Like most industry exec's at a trade show, I imagine that Mr. Chee was up until the wee hours of the morning, wining and dining potential customers. That didn't keep him from responding to an early morning SMS message asking if he could meet me for breakfast. He gladly obliged and seemed to be thankful for an excuse to get an early start as he had only one free day in Berlin and he was ready to see some sites!

Spinal dynamics has a new cervical total disc replacement (M6°) that is very interesting. I hope to write much more about it later. Mr. Chee had just spent a most greuling week representing his company at SAS. I do not envy the people who work the shows... it's endless hours; zero rest; non-stop work work work. He must have been exhausted. Even so, as we got into almost 3 hours of non-stop spine, it was clear that we could have gone on all day. He's excited about what he does and has so much interesting information and insight to share. Being so many years into this, I should not be suprised by this phenomenon, but I still am. I too am excited about what I do and want to soak up the information like a sponge. I think and hope that he finds my unique perspective as a patient and patient advocate interesting and useful as well! .

Our conversation covered so much ground. He's a design engineer that's been involved in new medical devices for 25 years. As EVP of SpinalKinetics, he oversees and/or is involved in many aspects of development, manufacturing, operations and marketing. His insights into the difficulties of bringing new product to market were eye-opening. We discussed many of the new technologies being presented at SAS; what is going to work... what's not; patent infringement lawsuits; ethical issues surrounding clinical trials; marketing spin vs. useful information, constrained vs. unconstrained prostheses, keel vs. cleats... and on and on and on. One of the more interesting topics we discussed was why some centers get such different results than others. For me, I could not have had a more interesting breakfast. I hope it was more than just another morning at the office for him. After our 3 hour breakfast... so much for an early start on his sightseeing. Maybe with the 40 cups of coffee that we each had, he can tour them at high speed.

As Mr. Chee and I were saying goodbye in the hotel lobby, we bumped into Jenni Buckley. I'd been meaning to talk to her throughout the conference, but never caught up with her. (You have to understand how fast these conferences move. If you blink or stop to chat with someone, you miss something important. You get to the end of the conference and realize how much you wanted to do that you never got to.) "Jenni, you get the Mark Mintzer award for best questions asked throughout the conference." No joke, she really asked some provocative questions that spawned some great discussions during many of the panels. (I don't know how prized the Mark Mintzer award will be. It's probably not worth much, but she seemed to appreciate the compliment.) I asked if she had a few minutes to chat? "Sure, I'm going for coffee, why don't you join me." I really needed another cup, so we walked over to Potsdamer Platz for more caffeine.

I wanted to talk to her about an interesting issue that I perceive regarding spine researchers. Ms. Buckley is a postdoctoral scholar working in Orthopaedic Surgery and Bioengeneering Laboratory run by Jeff Lotz. At SAS-3 in Phoenix, AZ, I wrote about "My lunch with the researchers". I had gone out to lunch with a neurosurgeon and several prominent researchers. My friend, Neil Crawford, runs the spinal mechanics research lab a the Barrow Neurological Institute in Phoenix. His colleagues at the lunch run prestigious labs all over the continent. During lunch, I said, "OK, I have a captive audience here. I want to know... imagine for a minute that:

What do you do?"

I was shocked by the answer. I was honestly expecting gentlemen to give me some insight into the ProDisc vs. Charite' dilemma that many potential ADR patients were struggling with. That's the choice that I thought they were making. To a man... every one of them said that they'd most likely do nothing, or a 2-level global fusion. Remember that this was 4 years ago. At SAS-7, I was hoping to recreate that event. Unfortunately, there was not time, but I hope that Neil will help me recreate my informal poll of top researchers via email. 4-years later, I'm expecting that they've learned the error of their ways and will all embrace motion preservation technology. However, the buzz that I'm getting from the researchers I spoke to this year is something like: "If I'm a lumbar patient, I still think I'd still choose fusion. Cervical ADR is looking pretty good, so I'd take a closer look at it before deciding what to do."

What I wanted to talk to Ms. Buckley about is my theory about what I've heard from all these brilliant PhD's who study spinal mechanics, all day, every day. Some may think that the take-home message is, "Wow... these people really know what they are talking about... I'd better be worried about ADR." I don't think so. IMHO, the take home message may something more on the order of:

We had a wonderful walk and a great discussion. I got to have another latte' as I was feeling the need for some more caffeine. Jenni seemed to be intrigued by my "patient's perspective" of the industry that she lives in. Her experience is very interesting to me. Her publications include:

Poke around on her website, me.berkeley.edu/~jbuckley/. Look at her CV and research. She's been studing bone quality, vertebroplasty, spinal kinematics re: disc arthroplasty, and more for many years. Getting a private lesson from her on the difference between DEXA and QCT bone density measurements was very, very informative and really helped me to understand why so many doctors prefer QCT.

She's invited me to participate in a panel discussion at a conference for biomedical researchers, or a she discribed it, "a geekfest". As with the Ethics conference I've participated in for a few years now, having the patient's perspecitve represented is still a unique and refreshing idea.

Unfortunately, I had to cut our discussion short... we only an hour or so before I had to run. But the day's next event was amazing!

Charite', 22.7005 year follow-up, or

"How long will a poly core last?

What should this post be titled? Here is the math:

5-May-2007 minus 19-September-1984, that's 8,263 days, or 22.7005 years that Wolfgang Lehmann has had his SB-Charite' ADR in his spine.

5-May-2007 minus 20-September-2002, that's 1,688 days, or 4.637 years. Multiply 4.637 times 2 discs, to get my total experience with 2 SB-Charite-III ADR's.

So, on a tennis court in Berlin today, we had 31.975 years worth of Charite' ADR experience playing. I had been hoping to make this happen for some time and I have to give my thanks to Karin Büttner-Janz for making it so. I can't tell you how much fun this was or how emotional it was for the both of us. I ran from my morning meetings to my hotel to change and just barely make it on-time to SportClub Mitte in what in 1984 was East Berlin.

I had hoped to have someone to video for us, but that didn't happen. We started warming up and I was wondering how I'd get the video... what pictures should I take? After a nice warm-up, we decided to play a set. Keep in mind that I have settled into a lifestyle working, and working more, and then working some more. (My clients that have me call them at all hours will attest to that.) I am waaaay out of shape, but hopefully, I'll correct that soon. In any case, just a few minutes into our match, I was suprised how the need to create a photo opportunity was 100% replaced with the joy of running and sweating, and hitting a tennis ball and competing again. I rediscovered why I probably don't participate in athletics much anymore. I don't have a medium switch. I want to run every ball down... I think I can reach every passing shot. The extreme lunging, sprinting, rapid direction changes, etc... are a little extreme for an out of shape 50 year old grandfather with 3 spine surgeries and 2 artificial disc. I don't understand what none of that is in any way limiting for the 64 year-old grandfather across the net who's running my legs off. ("Me, a grandfather... that still sounds wierd!)

Just a couple of games into the set, I really went for an impossible ball and pulled up a little lame with a minor groin pull. OK... work it off... run it off... I'll be OK. There was no way that I'd stop playing now... this is way too cool. I wondered if I got hurt, how would I get the video of us playing tennis that I wanted. Oh well... if it happened, I'd have Wolfgang video them putting me into the ambulance... that would make a better story anyway. (Maybe it would teach me a lesson that I need to learn!)

Wolfgang's English is much better than my German, but my German isn't very good. It was often difficult, but we communicated OK and some of our court-change conversations were quite interesting. In 1988, I played tennis 6 days a week. A minor fall skiing injured my rotator cuff. A few weeks later, I still could not lift my arm above shoulder height, but I was getting very antsy not playing tennis. So, I signed up for the tennis leagues at my club and played left handed. I was a 5.0 player, but joined the 3.0 league as a lefty. I came in second and moved up to 3.5 where I won about 1/2 of my matches. I've never met anyone else who'd done that... until today. Wolfgang had exactly the same experience. We are so different, yet have so much in common.

Later in the match, I was ahead, so I 'gifted' him a point by electing to volley a ball that was clearly going to be way out. It was going to be so far out that I was embarrassed by having done that. He was clearly unhappy by my choice but politely accepted the point. A few seconds later, he gifted a point back to me in a similar fashion.... just like I would have done. Nobody is going to give me a point that I didn't earn... I don't care what the score is. We are so different, yet have so much in common.

After our set, we did try to capture some video. I'll put it up as soon as I can. We sat down for a beer and talked a bit about our spine ordeals. Remember that we have a significant language barrier. I was interested in his recovery, so I drew him a graph of mine. Starting at a constant pain of 8/10, I drew a blip to 9 for the first week post-op, back to 8 for the second, then a steady march downwards till week 7 where my pain levels were down in the 2,3,4 range. I was surprised to hear that his graph started at a constant pain level of 9, then at 24 hours post-op it was less than 1. He was classic discogenic pain... remove the disc and your pain goes away. He was in it for 1.5 years and I believe that he was as severely disabled, or more than I was.

I talked about the impact on my family... my wife being a stay-at-home mom for 18 years, suddenly needing to support the family financially and still clean and shop and... We talked about the depression that comes along with endless months or years of chronic, severe pain. I think that our ordeals were very much the same. Again, we are so different, yet have so much in common.

I have to discuss the disc. Wolfgang's Charite is nothing like mine. They call it the 'bottle cap'. This surgery was done before placement and implant sizing issues were understood. This surgery was done before potential complications for total disc replacement were understood. Today, when I'm dealing with someone who's going for a single-level ADR of any type, I worry for them... 23 years after Wolfgang's surgery, we are still dealing with many of the same issues that were discovered in the early patients through the 80's and 90's. The fact that Wolfgang is playing tennis 23 years later is a testament to the genious of Kurt Shellnack and Karin Büttner-Janz - the 'S' and 'B' in SB Charite'. The fact that they got it right the first time... with no roadmap to guide them... I find remarkable.

While we were playing I kept thinking how amazing this is... East Berlin, 23 years with the very first disc, and now at age 64, still playing tennis twice a week.. When we were done and enjoying a beer it was great to get to know him a little better. Knowing that we had been through the same experience with almost the same device, 18 years and 1 day apart... this was just too much fun. Looking at my new friend's natural smile instead of that grimace of pain made this one of the most incredible experiences I've ever had. We both had to come to Germany to get it done, but his trip was a little shorter than mine.