Becker's Spine Review

31 DEVICES & IMPLANTS Robotic spine company with $1B in cash open to M&A opportunities By Alan Condon W ith about $1 billion in cash on its bal- ance sheet, Globus Medical is look- ing to explore strategic partnerships that could capitalize on some weaknesses in the medtech market, according to the company's first-quarter earnings call, transcribed by e Motley Fool. "We're always out there looking at M&A," Keith Pfeil, Globus senior vice president and CFO, said on the call. "As [inflation] rates go up, I think that smaller companies out there that might be laden with debt will be opportunities for us to poten- tially look at and acquire." Spine companies that offer the biggest opportunity for Globus to acquire would be smaller startups looking at research and development that are not fully developed as well as complementary technol- ogy that would benefit the company's enabling technologies business, Mr. Pfeil said. In the first quarter, Globus experienced a slow- down in enabling technology sales as hospitals fo- cused on COVID-19 and staffing shortages. How- ever, robotic procedures and implant pull-through continued to accelerate, growing 27 percent year over year. e company said more than 31,000 robotic spine surgeries have been performed with its flagship ExcelsiusGPS system, which combines a robotic arm with navigation to improve accuracy in the placement of screws during spine surgery and re- duce radiation exposure for the surgical team. "Entering Q2, our pipeline is stronger, and we're focusing on driving robotic sales throughout the rest of the year," Dan Scavilla, Globus president and CEO, said on the call. "In May, we began shipment of our Excelsius 3D imaging system and successfully completed the first surgeries in several sites." Excelsius 3D is a three-in-one imaging platform with high maneuverability, a large field of view and seamless integration with the ExcelsiusGPS Robot, according to the company. "Market interest is high on the state-of-the-art technology and customer orders continue to grow. Excelsius 3D is positioned to be a major growth driver for us as we continue to penetrate the mar- ket," Mr. Scavilla said. n Stryker spinal imaging system gets FDA clearance By Carly Behm Stryker's Q guidance system received FDA 510(k) clearance for spine sur- gery applications. The Q system is designed for advanced surgical planning and intraopera- tive guidance for open or percutaneous computer-assisted surgery, ac- cording to a May 31 news release. It is used with Stryker's Spine Guidance Software, which is approved for use in patients 13 and older. "The versatility of the Q Guidance System will help to streamline our tech- nologies across multiple specialties such as cranial, spine, ENT and orthope- dics," Robbie Robinson, president of Stryker's spine division, said in the re- lease. "The system is designed for future compatibility with a fully integrated ecosystem, driving more value for our customers." n Competitors challenge Medtronic's lead in the spine robot market By Alan Condon M ore than a decade after the first spine surgical robot was launched, Medtronic is still considered the market leader, but smaller device companies could chip away at its market share as they launch their own platforms and adoption increases among surgeons. Medtronic acquired Mazor Robotics for $1.7 billion in 2018 to accelerate the advancement and adoption of robotic spine surgery. The companies incor- porated Medtronic's StealthStation with Mazor's robotics platform to launch the Mazor X Stealth Edition in 2019, but rival competitors including Globus Medical, NuVasive and ZimVie aim to compete with the medtech giant as robotics continues to gather momentum in the spine field. Globus' ExcelsiusGPS is currently the closest rival to Medtronic's spine ro- bot, but other device companies are looking for a slice of the pie. NuVasive is developing a robotic application for its Pulse integrated spine platform, Brainlab's Cirq spine robot received FDA clearance last year and Accelus — the latest company to enter the spine robotic market — is launching its Remi robotic navigation system. The next generation of spine robots aim to address some of the well-docu- mented challenges of the legacy systems, such as extended setup and tear- down time, procedural workflow disruptions, large footprints and high cost. Robots currently on the market cost about $1 million, but some companies also offer lease and bundle options with other products. However, as spine surgery continues to migrate to the outpatient setting, device companies are developing new business models that will make it more feasible for ASCs and hospitals that operate on fine margins to implement robots in their op- erating rooms. The robotic spine surgery market is still in its infancy but the technology is developing rapidly. As competition continues to grow, the cost of these systems is likely to drop and spur greater adoption across the industry. n

• Cover