Q: NuVasive rolled out the iGA platform focused on sagittal alignment in spine cases last year. How has the roll out been? Where is the technology headed over the next few years?
Michael Farrington: We have been talking about alignment for some time and received tremendous feedback from surgeons after the roll out of iGA in 2015. With the introduction of iGA we are finding surgeons are more proactive in prioritizing alignment and pre-operative planning as they work to fix basic spondylolisthesis cases. iGA has a preoperative platform so surgeons know what they want to measure during surgery and can confirm that postoperatively.
Our unique software NUVAPlanning for intraoperative monitoring capabilities has been updated to manage alignment for all cases, including cervical. Both Medtronic and Mazor are now following our lead, saying they can help with spinal alignment, but their offering is not as robust. We are going to continue to drive more research and evidence that alignment is important before, during and after surgery. Our unique software NUVAPlanning for intraoperative monitoring capabilities has been updated to manage alignment for all cases, including cervical. No other company is offering such as comprehensive platform that can address alignment pre-, intra- and post-operatively.
Q: How is NuVasive changing as a company with the evolution of the healthcare space?
MF: NuVasive’s roots were originally as a product-based company; today we are viewed as a procedure-based company, and we are evolving into a systems-based company. iGA was the first step in that direction; the next step is around radiation reduction.
You can sit down with 100 surgeons and ask what are the issues affecting them in the OR today and the placement of a pedicle screw isn't even in the top 10. Issues such as radiation exposure, visualization and workflow are far more relevant. We are aware that that some companies are attempting to promote robotic technology for pedicle screw placement as a sexy new tool. However, we believe these efforts are mis-focused at this time. In our estimation we’re quite a ways away from where robotic capabilities in spine will meet or exceed the clinical need. We believe the future is in automation, but we are focused on the needs of the surgeon today and in doing so are focusing our efforts in areas such as MIS and radiation reduction.
Radiation is a concern because surgeons need to see what they are doing during the cases so they are constantly taking X-rays, and that really adds up, especially for complex cases. Reducing the radiation exposure will remove one of the largest barriers to MIS adoption.
Q: How is NuVasive addressing the issues associated with radiation exposure for spine cases?
MF: NuVasive acquired the LessRay software technology suite and its patented algorithm to manage radiation exposure while maintaining the intraoperative workflow and allowing for visualization. In some instances we've seen upwards of a 75 percent radiation reduction. Research estimates that a surgeon beginning their career at age 30 would exceed the lifetime limit for nonclassified workers in less than 10 years of work.
The technology takes a low dose image and gives you a high-resolution version without the higher dose of radiation. It's like image enhancement platforms because surgeons have the benefit of reduced radiation. You'll see this integration of radiation management with the future monitoring systems and we will be integrating it with our larger platform. That will solve the need of the surgeons today versus jumping on a potential path towards robotics without solving the issues surgeons need resolved today. This in turn helps drive further MIS adoption, which is nearing 30 percent of the total fusion market.
Q: NuVasive acquired Ellipse Technology with the MAGEC technology for early onset scoliosis. How does this technology fit with NuVasive's overall strategic plan?
MF: We are excited about the technology we acquired earlier this year. We are seeing substantial adoption of the technology and were pleased to achieve the CMS technology add-on payment, recognizing it demonstrates a substantial clinical improvement relative to available alternatives.
These patients tend to be fairly complex, which results in multiple MRIs and treatment plans. Having guidance from the FDA for early onset scoliosis (EOS) patients is another step forward. The technology delivers tremendous value- less surgeries, less blood loss, improved patient experience. The best benefit is helping young children reduce the number of surgeries from up to 15 to 20 surgeries to sometimes a single surgery, to correct EOS. With MAGEC, there is just one surgery and we can then magnetically grow the rods in a matter of minutes during future out-patient distractions.
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