By: 10 August 2015
Patient-specific sagittal alignment – Dr Frank Schwab

Patient-specific sagittal alignment – Dr Frank Schwab

Dr Frank Schwab discusses his experience with the world’s first patient-specific alignment rod.

Dr Frank Schwab is the chief of spine service at the Hospital for Special Surgery and a professor of clinical orthopaedic surgery at Weill Cornell Medical College. His clinical practice focuses on complex spinal pathology, adult spinal deformity and revision reconstruction procedures. Dr Schwab is widely recognised as a leader in the field and has pioneered many aspects of spinal deformity care, especially for patients with extensive surgical histories. He is a leader and board member of the International Spine Study Group (ISSG) and active within the American Academy of Orthopaedic Surgeons (AAOS), and North American Spine Society (NASS).

What has been your experience with the UNiD™ patient-specific rod since the recent FDA clearance?

We were proud to be the first in the USA to use the revolutionary patient-specific rod coupled with Surgimap™ pre-operative planning. We have been very happy with our experience, and our patients also recognise the value of this unique technology.

For what types of patients/indications do you feel the technology is suitable and why?

I would say that the UNiD technology is really relevant to just about any patient but most particularly to cases that involve multiple levels of fusion of the spine. In terms of my own criteria for selecting an appropriate patient, once more than two or three levels of fusion are required, then I don’t see any downside. Why would you not want to have a rod that’s more adequately aligned than having to bend it yourself and worry that there is too much or not enough curvature? So as soon as I’m dealing with more than a couple of levels of fusion, I will opt for a UNiD rod for my patient.

In what ways has your planning and technique benefited from the UNiD patient-specific rod? How do you expect those benefits to translate to patients in the short and long term?

It’s so simple once you have an alignment goal in mind: with just a few clicks you can also have a rod which is specific to the patient and that alignment. That’s a huge benefit and, given the ease of planning, it is a really big return on investment.

I expect the benefits to translate to patients in a number of ways both short and long term. Getting better alignment in the operating room translates to better alignment postoperatively and that’s been clearly shown to correlate with patient satisfaction and with long-term benefits of surgery. There are some more studies that show that alignment plays a role in the risk factors for proximal junctional kyphosis (PJK) and other complications, so the better we can align our patients, the more they benefit from our surgical intervention. We also know from a number of studies that revision rates go up if your alignment is suboptimal, so I absolutely feel that getting the alignment right the first time will reduce the likelihood of very costly revision surgeries that are clearly not pleasant for us or our patients. We really have to use technology to help us get it right the first time.

Where do you believe personalised medicine is heading? What is the next step?

Personalised medicine is going to play a role in everything that we do for our patients more and more, so I think in terms of spine surgery what that will mean is more customisation – not only in the implants such as the rod, but maybe personalisation of the shape of cages, maybe also in terms of what gets delivered or shipped to the operating room to make that much more efficient. Also, I think that we’re going to get more personalised in targeting and tailoring our procedures to the expectations of the patients and perhaps not treat all images or deformities the same.


Dr Frank Schwab is co-founder of Nemaris, which develops Surgimap Spine, among other products.