On his 90th birthday, August 16, 2024, while trying to pull wisteria out of the pine trees on his beautiful mountain top in Clarion County Pennsylvania, just 22 miles from where he grew up in Oil City, Arthur Steffee, M.D., one of the founding fathers and most consequential surgeons in spine surgery, died at age 90 years old.
The cause of death has not yet been determined.
The founder of AcroMed Corporation, mentor for thousands of spine surgeons, visionary, and irrepressible builder and innovator, Arthur Steffee’s contribution to modern spine surgery is incalculable.
The Life of Arthur Steffee, M.D.
Art Steffee was born in 1934 in Oil City, Pennsylvania, population 22,000. Today it is half that.
About two weeks before he was born, Eddie Hodgkinson, the new daughter of Cecil B. Hodgkinson, M.D. was also born in the same hospital. But, as Steffee recalls, “In those days, especially doctors’ wives, tended to stay in the hospital a little longer than usual. I met my wife in the room next door to me when I was born.”
Art and Eddie became boyfriend and girlfriend in the 9th grade (“The only girlfriend I ever had”) and married in their senior year of college.
Eddie’s father, it turns out, was one of George Crile’s staff members. Crile, along with Frank Buntz, M.D. and William Lower, M.D., founded the Cleveland Clinic.
Hodgkinson eventually set up a practice in Oil City and in the early 1950s became Art Steffee’s father-in-law. Steffee was already thinking about medical school when he married Eddie. “People ask me, why did you go to medical school? In fact, my mother told me and my brother Bill, ‘you have to go to medical school’. And I knew how to follow directions.”
“But you know my parents couldn’t afford to send us to school. I owe my medical education to a dentist in Oil City,” recalls Steffee. “He coughed up the cash for both my brother and me to go to medical school. When it was all said and done and over with, I paid it back actually. But times were different. You know how much tuition was at McGill year? $740 for Americans. $500 if you were Canadian $500. For the full year.”
Steffee was the oldest of three children. “My mother was a schoolteacher. My father was a teller in the bank. My dad started in the bank the day he graduated from high school. And he stayed in that till he retired in Oil City.” His brother, Bill went to University of Pennsylvania medical school, later earned a Ph.D. in physics from MIT, taught at Boston University, joined Steffee at Charity Hospital as Chief of Surgery, and helped, eventually, to found AcroMed. Both Bill and Art Steffee were at Cleveland’s Charity hospital for about 10 years.
“I do things because I can.”
“I guess, maybe, I’m a little bit impatient about things. I don’t wait for somebody else to do something. I sort of like the challenge.”
And, upon reflection, Steffee acknowledges that his ability to create and build probably ran in his family.
“My grandfather, on my father’s side was quite an inventor. I remember watching my grandfather take an old Hoover sweeper—take the whole thing apart, leaving the motor on the end of the long stick, fashioning a blade, putting it on four wheels—and creating a rotary lawnmower. That was before rotary lawnmowers were even invented. My grandfather then detached the wheels and used that converted Hoover vacuum to trim hedges. When my grandfather built his house in 1903, he installed central vacuuming, cleaning in every room, with a gas engine in the basement.”
Incessant Forward Motion
Art Steffee lived a life of incessant forward motion. He came into his career at the very moment when modern orthopedic and spine care was emerging. Every new idea—Charnley, Harrington—triggered, in Steffee, flashes of inspiration—followed by a beeline to a lab. Any lab.
“I was fortunate enough to come along right when total joints started,” recalls Steffee. “Do you remember the ring total hip? It preceded all the rest. It was a screw, a metal socket with a long thread and you screwed it up inside the iliac post. You put the femoral part in just like you would for Moore prosthesis—Austin Moore. I made several attempts at a finger joint. Initially I used a chimpanzee hand to test designs. I remember going to the Delta primate center in Covington, Louisiana, on my own time and my own money and did a series of cases putting the finger joints in chimpanzees. The only problem with them was the chimpanzees also walk on their knuckles.”
Steffee, who was excited about the explosion of articulating prosthetics for hip, knee, fingers, shoulder and more, was, in his words, “teased” to go a country hospital and set up an arthroplasty practice and became one of Richard Corporation’s best known and most productive surgeon champions. It was there that he met Patricia—“Best scrub nurse who ever walked”—who would follow Steffee back to Charity and be with him for the remainder of her life.
Charity wanted Steffee back.
Cleveland, in those years, was a hotbed of cardiovascular innovation. “Charity was one of the places where the original pump oxygenator machine was invented. The surgeon inventor of that oxygenator retired, and his lab was now without a leader.
“Charity hospital had closed it down because Bud had retired. They offered Bud’s lab to me. They said ‘You can have it. You can have the whole thing. We’ll put in whatever you want. We put an Instron machine in for testing.’ Charity did everything. I had a whole crew of people working.”
The way to Steffee’s heart was to give him tools. Machines. A lab. A workshop.
The “jealous mistress” of medicine combined with Steffee’s ability to fabricate solutions to clinical problems led to his leaving the Charity lab (which became better known as the Cleveland Research Institute, the home for a talented corps of engineers led by Jim Moran, Terry Stahurski, the remarkable Frank Janson and its immensely consequential and talented director, Seth Greenwald) to found AcroMed.
The Steffee Plate and Bone Screw
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.
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 bone first, adding the plate on top of the screws.
To achieve this counter-intuitive placement, Steffee cut the heads off traditional bone screws. 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 five days. And, today, with advanced MIS systems, pain management and post-op care, hospital stays are approaching 1-day.
The Pedicle Screw Lawsuit Feeding Frenzy
Starting AcroMed set in motion a series of events that, in retrospect, can only be described as biblical. Indeed, between 1983 and 1998, no good deed of spine innovation went unpunished.
In 1982, Dr. Steffee applied to the FDA for approval of his bone screws and plate for the spine. His application was denied. In 1984 the FDA classified the pedicle screw as Class III device. Dr. Steffee and his new company AcroMed had hoped that the FDA would recognize that these devices were bone plates and screws and would qualify under the Medical Device Amendments of 1976 (1976 Amendments, Public Law 94-295) as predicate devices.
In 1984, the FDA allowed AcroMed to market their products as bone plates and bone screws but did not specifically allow their use in the spine. That approval would not come for another 12 bitter and difficult years.
Then came the lawsuits.
Nine years after AcroMed began selling its pedicle screws and plates, the television program 20/20 aired a segment that told a sensational story of metal hardware being put in patient’s backs by unscrupulous doctors and companies and that these screws were not FDA approved for use in the spine.
Ultimately over 3,000 lawsuits were filed over pedicle screws. The suits began to gather momentum in 1993 and in 1995 metastasized to include the surgeon societies. The North American Spine Society (NASS) was sued over 400 times in 42 states. NASS, which is dedicated to surgeon training and education, had sponsored five continuing medical education (CME) activities that mentioned off-label uses of pedicle screws. Two other societies, the American Academy of Orthopaedic Surgeons and the Scoliosis Research Society, were also sued.
Every one of the cases against the surgeon societies was dismissed by 1999 for lack of evidence. AcroMed was forced to agree to a $100 million payment and that, as much as anything, prompted Art Steffee to sell his company to DePuy.
DePuy bought AcroMed in March 1998 for $325 million. Art Steffee retired to a bucolic part of Pennsylvania, a short drive from where he started life, Oil City, Pennsylvania.
Arthur Steffee’s Legacy
With his passing, Arthur Steffee leaves behind an unmatched legacy of service, innovation and vision. Surgeons in Asia, Latin America, Australia, Europe, and North America—learned the modern practice of spine surgery from him. They, in turn, trained other surgeons and collectively, restored millions of patients to productive lives.
God bless and rest in peace, Dr. Steffee.
