Innovation in spine dipped during the height of the COVID-19 pandemic last year, but many device companies are well-positioned for economic recovery as elective surgery volumes are projected to reach more normalized levels by the end of the year.
Robotics, 3D printing, navigation, augmented reality and artificial intelligence-based technologies are expected to continue to make noise in spine this year.
Eleven spine device companies to watch in 2021:
1. Medtronic (Dublin, Ireland): Medtronic is among the device companies best positioned for recovery in 2021, according to Morgan Stanley analysts. The company acquired seven companies last year including Medicrea, a spine device company that includes artificial intelligence, predictive modeling and patient-specific implant offerings. Medtronic recently received FDA clearance to integrate high-speed drills into the Mazor Robotic Guidance System, which will continue to be a focus for the company this year.
2. Johnson & Johnson — DePuy Synthes (West Chester, Pa.): Johnson & Johnson has 16 percent of the spine market, just behind Medtronic, which has 29 percent, according to a report from The Spine Market Group. Johnson & Johnson CEO Alex Gorsky expects elective surgical volumes to be most affected in the first quarter, but hopes to see more "normalized levels" by the year end. Mr. Gorsky said the company is "just starting to unlock the full potential and benefits of robotic and digital technologies," which will be play a key role in the future of the company.
3. Zimmer Biomet (Warsaw, Ind.): At the end of 2020, Zimmer Biomet acquired cardiothoracic surgery company A&E Medical Corp. for $250 million. In February, the company announced plans to spin off its spine and dental units to create a new company and invest in higher growth markets. The search for the spinoff company's CEO is in its final stages. The board of directors, management and headquarters will be announced as they are finalized.
4. Stryker (Kalamazoo, Mich.): Stryker closed last year by completing the acquisition of orthopedics and biologics-focused company Wright Medical in a $4 billion deal. The company led several products to FDA clearance in 2020, including the Monterey AL Interbody System, SpineJack expansion kit and Yukon OCT Spinal System. Stryker's Mako robotic technology has grown in the last year, but it is unclear when the company will introduce a spine robot, according to CEO Kevin Lobo.
5. NuVasive (San Diego): The Spine Journal posted promising findings of NuVasive's X360 approach to lateral single-position spine surgery, which demonstrated significant benefits over traditional open fusion. The company plans to secure FDA clearance for its Pulse system and its associated robotics application this summer, with first-in-human use of the robot slated for 2022.
6. Alphatec (Carlsbad, Calif.): A 120,000-square-foot headquarters is the new home for Alphatec, which plans a hiring spree through 2021. The company has about 300 staff, which has doubled since 2017. In December, Alphatec agreed to acquire EOS imaging in a $116.9 million all-cash transaction. The company plans to integrate EOS technology into its AlphaInformatiX platform, adding spinal imaging and anatomical modeling.
7. Globus Medical (Audubon, Pa.): The company had a strong end to 2020, according to Zacks Equity Research, selling more robots in October than it did for all of the September-end quarter. The company saw impressive growth in the fourth quarter, driven primarily by competitive recruiting, robotic pull-through and product launches. Globus introduced five devices in 2020, including Globus Spine 1.1 Interbody Solutions System, a software designed to improve outcomes and efficiency of its ExcelsiusGPS robot.
8. Surgalign Holdings (Deerfield, Ill.): Surgalign was formed last year after RTI Surgical sold its original equipment manufacturer business to a private equity firm for $480 million. RTI Surgical rebranded as Surgalign Holdings and is using the capital to bolster its spine portfolio. In October, the company acquired Chicago-based medtech company Holo Surgical, which has developed an augmented reality system for spine surgery.
9. Orthofix (Lewisville, Texas): The Spine Journal recently posted two-year data of Orthofix's M6-C artificial cervical disc, which was found to be a safe, effective and noninferior to anterior cervical discectomy and fusion for the treatment of cervical disc degeneration. Like most device companies, Orthofix saw a dip in full-year 2020 revenue, but continues to see the adoption of its motion preservation technology, which saw net sales increase about 129 percent year over year.
10. 7D Surgical (Ontario, Canada): 7D Surgical's flagship technology, the Machine-vision Image Guided Surgery system, is designed to replace standard fluoroscopy and offers a radiation-free tool to place spinal implants. The artificial intelligence-based system cost about $450,000 and has launched in several territories, including the U.S., Canada, Australia, New Zealand, Singapore and Europe.
11. Augmedics (Chicago): Interest in AR has grown significantly in spine over the past decade, stemming from a desire to limit complications associated with instrumented spine surgery and improve procedural efficiency. Augmedics' Xvision Spine system was named one of the best inventions of 2020 by Time magazine. The startup received FDA approval for its augmented reality surgical system in December 2019, with Johns Hopkins in Baltimore and Rush University Medical Center in Chicago among the first to install the technology. Several more hospitals have implemented the technology in recent months.