Treating Third World Spine Injuries

November 14, 2008

Later this month during Engineering Week, teams of students from the Pratt School of Engineering and across the campus will compete in the annual Duke Start-Up Challenge, a school-year-long competition that culminates in a $25,000 prize.

Last year's first place winner was a company that developed a chip to be implanted in the brain of epileptics to control their seizures, while the runner-up developed a framework for the creation of games.

One of this year's team is taking a different tack. They are not creating a device or computer application, but want to send already-existing medical devices for spinal injuries to Third World countries and make them available for free for patients. The plan is to use medical devices that are perfectly fine but have been superseded by updated models.

There is a tremendous need for these devices in under-developed countries, explained team member Jenna Maloka, a Pratt senior. A lot of attention is paid to infectious diseases like HIV-AIDS, malaria and tuberculosis. But there are also many people who are not getting treatment for such conditions as scoliosis, trauma or degenerative diseases.

The device the team is interested in sending overseas is fairly simple and straightforward. It consists of two metal rods that are attached to either side of the spine by screws or hooks. The plan not only includes the donation of the surgical equipment, but the training of local surgeons to perform the procedure.

The team has dubbed their company SpineFuSe, and it is made up of five students, two of whom -- Kristen Bova and Joshua Napora – graduated last year. The other team members include Maloka; Keddy Chandran, in the Master of Engineering Management Program; and Trinity senior Gordon Closter.

The initial idea for SpineFuSe came from Duke orthopedic surgeon Bill Richardson, who had been inspired by Lewis Zirkle, who completed his orthopedic training at Duke during the Vietnam War era. After falling in love with the country and its people, Zirkle created the Surgical Implant Generation Network (SIGN), which has grown into a network of more than 140 hospitals in 49 countries.

Zirkle shuttles between the U.S. and foreign hospitals treating patients with leg fractures with donated devices. To date he has helped more than 36,000 patients in under-developed countries walk.

I met Lou a number of years in Vietnam and realized that there was a real need for something like his program for spinal injuries, Richardson said. Over the years we've been thinking about how we could accomplish this, and then I decided to approach Larry Boyd (associate director of Duke's Center for Entrepreneurship and Research Commercialization), who then presented it to his class.

One of the first challenges the team faced when they took up the challenge last spring was defining a potential market for such a plan.

There wasn't a world-wide data base on spinal injuries in under-developed countries, Chandran said. So we sent surveys to the hospitals in Dr. Zirkle's network asking about the types and number of spinal cases they see and what kinds of treatments patients receive. The striking thing we found is that those patients who did receive surgery got devices that have been obsolete in the U.S.

Most commonly, overseas patients with spinal injuries do not receive surgery, but are put on bed rest. In some cases, patients can spend months on end in the hospital, according to Richardson.

This causes extreme hardships for the patient and the family, Richardson said. In my experience in Uganda, it is up to the families to provide food and care for their hospitalized loved one, and there can be as few as one nurse for 60 patients. When the injured person is the family bread-winner, the consequences can be devastating.

Now that the team has ascertained that there is a real need for these devices, they are busy putting together its business plan. They hope to interest an MBA student from the Fuqua School of Business to lend them the economic planning expertise that they lack.

As we organize SpineFuSe, we ultimately want to create an entity that self-sustainable, so we won't have to be continually looking for donations, Chandran said. That is our major challenge – it is unlikely that a venture capitol firm would support us, so we're hoping to identify a large company or foundation that wants to help change health care around the world.

The team plans to enter SpineFuSe in the Social Track category of the Start-Up Challenge. The other three tracks are Healthcare, Hi-Technology and Consumer Products. Winners are chosen from each track, and one is selected as the overall winner.