3 stories this morning, for surgeons and the people who support them.
- Pacira licenses EXPAREL to Molteni Farmaceutici for the EU and UK; Italy, Germany, Austria and Poland first, first commercial sale expected in 2027 — Pacira BioSciences announced Oct 5, 2026 an exclusive agreement giving Molteni Farmaceutici (Italian specialty pharma, pain management, oncology supportive care, hospital products) rights to distribute and commercialize EXPAREL (bupivacaine liposome injectable suspension) in the EU and UK. Pacira receives an undisclosed upfront payment, a supply price and royalties; Pacira manufactures, Molteni leads regulatory, market access and commercialization. Sequential launch starting in Italy, Germany, Austria and Poland; Swiss approval to be pursued; first commercial sale expected in 2027. Quotes from Pacira CEO Frank D. Lee and Molteni CEO Gianluca Corbinelli. Second source: Orthopedics This Week repost https://orthotw.com/2026/10/pacira-announces-exclusive-agreement-with-molteni-farmaceutici-to-commercialize-exparel-in-the-european-union-and-united-kingdom. EU label per EMA EPAR (https://www.ema.europa.eu/en/medicines/human/EPAR/exparel-liposomal): authorised 16 November 2020, MAH Pacira Ireland; adults brachial plexus or femoral nerve block, and field block for small-to-medium wounds in adults and children 6+. US label added adductor canal and popliteal sciatic blocks in November 2023 (Pacira release, https://investor.pacira.com/news-releases/news-release-details/pacira-announces-fda-approval-expanded-exparel-label-include-two). No prior Morning Brief coverage of Pacira/EXPAREL/Molteni (grep of all drafts). Source
- Spine RCT, 70 patients with grade III-IV spondylolisthesis: extending L4-S1 fixation to S2 or S2AI cut S1 screw breakage from 66% to zero and improved 36-month pain and ODI — Basiony M, Hamoud MA (Egypt). Spine (Phila Pa 1976), online ahead of print Oct 2, 2026; doi 10.1097/BRS.0000000000005896; PMID 42832654. Verified against the abstract via NCBI E-utilities. Prospective, randomised, single-centre: 70 consecutive patients with Meyerding grade III/IV L5-S1 spondylolisthesis undergoing PLIF, May 2020 to Nov 2022, 1:1 to standard L4-S1 (n=35) or bilateral S2 extension (n=35; S2 pedicle screws in 29, intraoperative conversion to S2AI in 6). 100% follow-up. Co-primary VAS and ODI at 36 months (Bonferroni-adjusted): VAS 1.9 vs 3.1, ODI 21.4 vs 30.1, both P<0.001 favoring S2. Fusion 88.6% vs 77.1%, pseudarthrosis 11.4% vs 22.9%, screw pull-out 2.9% vs 14.3%, none significant. S1 screw breakage only in the L4-S1 group, 65.7% vs 0% (P<0.001). Authors flag performance bias and technique heterogeneity and call for multicentre RCTs. No conflicts declared. No prior Morning Brief coverage (grep for S2 fixation). Source
- Spine, Houston Methodist: screening ligamentum flavum at lumbar decompression found transthyretin amyloid in 20% of 50 selected patients — Vemu SM, Hirase T, Miller RR, Prasarn ML, Saifi C, Ratusznik JJ, Weiner BK, Trachtenberg BH, Liberman SR (Houston Methodist). Spine (Phila Pa 1976), online ahead of print Oct 1, 2026; doi 10.1097/BRS.0000000000005884; PMID 42821312. Verified against the abstract via NCBI E-utilities. Prospective cross-sectional: patients with conditions linked to amyloidosis and axial T2 MRI ligamentum flavum thickness >4.9 mm undergoing lumbar decompression; LF stained with Congo red, positives subtyped, confirmed cases referred for cardiac evaluation. 50 enrolled; 14 (28%) Congo red positive, 10 (20%) ATTR (95% CI 17.5-41.7% and 11.2-33.0%). LF thicker in positives, 6.3 vs 5.6 mm (P<=.001); no difference in age or levels decompressed. 6 of 14 chose cardiac work-up including Tc-99m PYP scan, all negative. Authors: criteria identified at-risk patients; larger studies needed; LF analysis at routine decompression may be a practical early-detection method. No conflicts declared. No prior Morning Brief coverage of amyloid/ligamentum flavum (grep of all drafts). Source
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