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Thousands of orthopedic company executives and leading surgeons gathered in Chicago last week for the 39th annual meeting of the North American Spine Society (NASS). Our editorial team was also there, sitting in on education sessions and visiting booths in the exhibit hall to learn about the market trends and new technologies that are shaping the future of spine care. Here are some of the main themes we noticed.
Advanced Digital Care
Enabling technology sales account for just 2.2% of the global orthopedic market, according to ORTHOWORLD reporting. Still, spine companies of all sizes understand the importance of developing high-tech solutions to compete in the market.
Johnson & Johnson MedTech featured VELYS Spine, which is scheduled for commercial release in the first half of 2025. The platform features standalone navigation and active robotics that provide surgeons with flexibility in their surgical approach and planning. 8i Robotics exhibited a multi-arm active robotic system that can automatically perform portions of surgery under surgeon observation and is working toward commercializing the unit. Both systems represent the next generation of robotic assistance and generated significant buzz in the exhibit hall.
Medtronic, spine’s largest player with global sales of $2.2 billion, has around 10,000 capital installations worldwide. During NASS, Medtronic showcased the expanded capabilities of its AiBLE ecosystem, which combines navigation, robotics, data and AI, imaging, software and implants to improve the predictability of spine surgery.
“By converging these elements, we’re marking a significant shift in how surgeons interact with us,” said Skip Kiil, President of Cranial and Spinal Technologies at Medtronic. “We can provide support throughout the entire surgical journey — preoperatively, intraoperatively and postoperatively.”
The company also announced a partnership with Siemens Healthineers to co-market the Multitom Rax imaging system and integrate the platform into the AiBLE ecosystem.
Surgeon adoption remains a significant barrier to the widespread use of enabling technologies, although Kiil believes the tide is slowly turning.
“When we introduce them to AiBLE, they begin to visualize the spine and their surgical planning in a way they’ve never experienced before,” he said. “That moment of realization is transformative. They see tangible evidence of a better approach to surgery. This shift enables them to plan effectively before entering operating rooms, ultimately saving time and enhancing the quality of care.”
Stryker was among the companies that focused on finding value in enabling technology through improved outcomes, clinical efficiencies and reducing variability in surgical outcomes.
The company’s Q Guidance System for spine has been on the market for nearly two years, and the cranial software for Q Guidance has been available for a year. Both platforms are paving the way for enhanced software capabilities in general navigation, including the addition of CoPilot.
CoPilot offers 360-degree tracking of drills and features Smart Alert zones, which promote safer and more effective spinal decompressions. It also optimizes screw placement with a depth stop when paired with Stryker’s implants.
Josh Johnson, Vice President and General Manager of Core Spine at Stryker, believes spine surgery’s next frontier lies in how enabling technologies enhance surgical procedures.
“Emphasizing improved patient outcomes is crucial, but we must also consider the continuity of care,” he said. “If you were to ask 10 surgeons how to treat a particular patient, you might receive 10 different approaches and answers. By leveraging insights from enabling technologies, we can drive closer alignment in treatment approaches, fostering greater continuity between procedures and positions within the broader spine care framework.”
Steve Sanderson, Vice President, Marketing and Product Development at Centinel Spine, said the development of digital technologies among numerous major players and specialized companies is compelling, but he acknowledged the need for integration or end-to-end management of the data and insights the platforms produce.
“We see great potential in these developments and are actively seeking opportunities to incorporate the most relevant aspects of these technologies into improving total disc replacement surgery,” he said. “It’s important to note that we don’t intend to develop these solutions in isolation. We’re very interested in how surgeons want to apply technology in their procedures.”
Device Developments
Much of the talk at NASS centered on the continuing evolution of enabling technology, but Kiil also pointed to the importance of advancing implant and device designs.
“It’s not an either-or situation,” he said. “We need enabling technology and device innovation working in tandem. Within spine, 30% to 40% of companies focus solely on a single implant or screw system. A significant portion of our industry consists of small companies primarily concentrating on the metal side of the business. I don’t see enabling technology and implants as mutually exclusive. They will complement and enhance one another.”
David Nichols, CEO at Orthobond, said emerging data highlights a significant issue in spine care. “In cases where patients have failed surgery — meaning they continue to experience pain, reduced function or a diminished quality of life — cultures of removed hardware showed 40% of the devices exhibited bacterial contamination,” he said.
These findings were further supported by a recent study conducted by the Hospital for Special Surgery, which measured bacterial presence in the perioperative setting at the time of surgery and tracked patient outcomes. The study found that patients with measurable bacterial contamination were twice as likely to require revision surgery.
“As we continue to examine spine surgery outcomes, it’s becoming clear that bacterial contamination of screws and implants may play a significant role in many failed cases,” Nichols said.
Orthobond received a De Novo request for the use of Ostaguard, a proprietary antibacterial surface treatment. It was the first ever granting by FDA of a De Novo submission for a non-eluting coating designed to actively kill bacteria on the surface of a permanent medical device.
Ostaguard bonds a 60- to 80-nanometer-thick antibacterial coating directly to the implant. The coating actively kills bacteria, targeting the critical period from when the sterile supplies are opened until the implant is inserted into the patient. A series of large animal studies confirm that the coating showed no toxicity and caused no damage to healing bone.
Nichols said incorporating Ostaguard into implant manufacturing processes is one way for orthopedic companies to differentiate their products from the competition.
Future Opportunities
The spine market grew 5.5% to $10.4 billion in 2023 and is expected to grow about 4% in 2024. Global sales have normalized after the COVID-19 pandemic and have settled into single-digit growth.
“I anticipate a durable market ahead, which is exciting,” Kiil said. “For several years, the spine sector has been characterized by low or no growth, so this shift is promising.”
The segment is moving toward minimally invasive surgical approaches. Arthrex is bullish on endoscopic spine surgery. The company leveraged its sports medicine technology to launch an endoscopic spine portfolio before last year’s NASS meeting and at this year’s conference reported significant interest among surgeons in its education and training programs.
Stryker is also investing in endoscopic spine technology. “We already have a strong presence and category leadership in related segments such arthroscopic instrumentation,” Johnson said. “This is definitely an area we’re continuing to explore.”
The three days spent at NASS were filled with valuable insights about the current focus of companies within the spine segment and the innovations they are prioritizing with investment dollars and R&D resources. We’re looking forward to keeping a finger on the pulse of a segment that’s set up for steady growth.
