Thank you. We have a few moments for questions for the last four speakers. I'll perhaps start with a question for Dr. Odagwa. Very nice talk, an important topic, and I think that there's increasing interest in what we can all do in a collaborative way to enhance the recovery of patients who are having spinal surgery. The questions are twofold. One is, do you have any sense for the audience of what the cost is for implementing these types of collaborative programs, which I think you and others are showing are very, very helpful? And the second piece of that is, can you speak at all to, you know, what bias there may be around a new effort of any type to reduce narcotic usage and improve recovery, and how much of it do you think is directly attributable to the collaborative program that you've described? Okay. Thank you. That's two good questions. I'll start with the second question first. Whenever you start a new program, there's a Hawthorne effect, and that is everyone is very attuned to the fact that we are trying to address something or improve something, and that certainly increases attentiveness to some things that otherwise they might not be as attentive to. So I think that with any program that you initiate, that is something that you have to keep in mind. We are starting to collect the cost numbers now, and I think that's where the real value of some of this might come into play. If getting five services or six or seven services together shows that there is a significant cost saving to the hospital and there's a marginal benefit, then this makes sense. But if it's cost prohibitive, meaning that you bring ten services together, it's very expensive for the hospital systems, especially the small to medium-tier hospitals, then that might warrant some further discussion. Who actually needs to have a seat at that table, and what variables really need to be optimized to improve the outcomes of these patients? So we're starting to collect these cost numbers now. When I look at CMS's data, for instance, you look at the patients over the age of 65 who present to a hospital, the average health care concentration index, the number of specialists that these patients have on file, on record, are about six to seven. So they are seeing about six to seven specialists as it is when they present to a hospital. So when we look at these numbers, hopefully I'll have more data for you hopefully next year, or maybe at the spine section, to really see is there a benefit, is there a cost saving for the hospital, or what variables do we really need to tackle to optimize both the cost savings, the outcomes, and the complications profiles for these patients? Thank you. Question from Fred Harrington in the back. Hi, another question for Dr. Odagwa, very brief. What I want to know is that you had the co-care model, and you described some patients getting to oral antibiotics sooner than other patients. What was the overlap of the people receiving the co-care model? Did all of them receive the co-care model? In other words, what's the overlap between co-care model and getting to oral antibiotics? That's a great question, and I thought I had that in my results section. So 80% of patients who were in the co-care model, the majority of the patients, were oralized earlier. The vast majority of patients, or the minority of patients in the co-care model, were auto-paralyzed in a delayed fashion, so 20%. So if you were part of this co-care model, you were more likely to be transitioned to an oral regimen within 24 hours than if you were not. Question from Mick. Mick, let's say all this stuff works out, the umbilical blood stem cells, and you can grow an entire disc. At what point, five years from now, at what point would you use this technology? Do you see it as, okay, I'm doing a microdisc, I know I can put some regenerative technologies in there, or do you put it into that patient that we've all seen that comes in with back pain and annular tear and a darkened disc that stands out amongst the remaining segments of the lumbar spine? I think that's the million-dollar question. When do you use this effectively? We're already seeing clinics around the country injecting mesenchymal stem cells into patients' discs, charging them $5,000 to $10,000 and saying you're cured. And we around here know that that's probably not the case. This is a complex issue, and we have to be smart in how we cost-effectively use our system to address one of the most costly health care problems, and that's the treatment of degenerative spinal disorder. So I think this is a whole new era, and I do think that we have to be very selective on who we choose for this. I don't think just injecting a cell into a collapsed disc in a patient with back pain is really going to be that effective. We're looking at new technologies, the one I showed you, annulo, where we're looking at at least regenerating the height of the disc through a process that we already see is useful in the Alizarov method for long bone growth, and plastic surgeons use this all the time, and tissue expanders under the skin. You drink enough beers, you're going to get a beer belly. So we have a potential to do this. The question is how do we do it effectively? So this is a neat area of future development, and I think going about this smartly and scientifically and having organizations like this to really vet this out is very important. Question for Dr. Jin Zhao. You demonstrated very nicely the correlation with patient-reported outcomes and the various spinal parameter measurements. Was there any demonstration that it decreased, that correcting someone to that extent prevented a re-operation? I mean, we can all think of those as an action. I should have gone one level more, my correction is not as much, and then you're doing it six months or a year later. Did this demonstrate a decreased need for re-operation? I think it's a very good question. I think in general our data, I think we need to have some more data in terms of patients in different categories. For instance, we have a lot of patients in cervical group, but not too much in cervical thoracic, which is really critical as far as your question goes in terms of re-operation rate. But I think looking at our data, I'm pretty sure patients with posterior approaches, they have a higher re-operation rate, re-admission rate, versus patients with anterior versus anterior with posterior approaches. So that's the only one confirmative that I can find, I can tell from our data. So right now we don't know? We don't know. So to summarize it, even though we get the patient reported outcomes are very important, and correlating them with the various parameters are important, but your data at this point doesn't demonstrate a decreased need for re-operation. Agreed. Thanks.

spinal surgery

collaborative programs

cost effectiveness

Hawthorne effect

recovery enhancement