Orthopedics This Week – October 2012

Anthony Yeung, M.D., receives the Parviz Kambin Award of the Society for Minimally Invasive Spine Surgery (SMISS) in cooperation with joimax® for his outstanding achievements in the field of minimally-invasive endoscopic spinal surgery.

Yeung Honored by SMISS

Anthony Yeung, M.D., known to his many friends and admirers as “Tony,” is the 2012 recipient of the Parviz Kambin Award, given by the Society for Minimally Invasive Spine Surgery (SMISS) to honor outstanding surgeons in the field of endoscopic spine surgery. The Society held the ceremony during its annual meeting, September 23, and Yeung’s son, Christopher Yeung, M.D., accepted the award for his father.

SMISS established the Kambin Award, in collaboration with joimax®, to recognize the surgeons who have successfully performed more than 1,000 cases of endoscopic spinal surgery, trained more than 100 surgeons in the procedure, (in both cases specifically transforaminal surgery), published in numerous scientific publications and professional journals and given presentations at leading congresses. Finally, the recipient must demonstrate a strong commitment to clinical research and training. Choll Kim, M.D. and executive director, Society for Minimally Invasive Spine Surgery, wrote, “Tony is my hero and certainly deserves such an award.”

The award is named for Parviz Kambin, M.D. to recognize and honor his pioneering work that paved the way for minimally invasive endoscopic spine surgery. Kambin identified the unique safe access point to the spinal canal now known as the “Kambin Triangle.” Previous awardees are Parviz Kambin, M.D., professor of Orthopedic Surgery, Drexel University; Michael Schubert, M.D., APEX Spine Center, Munich, Germany; and Menno Iprenburg, M.D., Veenhuizen, Netherlands.

SMISS is the only society dedicated solely to advancing minimally invasive spine surgery. Endoscopic spine surgery constitutes but a small portion of SMISS’ overall educational content regarding minimally invasive spine surgery. SMISS’ primary role is to provide a forum for the exchange of ideas and information.

Orthopedics This Week – Yeung Honered by SMISS


joimax®, EndoSphere Spine, LLC and the University of Toledo, Ohio, have signed a license agreement on endoscopic cage technologies

Karlsruhe, 23 October 2012. joimax® as the recognized pioneer in endoscopic spine surgery has launched the transforaminal access to the spinal canal under the brand name TESSYS® in 2004. Since then the company has consistently extended its product range and covers the complete array of therapies for spinal disorders with its systems today.

TESSYS® and iLESSYS® are applied especially for the treatment of disc herniations and stenosis utilizing the transforaminal or interlaminar access to the spinal canal, aiming for a long lasting decompression. In the area of pain therapy the company offers the products of the Multiuse series for endoscopic rhizotomy and PeNuts® for percutaneous nucleus therapy. The product range is completed by systems and products in the field of VBA management.

Consequently the next step in the evolution of the joimax® product portfolio is the stabilization and restoration of the spinal column. With the joimax® EndoLIF® programme – the term stands for Endoscopic Lumbar Interbody Fusion – various cage technologies are brought into the intervertebral foramen step by step under endoscopic view. The cage is then being filled with autologous bone or a substitute material under endoscopic control also, the intervertebral disc space and hence the whole spine segment is raised and stabilized. This will be the world’s first interbody fusion device which can be inserted under direct vision.

EndoSphere Spine’s founding members Professors Vijay Goel, PhD and Anand Agarwal, MD at the University of Toledo are among the world leading researchers in the development of biomedical device for the spine. With the assistance of a team at the University of Toledo, they have developed the cage technology, in particular a novel ring cage that is being licensed to joimax® on an exclusive worldwide basis. Prof. Goel is enthusiastic with the idea to position the cage technology using the joimax® minimally invasive access technique: “The combination of our know how with the joimax® expertise leads us to a unique concept that will dramatically push endoscopic spinal surgery forward.” His colleague Prof. Agarwal considers it even a “quantum leap forward”. “In the team at the University of Toledo and the co-founders of EndoSphere Spine, LLC (Profs Goel and Agarwal) we have found a brilliant partner to provide the spine surgeons with state-of-the-art implants for most atraumatic interventions”, adds Wolfgang Ries, CEO and Founder of joimax®.

Both parties share the vision and mission of creating pioneering technologies in order to quickly bring back patients to their usual quality of life in the long run.

About The University of Toledo
Established in 1872, The University of Toledo is home to nearly 22,500 students across 13 colleges and six Ohio campuses. The University offers more than 230 doctoral, professional, graduate and undergraduate programs. UT has earned national and international acclaim for its expertise in medical bioengineering, solar and advanced renewable energy, environmental sciences, astronomical research, translational research and biomarkers.

joimax® goes BRIC and beyond


Right on time with the soon expected registrations of the joimax® products in Brazil – one of the most emerging BRIC economies – the German-based company showed a very successful presence at the third World Congress of Minimally Invasive Spine Surgery and Techniques (WCMISST) in Salvador de Bahia. The congress was supported by the main International MISS Societies. Almost 2.000 interested participants attended the congress which focused especially on promoting and enhancing the interventional minimally invasive treatment of spine diseases. joimax® is very proud of being part of this exciting development.

The eight largest emerging and developing economies by either nominal GDP or PPP are the BRIC nations (Brazil, Russia, India and China) as well as Mexico, Turkey, Indonesia, and South Korea. joimax® is represented in more than 60% of these countries – namely China, Russia, India, South Korea, and Turkey – and observes a fast growing number of registered products in these areas. In Brazil and Mexico submissions with the Health Authorities were started several months ago. The completion is expected in the near future. Then nearly 90% of the growth-leading economies will be covered.

joimax® provides the complete range of high-quality medical devices for minimally invasive endoscopic spine surgery “Made in Germany”. As a matter of course these devices are CE-marked and FDA-cleared and are sold throughout the European Union and the United States. The specific surgery methods they are used for, were developed by joimax® together with international experts and opinion leaders for the benefit of the patients:

Less pain, less trauma, less hospitalization, gain back quality of life and be back to work in shorter time!

The advantages are evident. Therefore joimax® has established a worldwide net of distribution partners allowing that as many patients as possible can get access to these progressive therapy methods.

Other important countries where joimax® is already present are: South Africa, Israel and Australia. One of the company’s goals within the next few years is to achieve the approval for its devices with the Japanese Ministry of Health.

Emerging and growth-leading economies are the key markets that are expected to lead global growth in the next 10 years. “joimax® is most pleased with its growing market penetration also in these countries, hence promoting these gentle, patient-friendly and economically beneficial surgery methods for the sake of the patients and of the health insurance systems at the same time”, states Wolfgang Ries, CEO and Founder of joimax®.

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

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”.

Two top notch cadaver workshops offered by joimax® in April

Karlsruhe, 25. April 2012. After March has been the month of international congresses – the ISASS in Barcelona and the EndoVienna in Vienna – April is the month of international workshops for joimax®.

From April 19th to 20th, 2012 joimax® held a cadaver workshop in collaboration with the anatomic institute of the University of Heidelberg – a since long established partner. Dr. Carl-Hans Fürstenberg, senior physician at the centre for spinal cord medicine and spine surgery of the University Clinic Heidelberg, talked about anatomy of the lumbar spine, the transforaminal access and suitable indications for less advanced learners. Dr. Menno Iprenburg from the Dutch Rugkliniek Iprenburg demonstrated the transforaminal approach step by step. The true potential of this method was illustrated by Dr. Ralf Wagner from the Ligamenta Spine Center in Frankfurt with the presentation of some of his most complex cases. The theory session was completed by some recommendations on anesthesia and especially on analgosedation by Dr. Alexander Godschalx from Deurze in the Netherlands. CEO and joimax® founder Wolfgang Ries gave a short outline on future developments in endoscopic spine surgery – a field that belongs to the core competences of joimax® as one of the market leaders. Guided by experienced instructors, the 12 international participants were able to intensively try and train the minimally invasive joimax® techniques on three cadavers during the hands-on session.

The second workshop for this month is currently taking place at the MEDucation Medical Training Center, Mülheim/Ruhr in Germany. This workshop is exclusively held for a Chinese group of physicians. The top delegation of 17 spine specialists from China participate at the company’s well known three-step education program. They have visited different German and Dutch clinics for visitations with the experienced joimax® faculty members. Back to Mülheim/Ruhr they will be able to instantaneously practice the joimax® access and treatment methods in the cadaver lab. Talks of the joimax® reference surgeons Dr. Michael Schubert, Munich, and Dr. Guntram Krzok, Friedrichroda, will complete the program. Both Germany-based physicians have a special relation to Chinese customs and culture due to several lecture tours with live surgeries through China. As the third step of the education program own surgeries “at home” guided by the joimax® faculty team or a joimax® application specialist can be arranged. “The combination of theory, practice and life surgeries makes this education program truly unique” – that’s what stated one of the Chinese professors.

The next cadaver workshops will take place in May in Salzburg, Austria and in June in Mainz, Germany.

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

Karlsruhe, 20 March 2012. Right on time with the start into a new decade of the joimax® history, the Karlsruhe-based medical technology company specializing in endoscopic resp. micro-invasive spine surgery will be present at two renowned congresses in March: ISASS from 20 to 23 March 2012 in Barcelona und EndoVienna from 29 March to 1 April 2012 in Vienna.

For the 12th Annual Meeting of ISASS (International Society for the Advancement of Spine Surgery) joimax® will take part in the exhibition and offer an industry workshop with the motto „Endoscopic Spine Surgery – Following New Paths in Barcelona“. Speakers at this event on 21 March 2012 will be Dr. Choll Kim, San Diego, focussing on the outstanding advantages of endoscopic access techniques especially in the area of the lumbar spine. Followed by Dr. Michael Schubert, Munich, with a presentation of complex cases, extending procedures from the lumbar to the thoracic spine, and varying the access path from the transforaminal to the interlaminar surgery method with the joimax® instrument systems TESSYS® und iLESSYS®.

joimax® displays the complete product range for endoscopic spinal surgery: Instrument sets for the treatment of disc herniations – with CESSYS® now being available for the cervical spine –, the novel pain therapy product “Multiuse” for endoscopic facet joint denervation and the iLESSYS® system for 360° decompression. Further special blades for the Shrill® shaver-drill resection and ablation system and namely the Shrill® Deflector Blades for resections „around the corner“, eagerly anticipated by the market, will now be launched.

Preluding the 5th World Congress for Endoscopic Surgery EndoVienna, joimax® has invited internationally renowned specialists to join a User Meeting with presentations of the joimax® Faculty members and a workshop to be held at the Institute of Anatomy of the Vienna University. The User Meeting will be dedicated to an intense exchange of knowledge and ideas of the most experienced users of the joimax® technologies. It will be followed by the keynote lecture of Prof. Dr. G.J. Groen, Utrecht, „High-Resolution Imaging of the Spine: Key to a Better Insight in 3D Relations Within the Spine“, at the opening session of the EndoVienna congress. The program of the „EndoVienna Spine Session“ on 30 March 2012 offers a whole bunch of scientific presentations on the most recent joimax® products. Members of the international joimax® faculty team will present their experiences when applying the joimax® access and resection systems. This session will be chaired by Univ. Doz. Dr. Sandro Eustacchio from the University Hospital Graz.

joimax® is currently planning its attendance to the upcoming congresses: The 80th Annual Meeting of the AANS in Miami in April at the first place. The BASS Britspine in early May. End of May Spine Week in Amsterdam. To be followed by SFCR in Strasbourg in June – it is the first time that joimax® will participate in this congress of the Society of French Spine Surgeons with an exhibition stand and a workshop. Subsequently the company will promote its technologies at the DGNC congress to be held in Leipzig this time. All events focus on industry exhibitions displaying novel product developments and on scientific presence within the conference programs.