Amid major spine medtech spinoffs, acquisitions and mergers over recent years, innovation in the medtech field has been challenged, Lali Sekhon, MD, PhD, told Becker’s.
“We basically have about five big players in med tech,” Dr. Sekhon said. “Interesting things are the changes that are happening including the acquisitions … The market for spine in the US is about $10 billion and orthopedics is about $50 billion — they’re not small markets.”
The magnitude of these markets makes moves such as Johnson & Johnson’s plan to separate its orthopedics market interesting, Dr. Sekhon said. Other companies like Stryker and ZimVie also split key spinal assets to private equity-backed groups.
And groups including Orthofix and Globus Medical have absorbed SeaSpine and NuVasive, respectively, further consolidating within the core companies.
While large companies excel in their strengths, such as robotics and AI, Dr. Sekhon said he wants to see more innovation in the basic tools for spine surgery. However, the current market layout is imposing structural challenges to get new ideas through.
“What I see is 70% of the [spine] market is these big companies,” he said. “Outside, innovation is getting more and more challenging. If you look at basic building blocks like pedicle screws, cages, we’re not seeing a lot of innovation on that side of it. I think it’s become harder.”
Dr. Sekhon likened challenges to spine innovation like the market for Coca Cola. Similar to spine innovation, he said that a smaller company putting out a new soda flavor would face major hurdles because larger corporations make up the majority of the market.
“There are GPOs that control entry to market as well and enabling technologies for surgeons to use particular vendors’ instrumentation,” he said. “So if you want to use robotics, you can either use Globus or Medtronic, but you can’t use a small vendor. Little companies are struggling to innovate. The big companies have consolidated [but] at the end of the day, competition is always good.”
But competition in the spine surgery market is more about surgeon choice than anything else.
“One of the really important things is that surgeons don’t just want two companies,” Dr. Sekhon said. “They want a choice of what’s out there. From a surgeon’s perspective, the more competition there is, the better it is. For patients, the more competition we get into a two-horse race for spinal Coke and Pepsi sort of thing. It’s bad because there’s less innovation. The market is captured. Surgeons don’t get as much choice. You can’t pick off a product here that you really like from a particular company, and at the end of the day, that’s not good for patients. So I look at all these consolidations, and I think we do need more competition, and we do need more innovation.”
