SSN meets Dr Paul Slosar, Chief Medical Officer at Titan Spine
Tell us about your role as Chief Medical Officer
As Chief Medical Officer of Titan Spine I have responsibilities to the surgeons in the field and to the company itself. It is a very exciting and dynamic role. As I still maintain a busy clinical practice, my role with Titan requires a fair amount of balancing time and energy. I bring efficiency to the company by being accessible and quickly distill complex issues for action. I have the opportunity to use all of the various interbody implants that Titan produces so I can directly interact with and assist the engineers and product managers.
I have the great fortune to speak with and meet many surgeons across the country. I speak their language, surgeon to surgeon, and understand the nuances of what distinguishes a good product from a great one. Many of these surgeons have remarkable insights and make tangible improvements to our technologies. An important part of my job as CMO is to bridge the gaps between engineering, product development and the needs of the surgeons. Finally, I oversee the research teams including those focused on basic science as well as our growing Scientific Advisory Board.
What made you choose your career in spinal surgery?
I first contemplated a residency in either neurosurgery or orthopaedic surgery. I chose orthopaedic surgery because the technology was growing at a remarkable pace during my training years and I knew I had a talent for building things or putting them back together after they break. I was fortunate to have a great experience in spine during my residency and found spinal surgery to be the most challenging of all the subspecialties. Someone once described spinal surgery as the ‘special forces’ of orthopaedics, which resonated with me. I have been fortunate to have lived through the technological revolution in spine, which began in the early 1990s and continues to the present day. Great spine surgeons must have a talent for both the delicate aspects of neurological work, coupled with the carpentry skills to stabilise complex mechanical problems. Spine surgery is incredibly challenging and remarkably rewarding.
Titan Spine recently announced that a research paper which evaluated its surface technology was awarded the prestigious Whitecloud Award for Best Basic Science Research from the Scoliosis Research Society at the IMAST meeting. Can you tell us more about the research and its findings?
IMAST is a spine conference sponsored by the Scoliosis Research Society which highlights advanced and emerging spine surgery technologies. I had the distinct pleasure to present a basic science paper which compared the Titan Spine proprietary implant surface to PEEK and smooth titanium. The work was performed independently by Dr Barbara Boyan and her renowned team of scientists out of Virginia Commonwealth University. The paper was awarded the highest honour (The Whitecloud Award) by the IMAST programme committee as the best original basic science paper of the meeting.
The study builds on a growing wealth of strong basic science which demonstrates that the Titan titanium surface fosters a remarkable cellular response from stem cells which favours bone formation. In contrast, PEEK stimulated a significant inflammatory response from cells, which is associated with necrosis, cell death and fibrosis, and obviously does not enable a viable micro-environment for bone formation.
What is the next step for Titan Spine following this research?
Over the past three to five years we have published a number of scientific papers demonstrating the cellular problems with PEEK and the strengths of roughened titanium surfaces with very specific topographies at the cellular level. Our focus now is to dispel the misconceptions around modulus of elasticity (MOE), which interestingly was born out of an old marketing campaign by one of the large implant manufacturers. (I will let your readers in on a breaking story about what we have found in our research regarding MOE; it has nothing to do with subsidence!). Additionally, we are shifting more research focus to clinical outcome studies that are labour intensive but tangibly useful to surgeons, patients and payers.
What could this mean for the future of spinal surgery?
As surgeons, hospitals and payers look to save money on spine cases, we believe Titan’s surface technology, with rapid bone-implant integration capacity, can be leveraged. We want to demonstrate high fusion rates with basic (not expensive) biologic bone graft options and reduce fusion failures that are enormously expensive. For too long, spine surgeons have not paid close attention to our interbody implants, using plastic spacers and ‘nuclear powered’ bone proteins. We believe the implant can play a meaningful role in the biologic success of a spinal fusion. Titan Spine has just announced a warranty for its implants that provides a one-time free replacement if revision surgery is required within five years of implantation. To my knowledge, we are the only company to ever do this in the spine surgery market. The era of surface technology is upon us in spine, and Titan is leading the way.