A dialogue with Alessandro Gasbarrini.

12 May 2016

We sat down and spoke with Alessandro Gasbarrini, spine surgeon at the Istituto Ortopedico Rizzoli, Bologna. He was a guest speaker at the Innovation Talks Spring Edition.

Orthopaedic Oncology, with a particular focus on spine surgery, degenerative spinal disorders, spine biological and minimally-invasive reconstruction. These are Doctor Alessandro Gasbarrini’s scientific interests: he is a “clinical experimenter” and he went from the trauma centre of the Ospedale Maggiore [major Bologna hospital] to the Istituto Ortopedico Rizzoli [prestigious orthopaedic hospital and research centre in Bologna] in search of advanced solutions in cases where the transplant of prostheses created with 3D printing is needed. This interview illustrates the state of the art of this discipline, offering a comprehensive overview of critical points and developments.


If we wanted to compare the role of a manager to the role of a physician, what would they have in common?

Definitely the management of financial resources. The expenditure for private and public health is enormous. In the case of orthopaedics, all prostheses and implants have staggering costs. A screw that would cost you 3 euro at the hardware store, costs 800 if it’s for medical applications, and basically they don’t differ much. In addition, it must be adjusted to the individual patient. It’s like buying for a high price a cheap dress to then having a tailor adjusting it for you. As it were, this market is currently 95% in the hands of the Americans. Now, in Italy we’re lucky we have a technology that gives us the possibility to directly create the “made to measure dress” for the patient. It’s the 3D printing technology, which allows us constructing the prosthesis of the exact segment you need to replace. This is a great revolution not just from a medical point of view but also from the economic one. I’m sure all big companies that produce orthopaedic parts will throw a spanner in the works, but technological innovation can’t be stopped.


A race against time.

We need to get there first. In advanced spine surgery, vertebral bodies damaged by a tumour, a fracture or deformity are replaced by prostheses, innovative projects must be devised. And we were the first in the world. I mean here in Bologna, and I believe it’s only fair that Bologna should be the first to be aware of it. My professionalism is at the disposal of whoever manages to develop technological research projects through business ideas that, I believe, could be of interest especially to large companies. Every innovative reality in the field of 3D printing in the biomedical sector would add lustre to Bologna but most of all would bring advantages to patients, with the maximum of the medical outcome and the minimum of expenses. We’d all gain from such a success.


What’s missing is an Italian organizational model.

The soil would be ready, though. After we implanted the first four 3D prostheses, we read on the web of an Australian chap who purported he’d been the first in the world to perform surgery with a prosthesis of the cervical spine. We’re serious, before announcing a success to the scientific community, our team must have the evidence of its efficacy. In this case, we decided to provide the scientific information thus unleashing interest from the media which gave quite a notoriety to the experimentation. And then there are the very Italian anomalies. There are instruments that aren’t used for clinical trials but just for pure research, without possible applications on the patients. Base research for its own sake where the researcher and the clinician don’t talk to each other is a missed collaboration, a dis-economy. Money is what it is and we need to do the reporting in terms of number of healing interventions as well.


Which is the perfect team?

The one featuring an engineer who highlights a performing material, a biologist indicating which cell particles are compatible, the histopathologist who checks the result and so on and so forth. When do I grow? When I attend a radiotherapy or oncology conference, where I collect other points of view different from orthopaedics A historical Bologna-based example? The Officine Ortopediche Rizzoli, they sold all over the world.


Where artisans too created innovation.

That’s right. And maybe it was them who found the “Columbus’ egg”. I come from a different environment, the Trauma Centre of the Ospedale Maggiore, where I didn’t work just in the oncology department and I had the chance of expanding my expertise. This allowed me to go beyond what the market has got to offer, in order to find new solutions and not just stick to what already exists.


Does innovation exist, nowadays, in Italy?

It does, it’s linked to 3D printing in the bio-medical industry. We’re talking about three very large companies, but the one we’re working with offers something more and it’s, unfortunately, located abroad. So, we need to improve research. At the Rizzoli [institute] we now have the technology to be independent. We’d have to combine these printers with talents and people who have different skills. A managerial support is needed as well, groups working at presentations showing the efficacy of the product using bio-mechanical stress tests, instrument reproducibility models, prosthesis load test, quality test, validations. Every model needs from one week to ten days in order to perform all the bio-mechanical tests. I’m convinced a highly innovative technological company could reduce this time-frame. The future looks very promising but important initial investments are needed. The market is there. The Italian one is small but indicative: if it works here, it’ll work for sure abroad too. The important thing is not to have one’s ideas stolen.


What would you say to young entrepreneurs interested in bio-medical?

I’d suggest they think about projects based on the 3D printing technology, because it’s a market characterised by large turnovers and low level of competition. Another field in which it would be important to work is chemistry applied to the bio-medical. If stitching up a nerve is impossible, it means glue is needed. IT technology could momentarily replace the invention of the definitive product. We physicians need materials to use. And only by comparing views and needs with those having different skills it is possible to find innovative solutions.


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