BalancedBack.com is now 3Spine.com
Same company, same mission.
- Restore Natural Balance
- Maintain Range of Motion
- Preserve Adjacent Spinal Levels
why fuse when you can replace?
The first total joint replacement for the low back.
Latin (mo-tus) noun
- A movement, motion
- An advance, progress
- Etymology: Perfect passive participle of moveō (“I move”)
Replaces the function of the disc and facet joints.
Allows direct decompression to address leg and back pain.
Powerful surgical technique corrects sagittal balance.
20 years in the making.
Hear from patients who chose MOTUS over spinal fusion.
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The world’s first MOTUS patient talks about life post-surgery.
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See how Don got back to work and playing golf.
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At age 26, Samantha needed a solution.
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Note: This is not a complete list of patient experiences. Lumbar total joint replacement is not suitable for all patients, and there are risks associated with the procedure. Patient experiences may differ from the samples provided. The testimonials quoted were obtained from multiple OUS pilot clinical studies performed to date.
MOTUS replaces the function of the disc and facet joints, reestablishing stability after discectomy and broad decompression. By reconstructing all three structures in the functional spinal unit, all pain generators are addressed, including spinal stenosis, facet arthrosis, disc degeneration, spinal instability, and associated muscle spasms. Total joint replacement is a new spinal procedure tracked by CPT code 0719T.
Lumbar disc replacement is referred to synonymously as total disc replacement (TDR) or anterior disc replacement (ADR). There are two TDR/ADR disc replacements available in the United States: ProDiscL from Centinel Spine and ActivL from Aesculap, indicated for patients with degenerative disc disease. Both lumbar discs have demonstrated excellent clinical outcomes,1, 2, 3 replacing the function of a diseased disc. Additionally, the TOPS device from Premia Spine, currently in clinical trials in the United States, is intended to replace the function of the facet joints. The preliminary TOPS data are also encouraging for their specific indications. MOTUS is not a disc or facet replacement, but a first-of-kind device replacing the function of the disc and facet joints as a total joint replacement (TJR).
Fusion locks the spine in one posture. Even the best surgeon with perfect patient selection and the most advanced fusion hardware and enabling technology must still choose either a standing posture, a sitting posture, or something in between. But as we transition from standing to sitting, the lumbar spine flattens and the pelvis rotates (retroverts). MOTUS allows this dynamic adaptation whereas fusion, by definition, does not. Sitting intolerance, residual pain, and adjacent segment breakdown are potential consequences of a fused lumbar spine. Simply put, the low back adapts and moves with the pelvis in daily life, and total joint replacement preserves this natural motion by reconstructing instead of eliminating flexibility. Hip/spine syndrome is well documented in the literature.5, 6, 7, 8, 9, 10, 11
No. A segment of the degenerative spine population who meet the eligibility criteria may benefit from total joint replacement as an alternative to lumbar spinal fusion. Cancer patients who require reconstruction secondary to tumor resection; patients with spinal trauma; those requiring deformity correction; and other groups with low bone mineral density, very high BMI, poor diabetes management, smokers, etc. will likely continue to require spinal fusion. However, as lumbar total joint replacement matures, a new group of patients may emerge seeking care earlier in the disease process who may have otherwise deferred spinal fusion. This market-expanding trend has been seen with other total joints, and we believe that there may be an advantage to earlier intervention before mobilization of a diseased segment may not be possible.
The MOTUS device is approved for investigational use only in the United States under FDA Investigational Device Exemption (IDE) NCT 05438719. We anticipate completion of enrollment of our IDE study in 2023 and plan to seek Pre-Market Approval (PMA) to distribute commercially as our IDE data mature. Eighteen centers across the United States are participating in the IDE. A list of centers can be found here. Upon PMA approval, we plan to continue clinical data collection as a post-market surveillance program and as a component of a compulsory certification and CME program for lumbar total joint replacement centers. We anticipate that Motion Surgery centers will emerge who specialize in cervical disc, lumbar disc, facet replacement, and/or total joint replacement as a surgical sub-specialty, much as orthopaedics is currently bifurcated into joint replacement and other specialties.
In the U.S., total joint replacement procedure is indicated for the biomechanical reconstruction and stabilization of a spinal motion segment following decompression at one lumbar level from L1/L2 to L5/S1.Full List of Indications and Contraindications
3Spine has treated a total of 105 patients in three clinical pilot studies and is currently enrolling a +/-150-patient pivotal IDE clinical trial. Pilot study patients were propensity score matched to posterior fusion data previously collected by Vanderbilt University. Additionally, 3Spine is completing enrollment of a +/-150-patient prospective Real-World Evidence (RWE) fusion study. RWE fusion patients will be propensity score matched with total joint replacement IDE patients. Pilot study patient reported outcomes, published in The Spine Journal,12 showed a 2.4x improvement in Oswestry Disability Index (ODI) Substantial Clinical Benefit (SCB), 3.3x improvement in Minimum Symptom State (MSS), and 4.1x improvement in Minimally Important Clinical Benefit (MCID) as compared to fusion at one year. Additional publications are in review. The results of these pilot studies are encouraging and suggest a reasonable expectation that MOTUS could provide for more effective treatment relative to the current standard of care with a meaningful clinical improvement in function (disability), leg pain, and back pain.
The MOTUS procedure is performed using a posterior midline or paramedian (Wiltse) approach. A pre-operative plan is completed to calculate segmental parameters and appropriate segmental lumbar lordosis. The approach, decompression, and discectomy are nearly identical to a standard TLIF approach. Both facet joints are removed, and the surgeon can preserve or remove midline structures as indicated by pathology and preference. Whereas insertion of a TLIF or PLIF interbody implant is an additive maneuver, where height is added to the anterior aspect of the column to adjust segmental lordosis, sometimes requiring release if the anterior longitudinal ligament (ALL), the MOTUS procedure is a subtractive maneuver, where the posterior elements are adjusted to achieve the same effect and the ALL is always preserved. The tail of the prosthesis, coupled with a novel pedicle-based osteotomy, facilitate correction at a single level in the lumbar spine of up to 20 degrees, including at L5/S1, as allowed by patient anatomy. Upon preparation, each side of the prosthesis is inserted as a unit in a neutral posture, yielding the standing lordotic posture indicated by the pre-operative plan. The technique is completed freehand. Total joint replacement using the MOTUS device is an entirely new procedure tracked by CPT code 0719T.
3Spine is a Medtronic spin out. Medtronic purchased three-column IP in 2004 as the foundation for a posterior TJR IP portfolio, subsequently developing the KENAI device. In 2014 the portfolio was spun out to a private shell with Medtronic’s support to complete additional refinements and the US IDE, leveraging private capital. International Surgical purchased the IP in 2016, rebranding as BalancedBack and then MOTUS. International Surgical SEZC became 3Spine SEZC then 3Spine, Inc. 3Spine is now fully capitalized and entirely independent.
MOTUS is possibly the most researched biomechanical concept in spine history. Our team and prior teams at Medtronic completed primary research on spine morphology, nerve paths, movement patterns, new test methods, new materials including the first modern polyethylene13 in spine, and a first-of-kind technique. We were awarded Breakthrough Device Designation by FDA in 2020 and enjoy close collaboration with the FDA and CMS.
So why the name? 3Spine is built on some basic concepts: safely cross three columns of the spine (posterior, middle, and anterior) thereby gaining access, support, and correction; thereby replacing the function of three structures (two facets and the disc); thereby dynamically balancing the three curves of the spine; thereby transitioning safely between the three sagittal activities of daily living (standing, sitting, and slumped sitting).14, 15, 16, 17 After nearly 20 years of research and clinical use, we now have a 4th generation technology, capital, and a team who believe deeply in our mission of transforming outcomes for spine patients worldwide.
A team fueled by
We’re working to change the standard of care for leg and back pain so patients don’t have to compromise motion for pain relief.
Lead Product Development Engineer
Clinical Director, Rehabilitation
Associate Product Development Engineer
Director of Clinical Affairs
Product Development Engineer
Associate Director, Clinical Development
Joint replacement is standard of care across orthopedics.
Lumbar joint replacement will transform spine.
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Follow our progress as we obtain FDA commercial approval for our lumbar total joint replacement technology in the US.
US Regulatory Status CAUTION – Investigational device. Limited by US law to investigational use. The information on this site is not intended as a substitute for medical professional help or advice. Statements made on this site are not to be interpreted as a guarantee.
- Radcliff, K., Zigler, J., Braxton, E., Buttermann, G., Coric, D., Derman, P., Garcia, R., Jorgensen, A., Ferko, N. C., Situ, A., & Yue, J. (2021). Final Long-Term Reporting from a Randomized Controlled IDE Trial for Lumbar Artificial Discs in Single-Level Degenerative Disc Disease: 7-Year Results. International Journal of Spine Surgery, 15(4), 612–632. https://doi.org/10.14444/8083
- Bryant, J. P., Kolcun, J. P. G., Brusko, G. ¬D., Wang, M. Y., & Garcia, R. (2020). Long-Term Clinical Outcomes With the Activ-L Lumbar Arthroplasty System. International Journal of Spine Surgery, 14(5), 731–735. https://doi.org/10.14444/7105
- Zigler, J. E., Sachs, B. L., Rashbaum, R. F., & Ohnmeiss, D. D. (2007). Two- to 3-Year Follow-Up of ProDisc-L: Results From a Prospective Randomized Trial of Arthroplasty Versus Fusion. International Journal of Spine Surgery, 1(2), 63–67. https://doi.org/10.1016/sasj-2006-0003-rr
- Pinter, Z. W., Freedman, B. A., Nassr, A., Sebastian, A. S., Coric, D., Welch, W. C., Steinmetz, M. P., Robbins, S. E., Ament, J., Anand, N., Arnold, P., Baron, E., Huang, J., Whitmore, R., Whiting, D., Tahernia, D., Sandhu, F., Chahlavi, A., Cheng, J., . . . Anekstein, Y. (2022). A Prospective Study of Lumbar Facet Arthroplasty in the Treatment of Degenerative Spondylolisthesis and Stenosis. Clinical Spine Surgery: A Spine Publication, Publish Ahead of Print. https://doi.org/10.1097/bsd.0000000000001365
- Devin, C. J., McCullough, K. A., Morris, B. J., Yates, A. J., & Kang, J. D. (2012). Hip-spine Syndrome. Journal of the American Academy of Orthopaedic Surgeons, 20(7), 434–442 https://doi.org/10.5435/jaaos-20-07-434
- Esposito, C. I., Carroll, K. M., Sculco, P. K., Padgett, D. E., Jerabek, S. A., & Mayman, D. J. (2018). Total Hip Arthroplasty Patients With Fixed Spinopelvic Alignment Are at Higher Risk of Hip Dislocation. The Journal of Arthroplasty, 33(5), 1449–1454. https://doi.org/10.1016/j.arth.2017.12.005
- Onggo, J. R., Nambiar, M., Onggo, J. D., Phan, K., Ambikaipalan, A., Babazadeh, S., & Hau, R. (2019). Clinical outcomes and complication profile of total hip arthroplasty after lumbar spine fusion: a meta-analysis and systematic review. European Spine Journal, 29(2), 282–294. https://doi.org/10.1007/s00586-019-06201-z
- Diebo, B. G., Beyer, G. A., Grieco, P. W., Liu, S., Day, L. M., Abraham, R., Naziri, Q., Passias, P. G., Maheshwari, A. V., & Paulino, C. B. (2018). Complications in Patients Undergoing Spinal Fusion After THA. Clinical Orthopaedics & Related Research, 476(2), 412–417. https://doi.org/10.1007/s11999.0000000000000009
- Lazennec, J., Riwan, A., Gravez, F., Rousseau, M., Mora, N., Gorin, M., Lasne, A., Catonne, Y., & Saillant, G. (2007). Hip Spine Relationships: Application to Total Hip Arthroplasty. HIP International, 17(5_suppl), 91–104. https://doi.org/10.1177/112070000701705s12
- Vigdorchik, J. M., Sharma, A. K., Buckland, A. J., Elbuluk, A. M., Eftekhary, N., Mayman, D. J., Carroll, K. M., & Jerabek, S. A. (2021). 2021 Otto Aufranc Award: A simple Hip-Spine Classification for total hip arthroplasty : validation and a large multicentre series. The bone & joint journal, 103-B(7 Supple B), 17–24. https://doi.org/10.1302/0301-620X.103B7.BJJ-2020-2448.R2
- Elbuluk, A. M., Wright-Chisem, J. I., Vigdorchik, J. M., & Nunley, R. M. (2021). Applying the Hip-Spine Relationship: What X-Rays and Measurements Are Important? The Journal of Arthroplasty, 36(7), S94–S98. https://doi.org/10.1016/j.arth.2021.02.058
- Alex Sielatycki, J., Devin, C. J., Pennings, J., Koscielski, M., Metcalf, T., Archer, K. R., Dunn, R., Craig Humphreys, S., & Hodges, S. (2021). A novel lumbar total joint replacement may be an improvement over fusion for degenerative lumbar conditions: a comparative analysis of patient-reported outcomes at one year. The spine journal : official journal of the North American Spine Society, 21(5), 829–840. https://doi.org/10.1016/j.spinee.2020.12.001
- Spece, H., Yarbrough, R. V., & Kurtz, S. M. (2022). In Vivo Performance of Vitamin E Stabilized Polyethylene Implants for Total Hip Arthroplasty: A Review. The Journal of Arthroplasty. https://doi.org/10.1016/j.arth.2022.11.010
- Patwardhan, A. G., Sielatycki, J. A., Havey, R. M., Humphreys, S. C., Hodges, S. D., Blank, K. R., & Muriuki, M. G. (2021). Loading of the lumbar spine during transition from standing to sitting: effect of fusion versus motion preservation at L4–L5 and L5–S1. The Spine Journal, 21(4), 708–719. https://doi.org/10.1016/j.spinee.2020.10.032
- Hey, H. W. D., Lau, E. T. C., Tan, K. A., Lim, J. L., Choong, D., Lau, L. L., Liu, K. P. G., & Wong, H. K. (2017). Lumbar Spine Alignment in Six Common Postures. Spine, 42(19), 1447–1455. https://doi.org/10.1097/brs.0000000000002131
- Lazennec, J. Y., Kim, Y., Folinais, D., & Pour, A. E. (2020). Sagittal Spinopelvic Translation Is Combined With Pelvic Tilt During the Standing to Sitting Position: Pelvic Incidence Is a Key Factor in Patients Who Underwent THA. Arthroplasty Today, 6(4), 672–681. https://doi.org/10.1016/j.artd.2020.07.002
- Sielatycki, J. A., Patwardhan, A. G., Hodges, S. D., Humphreys, S. C., Havey, R. M., Blank, K. R., & Muriuki, M. (2022). P74. During activities of daily living two-level motion preservation and hybrid constructs may be protective of adjacent segments. The Spine Journal, 22(9), S161–S162. https://doi.org/10.1016/j.spinee.2022.07.030
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7,555,010; 7,875,077; 8,888,852;
8,372,150; 9,770,338; 10,631,995; 10,821,003