Tommy Carls, VP of Product Development and Marketing at Proprio03.28.23
It’s common knowledge across the spinal technology industry that spinal implants have become commoditized, and it is increasingly difficult for companies to differentiate them based on implant features alone.
Even though the global spinal implants and surgical devices market is set to be worth $14.1 billion by 2028, innovation when it comes to implant technology has been largely stagnant in recent years.
While it was once a rapidly expanding area of the industry, product differentiation has stalled. Over 20 years ago, it didn't really matter what type of implants were developed. There was such a dearth of good procedure-specific implants and tools for spine surgery available in the market that almost every system designed at the time was successful. But as time has marched on, the speed of the innovation has slowed on the implant side, and actually started narrowing in the variety of products available.
At some point, everything began looking and functioning similarly. What started speeding up, however, was the addition of enabling technologies to place those implants.
Robotics is a recent example of an enabling technology that entered the operating room with the intention to improve implant placement and outcomes. All of these technologies were introduced with the promise of safer, faster and better placements of the implants. But, was the proof truly there?
One study found that a patient's radiation exposure was doubled by using an O-arm imaging device for navigation instead of navigating via fluoroscopy during lumbar fusion surgery. This is the type of variable we should be evaluating when bringing new technology into the fold. Does the introduction really warrant the impact? Are the clinical outcomes desirable when we account for the risks?
If companies prioritize enabling technology and navigation development, it could be very disruptive for companies focusing solely on implants. The value will be placed on what’s delivering the implant and enabling patient care.
Startups and early-stage companies are finding unique ways to differentiate themselves and legacy companies are eyeing them for differentiation. Organizations should focus on developing enabling technologies that improve a workflow without disrupting it or requiring a surgeon to change their entire approach in order to accommodate new technology. New technologies should allow a surgeon to defer to the technique and workflow that they tailor to the patient and their unique condition, not the needs of the device.
The hard truth is that for most legacy medical technology companies traveling down this path, creating game-changing, new technology is going to be a reach. It’s more likely that we’ll see incremental, iterative developments moving forward and a big reason for that is because research and development budgets at legacy implant companies are better spent going toward fine-tuning existing technologies, rather than designing a breakthrough technology that may make legacy technology obsolete. Smaller, more nimble start-ups are better poised to take on the type of risk required to create these innovative new technologies.
Despite volatility in global markets, medical technology start-ups are poised to continue benefiting from the interest of venture capitalists, with non-traditional partnerships being central to developing new technologies. This is largely related to the appetite for new technology, especially those featuring artificial intelligence tools.
Legacy companies are risk averse and find it more economical to acquire existing or new technology that’s already been developed, rather than innovating their own. In this environment, it’s important that innovative companies stay true to their core competencies and innovate new technologies that improve existing products rather than reinventing the wheel. To put it simply: Stick to what you’re good at.
A challenge that will persist, however, is that as pocketbooks tighten in medical settings, hospitals and insurance companies are increasingly less likely to purchase the latest, buzzworthy technology. Administrators making purchasing decisions will scrutinize new technology as they look for the ultimate drivers in value—devices, products, and services that work seamlessly, optimally, and advance surgical workflows while improving patient outcomes, both clinical and economical.
Imagine developing an enabling technology like a razor handle that could work with every company’s razor blades. If a surgeon has to disrupt their workflow to incorporate a new technology, then the value of that technology must be proven clinically and for patient outcomes before implementation. The current model where enabling technologies gain approval mostly on benchtop testing or small clinical studies should be critically assessed by the hospitals and surgeons that are going to purchase them and utilize them on patients.
Imagine if surgeons had access to real-time feedback during a procedure to tell them exactly what they are doing, where they are doing it and how they are doing it. We need a baseline of information within the operating room that can be utilized for comparative purposes for the introduction of any change within that baseline.
Imagine a technology that could collect data about what is happening inside the operating room with regard to the surgeon and the patient and compare it to the standard clinical and economic outcomes of thousands of patients. It could objectively measure and evaluate the implant therapy being used and determine the impact on the surgical workflow.
Imagine understanding the impact of the introduction of a new implant or enabling technology on the outcomes of a procedure. This is what the future of medical technology looks like.
Tommy Carls serves as the Vice President of Product Development and Marketing at Proprio. Carls received his Bachelor of Science in mechanical engineering from Tulane University and his MBA from the University of Memphis. He most recently served as the Vice President of Research and Development at Medtronic, where he was responsible for all engineering activities for the $2.8 billion medical technology group. He holds over 80 patents, has led global teams of more than 150 engineers and is held in high regard by the top clinical and industry leaders in the global spine market.
Even though the global spinal implants and surgical devices market is set to be worth $14.1 billion by 2028, innovation when it comes to implant technology has been largely stagnant in recent years.
While it was once a rapidly expanding area of the industry, product differentiation has stalled. Over 20 years ago, it didn't really matter what type of implants were developed. There was such a dearth of good procedure-specific implants and tools for spine surgery available in the market that almost every system designed at the time was successful. But as time has marched on, the speed of the innovation has slowed on the implant side, and actually started narrowing in the variety of products available.
At some point, everything began looking and functioning similarly. What started speeding up, however, was the addition of enabling technologies to place those implants.
The Benefits of Enabling Technology
As spinal navigational technology came onto the scene in the 1990s, it wasn’t well received. As a marketer of these devices, our team struggled for adoption. Across iterations, it improved over time, but enabling technology was added to the spinal field to enhance the delivery and effectiveness of those implants. We saw the entry of power equipment and specific drills to help place pedicle screws. Then came nerve monitoring technology that would alert a surgeon if they got too close to a nerve root with one of their instruments.Robotics is a recent example of an enabling technology that entered the operating room with the intention to improve implant placement and outcomes. All of these technologies were introduced with the promise of safer, faster and better placements of the implants. But, was the proof truly there?
One study found that a patient's radiation exposure was doubled by using an O-arm imaging device for navigation instead of navigating via fluoroscopy during lumbar fusion surgery. This is the type of variable we should be evaluating when bringing new technology into the fold. Does the introduction really warrant the impact? Are the clinical outcomes desirable when we account for the risks?
The Way Forward for Spine Surgery and Implants
There is a way forward when it comes to advancing the future of spine surgery and implants. We must create products and technology that bring additional but proven value to our industry.If companies prioritize enabling technology and navigation development, it could be very disruptive for companies focusing solely on implants. The value will be placed on what’s delivering the implant and enabling patient care.
Startups and early-stage companies are finding unique ways to differentiate themselves and legacy companies are eyeing them for differentiation. Organizations should focus on developing enabling technologies that improve a workflow without disrupting it or requiring a surgeon to change their entire approach in order to accommodate new technology. New technologies should allow a surgeon to defer to the technique and workflow that they tailor to the patient and their unique condition, not the needs of the device.
The hard truth is that for most legacy medical technology companies traveling down this path, creating game-changing, new technology is going to be a reach. It’s more likely that we’ll see incremental, iterative developments moving forward and a big reason for that is because research and development budgets at legacy implant companies are better spent going toward fine-tuning existing technologies, rather than designing a breakthrough technology that may make legacy technology obsolete. Smaller, more nimble start-ups are better poised to take on the type of risk required to create these innovative new technologies.
Despite volatility in global markets, medical technology start-ups are poised to continue benefiting from the interest of venture capitalists, with non-traditional partnerships being central to developing new technologies. This is largely related to the appetite for new technology, especially those featuring artificial intelligence tools.
Legacy companies are risk averse and find it more economical to acquire existing or new technology that’s already been developed, rather than innovating their own. In this environment, it’s important that innovative companies stay true to their core competencies and innovate new technologies that improve existing products rather than reinventing the wheel. To put it simply: Stick to what you’re good at.
A challenge that will persist, however, is that as pocketbooks tighten in medical settings, hospitals and insurance companies are increasingly less likely to purchase the latest, buzzworthy technology. Administrators making purchasing decisions will scrutinize new technology as they look for the ultimate drivers in value—devices, products, and services that work seamlessly, optimally, and advance surgical workflows while improving patient outcomes, both clinical and economical.
The Future of Differentiation
I believe the future of differentiation is an enabling technology that works with a variety of implants and fills a unique need, providing real-time information during surgery. While I think that could be threatening or disruptive to implant companies that are still operating in the 1990s era of spine technology development, I believe it is a strong path forward for our industry.Imagine developing an enabling technology like a razor handle that could work with every company’s razor blades. If a surgeon has to disrupt their workflow to incorporate a new technology, then the value of that technology must be proven clinically and for patient outcomes before implementation. The current model where enabling technologies gain approval mostly on benchtop testing or small clinical studies should be critically assessed by the hospitals and surgeons that are going to purchase them and utilize them on patients.
Imagine if surgeons had access to real-time feedback during a procedure to tell them exactly what they are doing, where they are doing it and how they are doing it. We need a baseline of information within the operating room that can be utilized for comparative purposes for the introduction of any change within that baseline.
Imagine a technology that could collect data about what is happening inside the operating room with regard to the surgeon and the patient and compare it to the standard clinical and economic outcomes of thousands of patients. It could objectively measure and evaluate the implant therapy being used and determine the impact on the surgical workflow.
Imagine understanding the impact of the introduction of a new implant or enabling technology on the outcomes of a procedure. This is what the future of medical technology looks like.
Tommy Carls serves as the Vice President of Product Development and Marketing at Proprio. Carls received his Bachelor of Science in mechanical engineering from Tulane University and his MBA from the University of Memphis. He most recently served as the Vice President of Research and Development at Medtronic, where he was responsible for all engineering activities for the $2.8 billion medical technology group. He holds over 80 patents, has led global teams of more than 150 engineers and is held in high regard by the top clinical and industry leaders in the global spine market.