Becker's Spine Review

38 DEVICES & IMPLANTS 23 spine device companies to watch in 2022 By Alan Condon D espite the COVID-19 pandemic's effect on the spine indus- try, innovation and mergers and acquisitions activity contin- ues to pick up steam among medtech companies in 2022. Robotics, navigation, augmented reality, 3D printing and artificial intelligence-based technologies are expected to continue to make noise in the spine industry. Twenty-three spine companies to watch in 2022: 1. Medtronic (Dublin, Ireland): Medtronic kicked off 2022 with the ap- proval of its Intellis and Vanta spinal cord stimulators for treating chron- ic pain associated with diabetic peripheral neuropathy. Harry "Skip" Kiil, who previously led global orthopedics at Smith+Nephew, became head of Medtronic's cranial and spine business in January. His responsibilities include driving innovation and delivering therapies to global markets more effectively. Arguably Medtronic's biggest development of 2021 was the clearance of its patient-specific UNiD Rods with the company's CD Horizon, Solera, Voyager and Infinity OCT spinal systems. e rods are bent before surgery to match a preoperative plan created with AI. Medtronic's acquisition of Medicrea is designed to help the company leverage data and artificial intelligence in preoperative planning, which is a central focus for the medtech giant, CEO Geoff Martha said. 2. Johnson & Johnson — DePuy Synthes (West Chester, Pa.): Johnson & Johnson has around 16 percent of the spine market, just behind Medtronic, which has about 29 percent, according to a report from e Spine Market Group. Despite the pandemic's effect on the spine market, sales in the company's "spine, sports and other" segment hit $2.9 billion in 2021, a 7.2 percent increase year over year. Johnson & Johnson CEO Alex Gorsky said the company is "just starting to unlock the full potential and benefits of robotic and digital technologies," which will play a central role in the future of the company. 3. Stryker (Kalamazoo, Mich.): Stryker kicked off 2022 with a definitive agreement to acquire Vocera Communications for $3.1 billion. e acquisition, expected to close in the first quarter, will help the company address the increasing need for hospitals to con- nect caregivers and disparate data-generating medical devices. Last year, Robbie Robinson was appointed president of Stryker's spine division aer 17 years with the company. Robotics continues to be a key element in Stryker's total joint business, but CEO Kevin Lobo has yet to provide a timeline on when the company will have a robot for spine surgery. 4. Zimmer Biomet (Warsaw, Ind.)/ZimVie (Westminster, Colo.): Zimmer Biomet's spine spinoff ZimVie, which will be completed March 1, is expected to earn $1 billion in revenue in 2022. Vafa Jamali, a former Medtronic executive, is tasked with leading ZimVie out of the gates in March alongside a newly appointed team of exec- utives. ZimVie will focus on key growth areas of the spine and dental markets, including implants, surgical tools, bone gras, spinal fusion implants, nonfusion alternatives and digital care technologies. 5. Globus Medical (Audubon, Pa.): Globus Medical's market-lead- ing spine robot, ExcelsiusGPS, continues to be adopted by spine surgeons and is the primary factor driving growth in the company's enabling technologies business, which increased 100.3 percent year over year to $958.1 million in 2021. ExcelsiusGPS has been used in almost 30,000 spine surgeries and robotic utilization — the number of cases performed per installed robot — was at an all-time high in 2021, according to CEO Dave Demski. 6. NuVasive (San Diego): Highlights of NuVasive's 2021 include the $150 million acquisition of Simplify Medical, which includes the Sim- plify artificial disc, and the launch of Pulse — an integrated platform designed to increase safety and efficiency in spine surgery. Reports of a potential acquisition by Globus Medical saw NuVasive's stock spike late last year, but financial analysts projected that deal would not come to fruition. 7. SeaSpine (Carlsbad, Calif.): SeaSpine's $110M acquisition of 7D Surgical was a significant coup for the company last year. 7D Surgical's flagship technology, the Flash navigation system for spine and cranial surgery, is designed to replace standard fluoroscopy and offers surgeons a radiation-free tool to place spinal implants. e sys- tem costs about $450,000, which is less than half the price of tradi- tional imaging systems, according to the company. Including results from the May acquisition, SeaSpine expects full-year revenue for 2021 to be around $191 million, reflecting 24 percent year-over-year growth, and is well positioned to carry that growth through 2022. 8. Alphatec (Carlsbad, Calif.): Alphatec will look to see the benefits of its $116.9 million acquisition of EOS imaging on its books this year. e company is integrating EOS technology into its Alpha In- formatix platform, adding spinal imaging and anatomical modeling. Recent product launches include the ALIF standalone interbody sys- tem and the OsseoScrew. Alphatec also continues to grow adoption of its prone transpsoas technique in spine surgery. 9. Augmedics (Chicago): Interest in augmented reality has spiked in spine over the last decade, stemming from a desire to limit compli- cations associated with instrumented spine surgery and improve procedural efficiency. In January, Kevin Hykes took over as president and CEO of Augmedics, which he said aims to "continue to funda- mentally disrupt the way that surgery is practiced with the ground- breaking Xvision system." e AR system, which gives surgeons a 3D visualization of the spine intraoperatively, has been adopted at multiple hospitals and practices in the past two years. In 2020, it was named one of the best inventions of the year by Time magazine. 10. Surgalign Holdings (Deerfield, Ill.): Surgalign was formed in 2020 aer 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 January, the company received FDA clearance for its Holo Portal AI-driven augmented reality guidance system for lumbar spine surgery. e company is also developing the ARAI surgical navigation system. Spine surgeon and CMO Kris Siemionow, MD, PhD, is overseeing the development of the ARIA system. 11. Bioventus (Durham, N.C.): is orthobiologics company made headlines last year aer it acquired spine company Misonix for $518 million in a cash-and-stock transaction. e acquisition, which closed in October, is expected to accelerate growth, boost dou- ble-digit revenue and provide a significant opportunity for long-term market expansion, according to Bioventus CEO Ken Reali. 12. SI-Bone (Santa Clara, Calif.): Laura Francis, SI-Bone's for- mer CFO and COO, assumed the role of CEO from Jeff Dunn last year. e company anticipates full-year 2021 revenue to be around $90 million, representing year-over-year growth of between 22 and 23 percent. SI-Bone's iFuse implant has been evaluated in 90

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