Author: Antonio Berlen

The Spine Movement – May 2012

Posted on by Antonio Berlen

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

Eurospine 2016: joimax® launches its new MultiZYTE® SI-Joint Endoscopic Therapy Set and its new Intracs® Intraoperative Navigation Tracking & Control System

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Karlsruhe – October 05, 2016 – joimax®, the global acting German developer and marketer of technologies and training methods for endoscopic minimally invasive spinal surgery, will again exhibit at Eurospine 2016 taking place from October 5 – 7 in Berlin. During the conference, joimax®will launch two new products – the MultiZYTE® SI Endoscopic Sacroiliac Joint Therapy Set and its new Intracs® Intraoperative Navigation Tracking & Control System.

MultiZYTE® SI Endoscopic Sacroiliac Joint Therapy is developed for the treatment of the Sacroiliac Joint Syndrome (SIJS), which has been rediscovered as a major back pain generator in recent years. This kind of pain is commonly felt in the lower back, the gluteal region, the hip and thigh and can even radiate into the leg and foot. Until the 1930s, SI-Joint was the main reason for low back pain, but since 1934 the focus has been on disc herniation. According to recent studies 15 to 25% of all low back pain is caused by the SI-Joint and up to 43% in patients having undergone lumbosacral fusion. MultiZYTE® SI joimax® now offers a well developed and lasting treatment option for this disease.

The Intracs® Intraoperative Navigation Tracking & Control System was developed in cooperation between joimax® GmbH Karlsruhe and fiagon GmbH in Berlin, both located in Germany. With the Intracs® system, joimax® instruments can be navigated directly at the tip using Fiagons “chip at the tip” technology which allows tracking of instruments with a diameter in the 1mm range. The Intracs ® Navigation and Monitor Unit is integrated in the joimax® Endoscopic Tower and all necessary tools are tailored for the TESSYS® (transforaminal) and iLESSYS® (interlaminar) procedures as well as for minimally invasive stabilization procedures, like EndoLIF® and Percusys®. The main features of the Intracs® system are needle navigation through Vector-Tip-Target processing tools, the merging of 2D X-Rays with 3D- images of a patient’s CT or MRI scans, and the constant orientation control of any endoscope used in joimax procedures.

“With these two new developments we are in the position to enhance our endoscopic minimally-invasive product portfolio, driving adoption rates to meet new heights. With the world unique Intracs® system, navigation is now faster, safer and more accurate than ever before using an electromagnetic (EM) field. Radiation exposure for both, patients and surgeons will be significantly reduced,” says Wolfgang Ries, CEO and founder of joimax®. “Additionally the learning curve for all spinal endoscopic procedures offered by joimax® will now be significantly reduced and the rapid expansion of all these techniques is now well layed-out,” he continues.

FDA Approves joimax® Intracs®em Electromagnetic Navigation System for Endoscopic Minimally Invasive Spine Surgery

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IRVINE, CA – joimax®, the German-based market leader in technologies and training methods for full-endoscopic and minimally invasive spinal surgery, is pleased to announce that Intracs® em, its electromagnetic navigation tracking and control system, has been approved by the FDA.

The Intracs® em Navigation System allows for spinal procedures to be carried out with minimal X-ray control, drastically reducing radiation exposure, access time, and the entire length of the surgical procedure. In fact, all joimax® instruments and scopes can be tracked and accurately navigated through the appropriate sensors, which improves safety, expands endoscopic indications, and flattens the learning curve.

Intracs®em is a multiyear development. Its first cadaveric trials were made with a group of surgeons at the ESPINEA® Labs in Karlsruhe, Germany and Irvine, CA.

FDA Approval , joimax endoscopic navigation system Intracs em

According to Prof. Dr. med. Michael Kraus of ORTHIX Zentrum in Augsburg, Germany, who headed the preliminary trials: “Using Intracs® em Navigation System in the full endoscopic spine surgery is safe and easily applicable. The technology helps master precise access to the spine, and the clinical trials have confirmed the technique’s multiple advantages.”

Prof. Dr. Chris Hofstetter of UW Medical Center in Seattle, Washington, USA, adds: “joimax® Intracs®em constitutes a highly precise image-guided navigation platform designed for the specific needs of full-endoscopic spine surgery. Using electromagnetic navigation technology allows to track the leading edge of endoscopic instruments in real time, and facilitates needle targeting and orientation during the surgery, while minimizing radiation exposure. No doubt, this technology will expand the indications for full-endoscopic spine surgery and pave the way for innovations in minimally invasive arthrodesis techniques.”

joimax® is also excited to announce its second joint Global Symposium being held in partnership with Integrity Implants, Inc., August 21 – 22. For details, visit www.joimax.com.

First workshop with live operations on the endoscopic removal of disc herniations held in the ATOS Private Clinic, Munich

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Karlsruhe, 11th March 2009: On March 9th and 10th a joimax® workshop on the endoscopic removal of disc herniations using the TESSYS® method took place in the ATOS Private Clinic in Munich. For the first time, participants were able to view the operation live from the conference room in the neighbouring Sheraton Hotel as it was transmitted from the clinic. Dr. med. Michael Schubert carried out the operation, explaining the individual steps and answering questions from the auditorium throughout the operation.
Intensive training on cadavers preceded the live operation, allowing all participating doctors to get the most out of the transmitted procedures. Presentations by experienced surgeons complemented the workshop on minimally invasive endoscopic intervertebral disc surgery.

Read more about the workshop at: ATOS Private Clinic Munich News

A prime example of collaboration between China and Germany

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Karlsruhe – joimax® opens the 3rd Training and Reference Center in Shanghai, China, at Changzheng Hospital, Tongji University, under the direction of Prof. Ye Xiaojian. The prestigious university and its affiliated Tung-Chee Hospital were founded in 1907 by the German government as its first major project in foreign cultural policy.

It is a prime example of Sino-German collaboration, which continues to this day at Tongji University and also at other centers in Chongqing at Xinqiao Hospital under the direction of Prof. Zhou Yue, and in Beijing at the General Hospital of the People’s Liberation Army (PLAGH) under the direction of Prof. Zhang Xifeng. The Training & Reference Centers provide targeted training to surgeons in endoscopic treatment methods on the spine as part of the joimax® Education Program. Above all, this features TESSYS®, the technique of transforaminal access to the lumbar spine for treatment of herniated discs and stenosis – an osseous narrowing of the spinal canal. Qualified and standardized training in these surgical techniques is essential. joimax® is therefore supporting the basic principle that patients should always receive high quality, reliable, and safe therapy in line with the very latest technology and scientific progress.

joimax® reports another record in revenues globally in Q3/2017 and introduces new products at EUROSPINE in Dublin, Ireland and at NASS in Orlando, Florida

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IRVINE, CA – October, 10, 2017 – Due to the fast growing user interest, but moreover the patient demand for endoscopic spinal surgery, joimax® sees another record in revenues in Q3/2017, with almost 60% of growth year over year, whereas joimax USA is almost doubling its revenues compared to 2016. “These results are also reflected in the huge interest at the SMISS Annual Forum which took place Sept 14- 16, 2017 in Las Vegas and the ISASS MIS Couse which took place Sept 22 – 23 in Long Beach, where joimax® as market leader supported the cadaveric lab sessions” explains Wolfgang Ries, Founder and CEO of joimax®. Key presenters at these meetings had been Albert Telfeian, MD, PhD, Brown Univ., RI and Jian Shen, MD, PhD, Nathan-Lattauer Hospital, NY, both excellent surgeons with great experience.

Now at EUROSPINE, taking place Oct 11 – 13 in Dublin, Ireland, joimax® will introduce its new Shrill® Deflector Blades for spinal decompression. By deflecting, the blades provide an outstanding work-around-the-corner technology. They are applicable for the various joimax® TESSYS® systems as well as for the fast adopting iLESSYS® Delta system.

Additionally, a range of new Vaporflex® bipolar forceps for TESSYS® and iLESSYS® applications will be introduced as well. Those instruments are available in two handle versions and equipped with three different electrodes. The product portfolio will be completed by new sets of bipolar tweezers for micro surgery. All these bipolar instruments can be used with the very successful globally launched Endovapor® RF/HF generator, which received FDA clearance in April 2017 as well. joimax® underlines its market leadership with a professional trade fair appearance with Meet-the-Expert sessions at the booth and by hosting a Faculty and DIstributor meeting prior to the conference in Dublin.

At NASS, for the first time ever, a full endoscopic spinal surgery session is included in the main program, held on October 26th in room WF3. The session is followed by an onsite cadaveric lab running from 5:10 PM – 8:00 PM with a full joimax® presence. In order to share the vast growing endoscopic user experience more widely, joimax® will hold a Meet-the-Expert presentations at the booth as well.

joimax® will wrap up its presence at NASS congress with an Expert meeting, including a wet lab, aiming to coordinate all training and education activities, specifically those which are related to US market needs.

joimax® Experiences Major Growth, Launches TESSYS® TransSAP Endoscopic Surgical System

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KARLSRUHE, Germany – (BUSINESS WIRE) – joimax® is continuing its year-over-year double digit growth. Over the past 9 months, joimax® has grown more than 25% globally and in the United States alone, more than 35%. Among this major spurt, the market leader in technologies and training methods for full-endoscopic and minimally invasive spinal surgery is launching a new endoscopic surgical system, TESSYS® TransSAP.

“This allows for more extensive foraminal decompression and provides an optimal basis for transforaminal endoscopic fusion”

The company attributes strong growth to their popular workshop and educational program, which is now offered worldwide under the ESPINEA® training academy. To keep momentum, joimax® is releasing the TESSYS® TransSAP — the fourth addition to the TESSYS® family encompassing the standard TESSYS® Std, TESSYS® XT featuring longer reach instruments, and TESSYS® Thx, the optimized version for the thoracic spine.

The system is based on the proven TESSYS® method introduced in 2004. Since then, the technology has been enhanced and can be used for more complex indications, widening the spectrum of disease and vertebral level applications.

joimax® faculty surgeon masters, Dr. Christof Hofstetter and Dr. Ralf Wagner, demonstrate TESSYS® and iLESSYS® to an at capacity crowd during NASS 2022 in Chicago. (Photo: Business Wire)

“The TransSAP method follows an adopted access path to the spine, directly targeting the Superior Articulating Process,” says Dr. Christoph Hofstetter, associate professor in the Department of Neurological Surgery at the University of Washington. “This allows for more extensive foraminal decompression and provides an optimal basis for transforaminal endoscopic fusion,” adds Dr. Ralf Wagner, a longstanding joimax® ESPINEA® Faculty orthopedic surgeon based in Frankfurt.

In addition, joimax® provides a series of implants for fusion indications, such as the percutaneous pedicle screw system, Percusys® Plus, and a family of 3D-printed titanium cages within the EndoLIF® program. The EndoLIF® suite of products consists of the static implants O/On-Cage, Delta-Cage and DoubleWedge-Cage. “There are plans to add a new fully-expandable cage, as well as a navigated solution for endoscopic disc preparation and implant positioning to provide a full endoscopic assisted fusion platform,” says Wolfgang Ries, CEO and founder of joimax®.

All joimax® implants can be safely inserted using the “Over-the-Wire” technique for precise implantation, making them ideal for endoscopically-assisted fusion procedures established and protected by joimax®.

These new products have been exhibited at the following trade shows: SMISS in Las Vegas, CNS in San Francisco, and NASS in Chicago, and will be featured at EUROSPINE in Milan and at the German Spine Congress, DWG, in Berlin later this year.

joimax® conducts an international Live Spinal Surgery Workshop in cooperation with the Medical University of Graz, Austria

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Spine specialists take part at the joimax® endoscopy workshop with live spinal surgeries

Karlsruhe, 14 March 2011: On 17 and 18 March 2011, the Medical University as well as the Institute for Anatomy in Graz, Austria, were the sites of a two-day international joimax® Workshop focused on the endoscopic resection of herniated discs utilizing the TESSYS® method. The first day, Dr. Wolfgang Kreil and Univ. Doz. Dr. med. Sandro Eustacchio of the Medical University Graz will operate on two patients with herniated discs using the TESSYS® method. The participating orthopaedic surgeons and neurosurgeons from Germany, Austria, Greece, Bulgary, Italy and Macedonia will experience the surgery procedure firsthand. While operating on the patients, one of the operating surgeons will explain each step of the TESSYS® surgery and answer questions of the workshop attendees. Afterwards Dr. Wolfgang Kreil and Dr. Sandro Eustacchio will lead scientific presentations and panel discussions on how the transforaminal endoscopic technique works and what their experiences have been, while discussing several case examples.

On the second day, joimax® hosts an intensive cadaver training course at the Institute for Anatomy Graz. The practical training and hands-on learning experience gained at cadaver workshops such as this one is an important first step in the three-step joimax® CM3 Education Program. In this comprehensive program, experienced surgeons and application specialists train each workshop member to use the TESSYS® Method. The subsequent steps of the Education Program are visitations, followed by live surgeries accompanied by joimax® Medical Trainers and application specialists.

joimax launches the iLESSYS® Delta system for treatment of spinal stenosis at DGNC 2015 annual meeting

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Karlsruhe, Germany – June 8, 2015 (BUSINESS WIRE) – The German company joimax®, developer of technologies and training methods for minimally invasive endoscopic spinal surgery, today announced it will introduce the company’s new iLESSYS® Delta system to the market at the 66th Annual Meeting of the German Society of Neurosurgery (DGNC) taking place in Karlsruhe, Germany from June 7-10.

iLESSYS® Delta, an advanced development of the joimax iLESSYS® technology, is suitable for dorsal and dorso lateral treatment of central spinal canal stenosis. The iLESSYS® Delta system enables a large area to be decompressed by means of the interlaminar access, guided by endoscopic-assisted vision.

“Since the access to the spine is the same as with the already well-established iLESSYS® technique, usage is very straightforward.” said Dr. Guntram Krzok, orthopedic surgeon from Waltershausen, Germany after testing the new system at a joimax workshop early this year. “I was impressed by the new scope which delivers outstanding image quality. With the specialized instrument set, it is finally possible to achieve decompression of central spinal canal stenosis.”

The iLESSYS® Delta instrument set includes specially developed tools that enable extensive, yet gentle, tissue-sparing decompression. The 6 mm working channel of the new endoscope allows for the use of large shaver blades designed for bone resection and endo-kerrisons. An additional option is the plastic (PPSU) working tube for unimpaired X-ray examination.

“iLESSYS® Delta is a logical addition to our portfolio. Not only is the system suitable for endoscopic decompression, but it also allows the parallel implantation of cages. This way we can achieve dorsal decompression and stabilization in one step,” comments Wolfgang Ries, CEO and founder of joimax.

About joimax

Founded in Karlsruhe, Germany, in 2001, joimax® is one of the leading medical device companies in minimally invasive spinal surgery („joined minimal access“). The company’s U.S. subsidiary was established in Irvine, California, in 2005. The company is primarily focused on the development, production and marketing of technologies and methods for minimally invasive endoscopic spinal surgery. joimax is active in 40 countries around the globe and its methods have been successfully employed in approximately 130,000 surgeries. With a special focus on education, the company provides surgeons with specialized technique training through the three-step joimax CM3 education program. This program includes visitations, cadaver workshops and live-surgery support.

joimax® presents product portfolio at JSSR in Yokohama Japan
Further continues International Growth Strategy

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Karlsruhe, GER– April 18, 2019 – joimax®, the Germany-based market leader of technologies and training methods for full-endoscopic, minimally-invasive spinal surgery, is presenting its complete product portfolio at the 48th Annual Meeting of the Japanese Society for Spine Surgery and Related Research (JSSR). The annual meeting is currently underway running April 18-20, 2019 in Yokohama, Japan.

Earlier this year, joimax® announced its partnership with United Biomech Japan, Inc., who is overseeing distribution of the complete joimax® product line throughout Japan. Approval of the Pharmaceutical Medicals and Medical Devices Agency (PMDA) is expected within the next couple of months.

“The Japanese market is characterized by a strong demand for innovative products on endoscopic spinal surgery,” explained United Biomech Japan, Inc. Executive Kazuya Oribe. “The interest at our booth is overwhelming. There are approximately one thousand Japanese surgeons that are now already interested in doing endoscopic spinal surgery.”

“The patients’ demand for gentle surgery methods that result in a very quick recovery, is continuously increasing,” said joimax® Group Founder and CEO Wolfgang Ries. “Our entrance into the Japanese market is another milestone in expanding our global presence to offer superior medical products. Coupled with an outstanding, international training and education program, we’ve positioned ourselves for long-term growth.”

joimax(R) presence at JSSR Yokohama, Japan, endoscopicspine surgery, Minimally invasive, Transforaminal, Interlaminar, Training and Education, Japan, United Biomech Inc., JSSR
joimax(R) presence at JSSR Yokohama, Japan, endoscopicspine surgery, Minimally invasive, Transforaminal, Interlaminar, Training and Education, Japan, United Biomech Inc., JSSR
joimax(R) presence at JSSR Yokohama, Japan, endoscopicspine surgery, Minimally invasive, Transforaminal, Interlaminar, Training and Education, Japan, United Biomech Inc., JSSR