reality is that there are over 200 spine device companies competing for a spine surgeon’s attention with new fashion features and no clinical feedback loop.
The spine fashion cycle is just too fast to figure out which products have the better outcomes.