We have time for a few questions for the previous speakers. This is for Dr. Kalfus. The study was injury reported imaging for the baseball players. Does the MLB do, like the NFL does, the combine health, I mean they do a very thorough health workup on all the first round draftees and second, does the MLB do something like that? You would think they might pick up more of these that may be from college or high school. Question for Dr. Kalfus. I think that's a great, great project there. In Phoenix we have the Cactus League, all of these kids that want to make the majors stay there and we see these patients in clinic and it seems that they arrive with spectroscopy studies that show almost a pre-PARS injury. In my experience it's predominantly in pitchers. What has your experience been or what does the data show with the risk of re-injury? And what do we do with a positive spectroscopy in a patient who doesn't have a fracture, has pain, and his entire, when these patients come into your clinic, it's not just the patient, it's the trainer, it's mom, it's dad, it's the agent, and a lot is riding on that clinic visit. So what guidance could you give? Yeah, this study didn't delve in that deep with that, but at least in my practice, it's going to be symptom related obviously and going through the same methodology of treatment as we would in other individuals with those findings. The data that we got from MLB was primarily just the MRI reports, the lumbar reports, nothing more than that. Obviously they're very tight with whatever information they give out. Do you feel that that spectroscopy, which the CT scan does not show a fracture, but spectroscopy shows increased uptake in the PARS. Yeah. Do we wait for a cold spectroscopy to clear them back? Yeah, I've had false negatives with that. I've had patients that initially had back pain and they eventually got that study, but their symptoms have resolved, but that spectroscopy was positive. So I really don't know what to make of it. I don't know if it's maybe too sensitive. Again, I'm going to treat the patient based on their level of symptoms at the time. Bob. Yeah, Ian, if you could hold on a second. In the info that you presented, you had 75 patients for like 27% with either spondylolisthesis or spondylolisthesis, but the problem is without knowing the denominator, it's really unclear, and the thought is did the others not have these things or we don't know. Did they do imaging on the people who did not have back pain? No, these were just patients that presented with injury. Right, so the ones who didn't have back pain, we don't know. We don't have a prevalence rate. Right. We have the incidence of the two disorders in patients presenting with back pain. Right, and we don't know how many people who don't have back pain might also have that. Correct. And what the overall percent will be based on the denominator. That may be something we can tease out in the future, but with the data they gave us, we were not able to do that. I have a question for Praveen. First of all, very, very important data on this fractional curve versus the whole shebang. One of the things that I think happens is that many people in community practice see these patients and they really can only offer that patient one thing. And what is the sense that you have at your site for people who see these patients in the community? Who do they refer in so that they can have both options reviewed? And who do they treat locally? Yeah, I think the treat locally is a patient with radiculopathy only without back pain and a lot of sagittal imbalance. I think they're referring as a patient who has back pain, sagittal imbalance. In fact, we were just discussing that a second ago, back pain with sagittal imbalance because they're going to probably have to get more than the fractional curve treated. So this was 26 patients out of a cohort of 99. Their primary complaint was that radiculopathy from the fractional curve. It was not a primary complaint of spinal imbalances or with a lot of back pain because I think those, if you do the fractional curve only, they're going to end up very quickly coming back for the rest of it. Thanks. Praveen, another question. You mentioned that some of the statistical analysis may have been influenced by the power. It wasn't powered for that. How much more? I mean, you guys are continuing this study, and then do you think that that will because it seems like you have a gestalt on who's going to do well and who's not with this. Do you think after a certain number the statistics will pan out? Yeah, I think basically if we double our number to, you know, we're basically at 100 patients now. And Dean did a quick look just to make sure and see if we're doing the right thing. You know, it's sort of an interim analysis. It's a retrospective study. So we'll keep accumulating patients, and we'll look at it with bigger numbers later and see if some of those other P values pan out. But, you know, it's nice to know that at least we're getting away with it in about three-quarters of the patients. That's nice to know. And then the subsequent surgery is still breaking up. Having a surgery maybe month or time equals zero and then 18 months later still is not the same as having the whole kit and caboodle all at once. Yeah, that's right. So you're basically ending up staging it for them, you know, maybe a couple years down the road to have L4 to S1 now and then maybe up to L2 or T10 coming up in a couple years.

Q&A session

injury reported imaging

thorough health workups

fractional curve treatment

staged surgeries