When I think of Dr. Steffee, I think of three attributes—love, perseverance, and a sparkle in the eye. I cannot imagine how different the world would be if he had chosen any other profession.
Dr. Steffee, who lives outside of Pittsburgh, Pennsylvania, is the subject of an excellent new documentary short (link is below). It reminds us that we stand on the shoulders of giants.
Here is that video. https://youtu.be/Wn4HfVdnrhM
Launching Modern Spine Surgery
For about 10 years, one man was probably the best-known surgeon and entrepreneur in the spine industry. That was Art Steffee, founder of AcroMed Inc. Dr. Steffee, who retired in 1998, sold AcroMed to DePuy in 2008 for $325 million and to settle roughly $100 million in lawsuits. AcroMed’s sales that year were approaching $150 million.
Art Steffee founded AcroMed in 1983 on the basis of a napkin sketch that Dr. Ralph Rashbaum (of the Texas Back Institute) made for a pedicle screw fixation system (that first system was called the “Texas Connection”). Taking that idea and combining it with local capital and his own creative thinking, Dr. Steffee started AcroMed. (Acro, in Greek, means extremity or peak.)
In 1982, a spine bone screw and plate was considered an unlikely surgical treatment by most surgeons. Today pedicle screws and plates are universal. But before pedicle screws and plates, patients with a deformed spine or in severe pain had to endure literally months trapped in a full body cast.
In 1983 Dr. Steffee and Ed Wagner, a local Cleveland businessman and venture investor, founded AcroMed to bring to market a stainless steel bone screw and plate. Later the material was changed to titanium. He also introduced a new method to implant the screws and plates in the spine.
Before AcroMed, Dr. Steffee was the director of orthopedic services of the Cleveland Spine and Arthritis Center at Lutheran Medical Centre, and he had already pioneered several surgical techniques and developed a number of orthopedic implant devices.
In those days spinal implants were mostly hooks intended to correct spinal deformities, but which weren’t very reliable. They could not be firmly attached to the spine. During a spine operation in the early 1980s, Steffee discovered, while cutting bone in the lower part of the spine, that he could place a standard long bone screw in the pedicle bone of the spine. Putting a bone screw into the pedicle, which allowed the head of the screw to sit between two sides of bone, created a solid fixation.
The spine actually has a limited amount of bone. Further, nerves and arteries are immediately adjacent, even intertwined with the bony structures of the spine. Screw placement was critical. This was the key problem for Dr. Steffee. One napkin sketch later and Steffee had a potential solution.
Bone plates of the time were, in fact, long bone-fracture plates with holes that did not match the anatomy of the spine. Dr. Steffee’s solution was to make slots, not holes, in the bone plate so that screws could be adjusted during placement. Then, he placed the screws in first, before the plate! Which was counter-intuitive but dramatically reduced the risk of screw misplacement.
To do this, Steffee had to cut off the head of the traditional bone screw. After the screws were placed in the saddle of the pedicle bone, he positioned the bone plate over his headless screws and fixed them in place with a nut. His innovation will forever be known as the “variable screw placement” technique and it is one of the foundational inventions in spine.
When placed correctly, pedicle screw systems allowed patients a much easier postoperative course and quicker rehabilitation. The average hospital stay was cut by more than 50% to about 11 days. Later, the advent of the spine cage lowered hospital stays to about 5 days. And, today, with advanced MIS systems, pain management and post-op care, hospital stays are approaching 1 day.
