Interview
Interview with Peter Ullrich CEO
Titan Spine
SSN: Tell me about Titan Spine. Titan Spine is a surface technology company that is currently fo- cused on the production of interbody fusion devices with unique surface characteristics that have been proven to create an ideal environment for bone growth and fusion. All of our Endoskele- ton® interbody implants feature our proprietary nanoFIX™ Tech- nology, which consists of a unique blend of roughened topogra- phies at the macro, micro, and nano levels that has been shown to produce a superior bone-forming (osteogenic) response versus common interbody device materials, such as polyetheretherk- etone (PEEK). The surface energy of our implants causes the up- regulation of bone growth proteins, such as bone morphogenetic proteins (BMP’s), the upregulation of vascularisation, as well as down regulation of bone resorption (osteoclastic) activity. As a result of these factors, we feel that our devices and surface tech- nology create the potential for a faster and more robust fusion for our surgeons and patients.
SSN: What led you to develop the Endoskeleton line of inter- body implants?
I initially developed the original ALIF device in 2002 when I was an active Orthopedic spine surgeon. Like many surgeons, I was frustrated with the threaded titanium devices available at that time. Titanium as a material was a good choice, but the shape and design of the implant was the primary problem. The threaded design damaged the vertebral endplate during insertion, which led to a lot of implant subsidence. And because the cage was closed, it didn’t allow the bone graft to see any stress, which I felt nega- tively affected fusion rates. I wanted to design a cage that maxi- mised the area for bone graft and sat on the apophysis, which is the strongest portion of the vertebral endplate, without damaging it. And I wanted the implant to be an active participant in the fu- sion process, rather than just acting as a spacer. For this reason, I settled on a dual acid-etched process on the ends of the cage that would provide for an anti-expulsion surface and create the neces- sary surface energy to promote bone growth. The acid etching provides almost the same anti-expulsion strength as the threaded
cages without violating the endplate and dramatically reducing the risk of subsidence. And through our partnership with a re- nowned material scientist, Barbara Boyan, Ph.D., at the Institute for Bioengineering and Bioscience at Georgia Tech University, we were able to optimise the surface to maximise the potential for bone growth and fusion. Incorporating these concepts led to the development of a truly unique device.
SSN: When did you start commercially selling your devices? The initial development of the cage was performed by Orthovita, Inc. beginning in 2002. After they obtained FDA approval to market the device, I started implanting the ALIF cages in 2004. For almost three years, I was the sole user of the device but felt the clinical results were superior to what I had experienced with prior cages. Orthovita wanted to continue to concentrate on their core orthobiologics business and were unwilling to com- mercialise the cage. So I and four other cofounders of Titan bought the technology from Orthovita and started commercialis- ing the cage in 2006 from a corporate headquarters just outside of Milwaukee, Wisconsin. We have subsequently designed and commercialised five additional interbody cages and have several more in development.
SSN: What level of interest have you created in the U.S. mar- ketplace? We have seen the interest in our cages that interact with bone cells on a nanotechnology level skyrocket over the past couple of years. Our message is beginning to take hold and we are seeing a U.S. market that is beginning to swing back towards titanium for the reasons I previously mentioned. Outside forces have certainly also contributed, in particular the concerns surrounding the use of exogenous BMP-2 and its potential for adverse events. Surgeons are now becoming increasingly interested in cages being more than simply an anterior column spacer. They are looking for cages that participate in the fusion process like ours. Growth in sales has been outstanding with a current average of 40-50% quarter- on-quarter growth.
18 | SpinalSurgeryNews | Autumn 2012
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