The Spine Movement – May 2012

Choll Kim, MD, PhD gives a breakdown of some of the most exciting presentations in MIS at ISASS12, and looks ahead to ISASS13 in Vancouver.

Minimally Invasive Surgery Was Huge at ISASS12

ISASS12 in Barcelona was a remarkable venue for numerous presentations related to minimally invasive spine surgery. Great interest both in the US and abroad continues to grow in this area of spine surgery: MIS made up the content for one-third of all the general sessions, with a sprinkling of individual presentations in other general sessions.

The range and complexity of the MIS topics proved broad. One of the most striking findings emerging in the literature is the marked decrease in infections when minimally invasive surgery is performed. Pfandistiener et al. from the Clinic for Spine Surgery with Scoliosis Center in Germany reported on infection rates between open and MIS posterior instrumentation. In 284 open surgeries, deep infections were seen in 2.46%. In contrast, 199 patients underwent percutaneous posterior instrumentation procedures without a single infection.

The use of minimally invasive strategies to treat ever more complex conditions were highlighted. Phillips and co-workers presented the prospective, multi-center results of 107 adult degenerative scoliosis with 24 month follow-up. Excellent clinical results and a low complications were encountered in this this challenging group of patients with advanced age and co-morbidities. Anand showed similar results in 33 patients from a single site.

The fusion rates of minimally invasive interbody fusion remains high. As shown in a meta-analysis by Gwinn et al. from Walter Reed Medical Center, the MIS TLIF technique enjoys a greater than 95% fusion rate.

Topics in endoscopic surgery continue to generate interest, as well–Nagahama et al. (Hokkaido University) and Schubert (Munich, Germany) showed continued success of this promising procedure in the hands of experienced endoscopic spinal surgeons.

Lingering questions regarding MIS were also addressed: Lee et al. (University of California, San Diego) quantitatively examined hip flexion strength after the popular transpsoas lateral lumbar interbody fusion (XLIF/DLIF/LLIF). As experienced by many surgeons, hip flexion strength decreased in most patients immediately postoperation, but returned to baseline within 2 weeks of surgery.

Cost effectiveness of open versus MIS TLIF was assessed by Phillips et al. on worker’s compensation patients; the cost of overall inpatient care was slightly less for MIS than for open.

Pimenta et al. advised appropriate caution when he described low fusion success rates of 2-level AxiaLIF procedures. In their review of 27 patients undergoing L4-S1 2-level AxiaLIF, only 22% of patients were considered to have solid fusion at 2 year follow-up.

Emerging MIS technologies were presented by a wide variety of groups. Regev et al. from Tel Aviv Sourasky Medical Center described the minimally invasive transforaminal, thoracic microscopic discectomy; Husain et al. from Loma Linda University described a percutaneous cervical transfacet fixation technique; Araghi et al. showed the results of the first 40 Guyer Lumbar Interbody Fusion (GLIF) procedures; MacMillan described a novel all transosseous approach to the L5-S1 disc, and both Julien (West Virginia University) and Sharma et al. (Manassas, VA) described the use of percutaneous stabilization for thoracolumbar fractures. It is heartening to see so many attempts to make the best of minimally invasive technology in this still pioneering area of spine surgery.

Santos et al. (University of Minnesota) showed that 3-D navigation may be used to improve safety and accuracy of percutaneous pedicle screw placement. Finally, the potential changes in healthcare delivery were highlighted by Smith and Christian (Las Vegas, NV) when they showed that selected MIS fusions may be performed in the ambulatory setting.

The diversity of topics was matched only by the excitement surrounding them. I’m looking forward to even more fascinating research by my colleagues at ISASS13 in Vancouver.

Choll Kim, MD, PhD
Spine Institute of San Diego

Virtual Global Symposium on Minimally Invasive Spinal Surgery Highlights Livestream Training Benefits

Karlsruhe, Germany — The Global Symposium of the ESPINEA® Academy in Karlsruhe, sponsored by joimax®, showcased how modern, advanced training for surgeons works. Earlier this month, over four days, more than 300 participants from around the world learned about the latest endoscopic surgical methods for spinal diseases. Via live demonstrations, twelve world-renowned spinal surgeons presented case studies, gave tips and tricks, and allowed people to look over their shoulders at endoscopic videos while operating on cadavers. The livestream made it possible for participating surgeons to understand exactly how endoscopic operations are carried out.

“You can only get closer if you do it yourself,” said one participant.

Endoscopic spinal surgery is developing into the gold standard for back problems that need surgery,” said Wolfgang Ries, the academy’s founder and chairman. “A large number of studies show it is superior to conventional methods of open spine surgery. Unfortunately, this technique is still not taught in most training centers around the world”.

ESPINEA® fills this gap with an extensive training program. Webinar formats are unavoidable in the Coronavirus period. With today’s livestream technologies, ESPINEA® was able to provide real-time, interactive surgical training, zooming in on how its surgical instruments can be used successfully.

“The participants’ enthusiasm is confirmation that we need to further develop online trainings,” said Ries. “While virtual events cannot replace face-to-face instruction — after all, it’s learning by doing — they provide an excellent alternative”.

ESPINEA® Academy was founded by joimax® in February 2019. A month later, joimax® CEO and Founder Wolfgang Ries held its first faculty and user meeting at the Paracelsus Medical University in Salzburg. Since then, ESPINEA® has been accredited by the oldest surgical college in the world, the Royal College of Surgeons Edinburgh. Participants at events such as the Global Symposium can earn medical training credits for Continuing Professional Development (CPD points). Points can be applied to medical license renewals.

Underscoring the importance of virtual learning, three ESPINEA® board members chaired the symposium: Menno Iprenburg from Iprenburg Spine Clinic in Veenhuizen, Netherlands; Sang-Ho Lee, president of Wooridul Spine Hospital, Korea; and J. N. Alistair Gibson, Royal College of Surgeons in Edinburgh. The participants concluded, “It was worth taking part just to hear these luminaries in person. But the best part was the opportunity to see the operation as if you were performing it yourself.”

Contact:
joimax® GmbH 
Nicole Read
info@espinea.org

joimax® faculty member Dr. Albert Telfeian performs 1st endoscopic removal of a thoracic spinal tumor

We are proud to share this story about our joimax® faculty member Dr. Albert Telfeian and how he was able to help 17-year old Jenelle “Nelly” Camara who was suffering from a spinal tumor.

Already in 2014, Dr. Telfeian removed a thumb-sized tumor pressing the girl’s spine cord. The pathology was sent for identification but even the best U.S. labs weren’t able to figure out what the tumor was. Camara underwent radiation therapy and was free of symptoms for a while. But the tumor resumed growth soon and she and her family returned to Dr. Telfeian at Hasbro Children’s Hospital in Providence.

This time the surgeon decided to use an endoscopic approach with the girl under local anaesthetic. With Camara being awake during surgery, Dr. Telfeian was able to ask her to move her legs which is an important control for the surgeon operating in such close proximity to the spinal cord. With a tiny 8-millimeter incision on her back and specialized endoscopic instruments he was able to do a biopsy on the tumor without removing bony material like in the first surgery.

Within a week the family received a diagnosis which now allows a targeted therapy for Camara who will be able to return to school and cheerleading in fall this year.
Read all the details about how endoscopy helped to identify Camara’s tumor in this article.

NBC also featured the story in NBC 10 News. 

A scientific paper (case report) about the procedure was published online in the journal, Clinical Neurology and Neurosurgery, and will appear in the July 2015 issue.

joimax® goes HD: HD Technology for superior safety in endoscopic spinal surgery

Camsource®HD camera systems, HD endoscopes and HD flat screen monitors by joimax® at the 5th German Spine Congress (5. Deutscher Wirbelsäulenkongress) in Bremen, Germany

Karlsruhe, December 2010: The 5th German Spine Congress (5. Jahrestagung der Deutschen Wirbelsäulengesellschaft (DWG) will take place from 16 to 18 December 2010 at the Congress Centre in Bremen. joimax® is proud to present the innovative HD 5-in-1 complete system at their booth no.20: The C-Camsource®HD Twister offers state-of-the-art HD technology and works with both the joimax® HD endoscopes and HD flat screens producing an extremely precise and sharp picture and video imaging for endoscopic spinal surgery.

This is convincing technology for spinal surgery experts like Dr. Michael Schubert, Apex-Spine Center, Munich, Germany or Dr. Ralf Wagner, Frankfurt, Germany: „High resolution like this allows very precise working and provides the necessary safety required when operating – especially in the field of endoscopic spinal surgery.“ With this integrated combination of HD camera technique, HD endoscopes and HD flat screen monitors joimax® is the first manufacturer to offer a completely tuned and expandable HD system of highest imaging quality and picture resolution.

Both surgeons value the C-Camsource® HD Twister as a 5-in-1 system with its integrated xenon light source and picture rotation function; “There is optimal lighting at all times and with the Twister, image details can be zoomed in and rotated”, “and thanks to the imaging function and the diaphragm and mask function, optimal orientation in the operation area is possible.”
The HD 5-in-1 complete system has also a text generator in order to document each step of the surgery and it offers direct and simple data storage on a USB data carrier. “It was important for us to offer the surgeon a perfectly coordinated as well as a safe complete system“, says Wolfgang Ries, CEO and founder of joimax®, “for the best possible treatment of patients – without any compromises.”

Advantages of the C-Camsource® HD-Twister complete system and the joimax® HD endoscopes

– Best possible resolution due to High-Definition-Technology
– First-class brightness, brilliance of the pictures due to optimal co-ordination of the endoscope,
camera and screen as tuned system
– Unique image rotation, zoom and picture movement function
– As much system integration as sensible, possible and necessary
– Functions for intuitive orientation, marking and documentation

Advantages of the HD flat screen monitors by joimax®

– HD flat screen monitors in either 24“ or 42“ with an angle of
178 degrees for an exceptionally good view and safe operating
– Brilliant images in high resolution: 1.920 x 1.080 pixels
– Picture in picture function; size and position adjustable
– Touch Control Panel, multi-language menu navigation

joimax® Showcases New Electromagnetic Navigation System Intracs® em at Global Spine Congress (GSC), Toronto and at German Society of Neurosurgery (DGNC), Wurzburg Clinical Trials Start in Europe and Asia

IRVINE, CA – May 13, 2019 – joimax®,, the Germany-based market leader of technologies and training methods for full-endoscopic, minimally-invasive spinal surgery, is showcasing its Integrated Navigation Tracking & Control System, Intracs®em, at this year’s Global Spine Congress (GSC), which is currently being held in Toronto, Canada. The company is also promoting the system at the annual meeting of the German Society of Neurosurgery (DGNC), being held concurrently in Wurzburg, Germany.

The Intracs®em electromagnetic navigation system is simple to set up, very user-friendly, and seamlessly integrates into the joimax® endoscopic tower. It allows for navigation during any endoscopic procedure performed with the joimax® endoscopic surgical systems, TESSYS® (transforaminal) and iLESSYS® (interlaminar). Beyond that, it can serve as a stand-alone device.

The system relies on electromagnetic tracking, affording simultaneous navigation of multiple instruments such as needles, guiding rods, reamers and endoscopes. It was developed by joimax®  for easy planning of endoscopic approaches to the spine, as well as other minimally invasive procedures, like percutaneous fusions.

Various Intracs®em sensors guarantee the highest accuracy. Plus, for the patients’ benefit, the procedure can be carried out without further X-ray control – only starting X-rays are required. As a result, access, intervention time, and radiation exposure, are reduced to a minimum.

The system is CE-Marked. Currently, clinical trials and applications are running in Europe and Asia, where the product has already launched. In specific Asian countries, like Taiwan, the first systems have been sold and shipped.

Users are very impressed with the usability of the system. “I didn’t expect that navigation for both transforaminal and interlaminar procedures can be made so easy and that the set-up time can be so much streamlined,“ states Prof. Michael Kraus, spine specialist in Augsburg, Germany.  “And for the thoracic approach, it is so precise and a tremendous help,” continues Dr. Erik Traupe, spine specialist in Munich, Germany.

The launch of Intracs®em is a key milestone for joimax®. As part of its global strategy, joimax®  is providing surgeons, worldwide, with the devices they need for safe, easy and gentle spinal therapies, with US-FDA submission planned for Q2, 2019. “We are committed to overcoming any obstacles and concerns related to minimally invasive, endoscopic spine surgery,” states joimax® CEO and Founder Wolfgang Ries. “Our success lies with our innovative, user-friendly devices and instruments, and our ability to provide both doctor and patient with outstanding safety built into our systems.” Moreover, a well established and targeted clinical training program for the spinal surgical community, named CM3, rounds out the joimax® educational offering. Earlier this year, joimax® launched ESPINEA®, an Endoscopic Spine Academy focused on a complete endoscopic spine curriculum. Designed as a full training program to elevate surgeons to the next level of expertise, ESPINEA® offers professional and high-quality education for endoscopic spine treatment specialists, worldwide. The ESPINEA® Training and Education Centers are located in Karlsruhe, Germany in the newly opened joimax® building, and in Irvine, CA, where joimax® opened new labs and training rooms last November.

joimax® at the WCMISST congress in Paris

joimax® at the WCMISST Congress in Paris Karlsruhe – joimax® presented the EndoLIF® system as the latest development for endoscopic stabilization of the lumbar spine at the 4th Congress. The EndoLIF® system includes an O-cage (oblique cage) in addition to fully endoscopic access technology to the intervertebral disc space with the proven TESSYS® or iLESSYS® technique. In addition there is Percusys®, a screw and rod system for posterior percutaneous stabilization.

The WCMISST (World Congress of Minimally Invasive Spine Surgery and Techniques) is one of the leading international congresses for minimally invasive techniques in spine surgery. The Congress brings together spinal surgeons and pioneers from over 65 countries.

About joimax® joimax® Inc. from Karlsruhe, Germany, is one of the leading medical technology companies for minimally invasive spine surgery (joined minimal access). It focuses particularly on the development, production, and marketing of technologies and techniques for endoscopic spine surgery. joimax® complete systems offer the best possible all-in-one visualization, tissue removal (if required), stabilization, and documentation to enable the surgeon to work flexibly, independently, and efficiently. A three-stage joimax® CM3 Education Program trains surgeons in how to apply the surgical techniques in a targeted manner. In addition to training visits and compound workshops, the program also includes support from experienced medical trainers or application specialists during operations. joimax®, TES®, TESSYS®, iLESSYS®, CESSYS®, intENTS®, EndoLIF®, Percusys®, Vitegra®, Camsource®, Shrill®, Versicon®, Endovapor®, Vaporflex®, Legato®, Kyverment®, Tigrip®, Intracs®, and SPOT® are registered trademarks of joimax® GmbH.

Collage_WC_MISST_Paris_2014_med

joimax® Announces Executive Appointments Among Record-Breaking Sales for 2022

KARLSRUHE, Germany – (BUSINESS WIRE) – joimax®, the German-based market leader in technologies and training methods for full-endoscopic and minimally invasive spinal surgery, has appointed Mr. Maximilian Ries and Mr. Anthony Troncale to new executive positions, effective January 1. The announcement comes among record-breaking sales across Europe, Asia, and the United States in 2022.

Maximilian Ries

Ries took on the newly created role of Executive Vice President, Business Development and Operations at joimax®. In this position, based in Germany, he will be responsible for scaling global operations to ensure joimax® continues its exponential growth. Formerly the General Manager, for the past six of his 13-year tenure with joimax®, Ries built out the United States and Latin American markets.

Tony Troncale

Troncale was promoted to General Manager; he was formerly Vice President of Marketing and Business Development at joimax® Inc. Over the past two years, Troncale, in addition to increasing his responsibilities, successfully capitalized on the significant interest in endoscopic techniques to expand US sales operations. He joined joimax® in 2021 bringing 20-years of experience in the spinal device industry where he served in sales and marketing leadership roles at Stryker, K2M, and Synthes Spine. Contributing to the global organization’s continuous strong sales growth was the launch of a new surgical access system, “Tessys® Trans SAP” and the global expansion of the ESPINEA® Education Academy.

Wolfgang Ries

“I am extremely pleased with our 2022 global performance and the significant interest in endoscopic spine surgery,” stated joimax® Founder and CEO Wolfgang Ries. “With Max and Tony in their new roles, our market-leading endoscopic spine technologies, and our anticipated launch of two more new surgical access systems later in 2023, we are well positioned for another very successful year.”

JOIMAX® ANNOUNCES RELEASE OF FIRST ENDOSCOPIC AMA CPT CODE Company also releases newly designed joimax® homepage

Irvine, CA – September 26, 2016 – The AMA (American Medical Association) released the CPT 2017 Codebook (Current Procedural Terminology), now containing the first endoscopic spinal surgery code no. 62380. This new code covers endoscopic decompression of the spinal cord, nerve root(s), including laminotomy, partial facetectomy, foraminotomy, discectomy and/or excision of herniated intervertebral disc, 1 interspace, lumbar, and will be enforced as of January 1st, 2017. Under this code the specific transforaminal (TESSYS®) and/or interlaminar (iLESSYS®) procedures are fully covered in the USA herewith, which are already marketed by joimax® in 45 countries.

“The definition of this new code in the CPT codebook 2017 is a major milestone towards the acceptance of endoscopic minimally invasive spine surgery techniques and its benefits to both the surgeon and their patients,” states Wolfgang Ries, Founder and CEO of joimax®. Since 2012 joimax®  had been driving this effort to obtain CPT codes as these procedures required submission to payors for reimbursement coverage which was granted only in single cases under temporary codes, so-called T-codes.

“joimax® has been instrumental in driving the effort to obtain full code coverage of endoscopic spinal surgery,” says Daniel Laich, DO, Swedish Convenant Hospital, Chicago, who had been participating and presenting in almost every AMA meeting over the last five years. Due to the high research and publication activities by key users like Albert Telfeian, MD, PhD, at Rhode Island Hospital at Brown University, and a group of users around him, strong evidence has been accepted by AMA authorities, justifying the release of this new CPT code.

Many papers and publications on joimax® products can now be downloaded from the newly released joimax® homepage. The completely redesigned website offers visitors richer insight into the company’s innovative products and systems. A quick and easy access to essential information and features is available, including the latest workshop and education activities, which are essential in endoscopic minimally-invasive spinal surgery.

Meanwhile joimax® offers basic and advanced workshop training courses mainly in the USA, Germany and Austria, and oversees a participation population of almost 3,000 physicians. Independent training courses are also performed in China and Korea to support the fast growing Asian markets. Detailed information about those courses are updated regularly at www.joimax.com.

The website uses the latest technology so the site is compatible with today’s browsers and mobile devices, such as smartphones and tablets. Visitors can also use the new website to stay informed with the latest company news. The new website goes live today and is located at the same address: https://www.joimax.com.

joimax® at the early summer congresses: SpineWeek Amsterdam and DGNC Leipzig

Karlsruhe, May 28th 2012. After the very successful Britspine at the beginning of May in Newcastle in the UK the slogan is now “joimax® goes oranje“ – up, up and away to the SpineWeek in Amsterdam (May 28th to June 1st 2012). This conference is held by the leading international scientific societies in the field of spinal diseases. Up to 3000 participants from all over the world are expected and it is hence the biggest conference of this kind in Europe.

Under the motto “Sharing today’s ideas, shaping tomorrow’s practice” joimax® invites all its distribution partners to a meeting. Central topic will be joimax®’s new products and a special focus will be laid on the Deflector Blades for Shrill® – the Shaver-Drill-System which is indispensible in stenosis treatment. During this meeting Dr. Menno Iprenburg, long standing joimax® faculty member, will hold a presentation on his own success story. In spring 2010 he had opened his “Ruegkliniek” in Veenhuizen in the Netherlands with an exclusive specialization on endoscopic spine surgery with the joimax® systems. Right from the start the clinic was very popular. After a consumer program on Dutch TV, where the advantages of the surgery method and very satisfied patients were presented, the staff of Dr. Iprenburg virtually can’t handle the huge demand for appointments for surgery. A really striking success story in medicine!

“joimax® goes Leipzig” – at the 63rd annual conference of the DGNC (German Society for Neurosurgery) in Leipzig, Germany (June 13th to 16th, 2012), joimax® will focus on the newest technologies in pain therapy with the Multiuse Set for endoscopic facet joint denervation. Dr. Bernd Illerhaus from Recklinghausen, Germany will talk about his experience with this system during the joimax® Lunch Symposium on June 14th, 2012. Assoc. Prof. Dr. Sandro Eustacchio from the University Clinic for Neurosurgery in Graz, Austria will report on the application of TESSYS® and iLESSYS® – the transforaminal and interlaminar access systems of joimax® for the treatment of lumbar herniated discs and spinal canal stenosis.

Of special interest is the fact that the Japanese sister society to the DGNC joins in the meeting this year. Hence, there will be ample opportunity to make important contacts and set further mile stones for the upcoming entry of the Japanese market. In the meantime – thanks to very active partners – business in China and South Korea is steadily increasing – “joimax® goes Asia”.

joimax® Announces Partnership with Southeast Asia Distributor, Transmedic Group

Karlsruhe (GER) – joimax®, the German-based market leader in technologies and training methods for full-endoscopic and minimally invasive spinal surgery, is pleased to announce a new partnership with Transmedic Group, a top medical device distributor headquartered in Singapore. In this exclusive deal, Transmedic will represent joimax® in Singapore, Hong Kong, Philippines and Indonesia.

The long-term partnership will provide a broader surgical choice for patients considering endoscopic minimally invasive spinal surgery in these markets. With recent advances in the field of endoscopic discectomy (ED), the procedure has potential to supersedemicrodiscectomy (MD) as the gold standard of care in management of lumbar disc disease, as the latest literature suggests.

“joimax® is very much looking forward to working with Transmedic Group,” says joimax® Founder and CEO Wolfgang Ries. “With the rising popularity of endoscopic approaches in the management of spinal diseases, we’re able to deliver the highest standard of patient care, strengthen our sales activities, and enter into another important partnership across APAC.” 

Teo Kee Meng, managing director of Transmedic Group commented, “We’re very pleased to partner with joimax®. With their technological advancements and use of new spinal access corridors, a major prevention of spinal structure collateral damage is assured, allowing for significantly reduced complications and improved postoperative recovery times.”

About Transmedic Group
Transmedic Group was founded in 1980 with the aim of becoming the top specialist in the advanced medical technology area in Southeast Asia. Headquartered in Singapore, the privately held company has since grown its presence in seven countries with more than 500 employees, and is well-renowned as the leading provider of latest technologies in healthcare.