50 things to know about the spine industry I 2018


Whether inpatient or outpatient, spine surgery continues to advance. In 2018, spine surgeons and industry competitors can expect to see further use of robotics and biologics.

Learn more about spine surgery market trends at the 16th Annual Future of Spine + Spine, Orthopedic & Pain Management-Driven ASC Conference in Chicago, June 14-16. Click here to learn more and register. Contact Maura Jodoin at mjodoin@beckershealthcare.com or Kristelle Khazzaka at kkhazzaka@beckershealthcare.com if interested in sponsorship or exhibiting opportunities.

Here are 50 things to know about the spine industry in 2018.

Orthopedic spine surgeon and neurosurgeon compensation

1. According to the American Medical Group Associations' Physician Compensation Survey, spine surgeons make $758,869 a year on average.

2. The medical neurosurgeon salary tops $736,924 based on the American Medical Group Association's Physician Compensation Survey.

3. During the first two years of employment, spine surgeons earn around $400,000. By their third year, spine surgeons are earning $670,000.

4. The maximum orthopedic spine surgeon salary reached $1,352,000. The maximum neurosurgeon salary reached $963,000.

5. Neurosurgeons earn roughly $354,000 during their first year of employment. During their second on their year, they bring in $541,000 a year on average.

6. Based on location:

• New York City-based spine surgeon: $556,941
• New York City-based neurosurgeon: $697,015
• Los Angeles-based spine surgeon: $520,770
• Los Angeles-based neurosurgeon: $651,747

Spine surgeons on industry trends

7. Brian Gantwerker: spine surgeon at The Craniospinal Centers of Los Angeles
"In the next five years, we are going to see more consolidation between practices. We are also going to see insurance companies employing physicians directly. However, I am not sure this is a healthy progression in terms of the current employment models. In fact, I would argue this is not a step forward. There are certain organizations, such as Kaiser, that put the physicians at the forefront of governance and this allows the organization to succeed."

"In the clinical perspective, robotic surgery is going to be more prevalent and common. This will draw more physicians into doing more complex and challenging cases. Patient mortality will decrease, but there will be resistance from payers and insurance companies. More arthroplasty will be done in other areas of the spine, such as lumbar spine."

8. Nick Shamie: chief of orthopedic spine surgery UCLA School of Medicine
"I am seeing a trend toward less invasive surgeries performed as an outpatient in surgicenters. I am also see that with the aging population and more degenerative scoliosis, more surgeons are relying on more advanced technology like spinal navigation and robotics to perform these more challenging surgeries. The trend that began few years ago is using lateral fusion techniques in lumbar spine, and this trend continues to expand."

Spine market

9. The spine biologics global market is anticipated to grow at a 2.07 percent compound annual growth rate through 2020, according to a 360 Market Updates report. The growing geriatric population and increasing number of spinal disorder cases will spur market growth. The demand for minimally invasive procedures is helping market expansion.

10. ResearchMoz analysts predict the global spine surgery products market will hit $16.7 billion by 2025, growing at a 5.8 percent compound annual growth rate. An increase in spine surgery patients due to a growing number of spine disorder cases among the geriatric population is expanding the market. Dominant market players include Stryker, Medtronic, Zimmer Biomet and Globus Medical.

11. The global spinal surgical robots market is worth $26 million in 2018, and by 2022 market analysts anticipate the market will reach $2.77 billion. The growing demand for minimally invasive spine surgeries is also driving the market, as surgeons opt for increased repeatability and accuracy in procedures. The report notes in 2015, 11 million people in the U.S. experienced chronic back pain. Sacroiliac joint dysfunction is the underlying cause of 30 percent to 35 percent of lower back pain.

12. The global minimally invasive spine surgery market is estimated to grow at a 7.57 percent compound annual growth rate through 2021. Demand for MIS spine surgery is growing due to the technique's accuracy rate, less pain and quicker recovery; however, a dearth of spine surgeons trained in MIS techniques may pose a barrier to market growth.

13. The global lateral lumbar interbody fusion market will likely grow at a compound annual growth rate of 5.7 percent between 2017 and 2024, according to a Data Bridge Market Research analysis. The market is set to hit about $2.6 billion by 2024. In 2016, the market was worth about $1.6 billion. Key drivers include the increasing demand of minimally invasive procedures and growing number of spinal disorder cases.

14. The global neurosurgical products market is anticipated to grow at a 10.5 percent compound annual growth rate through 2023. The neurostimulation devices segment is leading the market, due to the increasing supportive clinical data of the devices' safety and effectiveness. North and South America are dominating the market, followed by Europe. The Asia-Pacific market will grow to $2.4 billion by 2023, reflecting a 13 percent CAGR.

15. By 2024, the global spinal fusion device market will likely be worth nearly $17.3 billion. Analysts predict the market will grow at 5.3 percent compound annual growth rate. Analogic, Alphatec, K2M, Globus Medical, DePuy Synthes, Medtronic, Orthofix, Titan Spine and NuVasive represent key market players.

16. The global spinal implants and surgical devices market is expected to reach $21 billion by 2025, expanding at a compound annual growth rate of 6.1 percent. North America currently drives the global market in terms of revenue share, but the demand for spinal implants and devices in the Asia Pacific geographic region has increased. There is potential for market diffusion in India, Mexico and China.

Best hospitals for neurology and neurosurgery

17. U.S. News & World Report ranked the top hospitals for neurology and neurosurgery:

• Mayo Clinic, Rochester, Minn.
• Johns Hopkins Hospital, Baltimore
• Massachusetts General Hospital, Boston
• New York-Presbyterian Hospital-Columbia and Cornell, New York City
• UCSF Medical Center
• Cleveland Clinic
• Barnes-Jewish Hospital, St. Louis
• University of Michigan Hospitals and Health Centers, Ann Arbor
• Northwestern Memorial Hospital, Chicago
• NYU Langone Medical Center, New York City

Spine device company powerhouses

18. DePuy Synthes (Raynham, Mass.). With spine on its mind, DePuy Synthes spent 2017 making strategic developments and relationships for further business growth. DePuy Synthes launched its Viper Prime spine system, a minimally invasive pedicle screw system designed for fusion procedures. To establish itself as a minimally invasive techniques developer, DePuy Synthes also unveiled its Purevue Visualization System for endoscopic surgery.

19. Globus Medical (Audubon, Pa.). FDA approvals, acquisitions and rising revenue filled Globus Medical’s calendar in 2017. One of the company’s highlights included receiving FDA clearance for its Excelsius GPS, a robotic guidance and navigation system. Noting its growth as 100 percent organic, Globus Medical saw a 12.7 percent increase in 2017 full year sales totaling $635.4 million. In 2018, the company has big plans to blossom with plans to generate $690 million in sales.

20. K2M (Leesburg, Va.). K2M achieved monumental milestones throughout 2017. To start, the medical device maker launched the first 3-D printed expandable corpectomy cage with cervical indications: Capri Cervical 3D Expandable featuring Lamellar 3D Titanium Technology. The 3-D corpectomy cage system alsorecorded its first successful case. Another record success, K2M announced the 300th surgical spine case using its Rhine Cervical Disc System. With a year of expanding success, K2M reported 2017 year-end revenue between $275.5 million and $258.1 million, a 9 percent year-over-year increase. In the fourth.

21. Mazor Robotics (Caesarea, Israel). Mazor Robotics continued its expansion with a three-phase partnership with Medtronic, partnering with Medtronic to co-market and promote the Mazor X robotic system. In total, Mazor has sold 73 robotic systems worldwide, with 27 systems in the past quarter. In the end of the third quarter, the company had a 17-system backlog. U.S. revenue skyrocketed in the third quarter of 2017 up 170 percent to $15.4 million.

22. Medtronic (Dublin, Ireland). Hurricane Maria disrupted Medtronic’s manufacturing plant in Puerto Rico in 2017, affecting the company’s bottom line. Second quarter revenues dropped 4 percent, with a $55 million to $65 million impact on revenues. However, Medtronic expects 2018 fiscal year revenue to have a positive impact of $275 million to $375 million, including a $155 million to $175 million positive impact in the third quarter of the fiscal year. The company recently announced a restructuring plan expected to save $33 billion by 2022.

23. NuVasive (San Diego). NuVasive spent 2017 acquiring various device companies to further expand its neuro and spine platforms. First the company acquired Vetera Spine, a medical device company focused on interbody implants. Along with acquisitions, NuVasive launched a new 3D-pinted porous titanium implant Modulus XLIF and the Coalesce Thoracolumbar Interbody Fusion Device. Although impacted by Hurricane Maria, the company saw $1.03 billion in 2017 revenues, an expected 7 percent growth. NuVasive expects the 2018 financial outlook to include the impact of its SafePassage acquisition.

24. Stryker (Kalamazoo, Mich.). Throughout 2017 Stryker made big moves to further its position as an orthopedic and spine leader. Stryker acquired Vexim, a vertebral compression fracture solutions developer, and now holds 95 percent of its shares. With all of its acquisitions and installments, Stryker reported a 10 percent boost of net sales to $3.5 billion in the fourth quarter of 2017. For the full year of 2017, orthopedics grew 6.6 percent and neurotechnology and spine grew 8.2 percent.

25. Zimmer Biomet (Warsaw, Ind.). Zimmer Biomet saw a slight drop in third quarter sales with net earnings totaling $98.8 million due to slow pace recovery in key brands as well as slower-than-anticipated sales recapture in the U.S. However, the company attacked hard in the following quarter with net earnings hitting $1.25 billion. Zimmer Biomet reported $7.82 billion in full-year 2017 sales, a 1.8 percent increase over the prior year. Net earnings for the full year grew to $1.8 billion.


26. In March 2018, Alphatec acquired SafeOp surgical, a privately held advanced neuromonitoring provider.

27. In February 2018, Johnson & Johnson, through French affiliate Apsis S.A.S, acquired Orthotaxy, a privately-held developer of software-enabled surgery technologies, including a robotic-assisted surgery solution.

28. In December 2017, NuVasive signed a definitive agreement to acquire SafePassage, a privately held intraoperative neurophysiological monitoring services provider.

29. In June 2017, Avista Capital Partners acquired Rockville, Md.-based National Spine & Pain Centers.

30. Centinel Spine completed the acquisition of the worldwide assets of DePuy Synthes' prodisc total disc replacement.

Outpatient spine surgery

31. In November 2017, CMS approved these two new spine codes for the ASC payable list in 2018:

• Cervical artificial discectomy (22856)
• Second level cervical discectomy (22858)

32. In 2016, CMS approved these codes for spine surgeries in ASCs:
• Spine bone autograft local add-on (20936)
• Spine bone autograft morsel add-on (20937)
• Spine bone autograft struct add-on (20938)
• Additional neck spine fusion (22552)
• Insert spine fixation device (22840)
• Insert spine fixation device (22842)
• Insert spine fixation device (22845)
• Insj biomechanical device (22853)
• Insj biomechanical device (22853)
• Insj biomechanical device (22859)

33. In March 2018, CMS released 32 episodes of care for the BPCI Advanced program, with three outpatient-only episodes, including back and neck except procedures, except spinal fusions.

34. A new study published in Clinical Spine Surgery compares outpatient single-level anterior cervical discectomy and fusion to inpatient cases. The outpatient and inpatient procedures were matched using a one-to-one propensity score analysis for short term outcomes assessment. There were 6,940 patients included in the study. The complication rate was higher among patients who underwent inpatient procedures — 2.5 percent — than outpatient procedures — 1.2 percent.

Minimally invasive spine surgery

35. Minneapolis-based Inspired Spine reported surgeons have performed more than 500 Oblique Lateral Lumbar Interbody Fusions. The minimally invasive procedure uses an incision of 15 mm and incurs 80 percent less blood loss compared to a traditional fusion. A study published in Cureus found OLLIF saved hospitals an average of $9,500 per case compared to transforaminal lumbar interbody fusion.

36. An April 2016 Spine study found patients undergoing minimally invasive fusions experienced 88.7 percent lower blood loss than the open procedure group. Additionally, the study found, hospital stays among the minimally invasive group were 64 percent shorter than hospital stays in the open procedure group.

37. According to an Apex Market Reports analysis, the top device companies in the global minimally invasive spine surgery market are DePuy Synthes, Medtronic, NuVasive, Stryker, Zimmer Biomet, Aesculap Implant Systems and Alliance Spine.

38. In January 2018, Blue Cross Blue Shield Association updated its quality evidence recommendation for minimally invasive sacroiliac joint fusion using triangular implants. BCBSA upgraded its BCBSA rating to "moderate" quality evidence, indicating the prevalence of sufficient evidence to determine the effects technology has on health outcomes. BCBSA believes individuals with SI joint disorders treated with sacroiliac fusion or fixation with a triangular implant results in a meaningful improvement to the net health outcome.

39. In February 2017, Kern Singh, MD, founded the Minimally Invasive Spine Study Group. Dr. Singh serves as co-director of the Minimally Invasive Spine Institute at Midwest Orthopedics at Rush in Chicago. A 501(c)(3) nonprofit organization, MISSG intends to promote research and advancement of MIS spine. The group features an online patient registry, REDCAP, containing data from 3,000 unique patients treated with MIS approaches. Frank Phillips, MD, co-director of the Minimally Invasive Spine Institute at Midwest Orthopaedics at Rush, and Sheeraz Qureshi, MD, associate professor at New York City-based Hospital for Special Surgery, join Dr. Singh on the board of directors.

Spine studies

40. A February 2018 study published in The Spine Journal examined the cost utility of cervical deformity surgery. Study authors examined data from a prospective, multicenter cervical deformity database for patients who underwent cervical deformity surgery. The patients all had one year of follow-up and costs were assigned with the Medicare one-year average reimbursement rate. Eighty-four patients were included in the study. On average, the reimbursement was $55,097 at one year after surgery.

41. A October 2017 study published in Spine examines the outcomes and length of stay for Medicare beneficiaries undergoing cervical spinal fusion. Study authors examined the 2013 and 2014 Medicare Provider Analysis and Review file, which included 86,265 beneficiaries who underwent cervical spinal fusion at two or three levels. Of all Medicare beneficiaries examined in the study, 6.2 percent reported at least one adverse event. The patients who experienced complications reported consuming significantly more hospital resources — totaling around $28,638 per beneficiary.

42. A December 2017 study published in the West Indian Medical Journal examined surgical site infection rate among spine surgery patients in inpatient and outpatient sites. Study authors examined a database of 1,010 spine procedures performed over a decade by a single surgeon. Researchers formed two groups of patients: 642 patients had a procedure in a hospital, while 368 had a procedure in an ASC. Surgical times in the hospital group were 217 ± 11 minutes, while the ASC group had times of 117 minutes ± eight minutes.

43. A study, published in The Spine Journal, examined the efficacy, dosing and safety of spinal mobilization and manipulation. Study researchers conducted a systematic review and meta-analysis of 51 trials from January 2000 to March 2017. Researchers selected randomized trials comparing manipulation and mobilization therapies and found manipulation significantly reduced pain and disability when compared to other active comparators. Mobilization significantly reduced pain, but did not reduce disability when assessing other active comparators.

44. A retrospective study in Clinical Spine Surgery found "outpatient" anterior cervical discectomy and fusion and lumbar discectomy procedures often did not correlate with same day discharge. While there has been an overall shift towards performing ACDF and lumbar discectomy in the outpatient setting, the distinction between inpatient and outpatient procedures is not always clear because of the possibility of patients staying overnight or longer at the hospital under "observation" status.

Global spine surgeon societies

45. Here are the major spine surgeon societies' current presidents and chairpersons:

• Cervical Spine Research Society: Jeffrey Wang, MD, president
• International Society for the Advancement of Spine Surgery: Jeffrey Goldstein, MD, president
• Spine Intervention Society: Timothy Maus, MD, president
• North American Spine Society: Daniel Resnick, MD, president
• Society for Minimally Invasive Spine Surgery, Greg Anderson, MD, international chairperson
• The International Society for the Study of Lumbar Spine: Teja Lund, president


46. DePuy Synthes filed a complaint against a former employee who allegedly went on to solicit former customers with new employer Zimmer Biomet. The complaint alleges DePuy Synthes former sales consultant who resigned in October 2017 is now soliciting his previous customers for Zimmer Biomet.

47. A Seattle Times report examined the spine and neurosurgery services at Providence Health & Services Swedish-Cherry Hill hospital. According to the report, the health system decided to overhaul Cherry Hill's neuroscience program to treat more high risk patients. Former Seattle-based Swedish Neuroscience Institute Johnny B. Delashaw, MD, then resigned from his post as chair of the Seattle-based Swedish Neuroscience Institute on the Cherry Hill campus on March 1, 2017, amid a state health regulatory investigation into complaints filed against him. Dr. Delashaw, MD, claims he has proof of a conspiracy to push him out of his previous employment. During a state medical hearing, Dr. Delashaw alleged an anonymous source sent him records proving other physicians colluded with The Seattle Times to remove him from his position. In a motion, his lawyers said this proves other physicians were "fabricating complaints against Dr. Delashaw and enlisting friendly nurses and a physician to provide protected health information to the media," The Seattle Times reports.

48. Indian River County officials charged 51-year-old orthopedic spine surgeon Johnny Benjamin, MD, with felony fentanyl trafficking, robbery and grand theft. Officials received a report from an individual who claimed Dr. Benjamin grabbed the man's cellphone at Vero Beach, Fla.-based Pro Spine Center and proceeded to place the phone in a peanut jar filled with cotton balls, according to TC Palm. Police arrested Dr. Benjamin for the allegations related to the phone. In addition to the two felonies related to the phone, the state's attorney's office also charged Dr. Benjamin with attempting to traffic fentanyl.

49. A federal grand jury indicted Cathleen Van Buskirk, MD, Dec. 4 for bankruptcy scheme allegations. Dr. Van Buskirk, of Boulder, Colo.-based Alpine Spine Center, is accused of "bankruptcy fraud, concealment of bankruptcy assets, fraudulent transfer and concealment and money laundering," Daily Camera Boulder News reports. The indictment report claims the spine surgeon didn't report $46,000 and 200 U.S. silver dollars, foreign currency, gold coins and a diamond ring. The report also alleges Dr. Van Buskirk transferred $170,000 to companies controlled by others.

50. On Dec. 8, 2017, Louis Kralick, MD, was conducting spine surgery on a male patient when he pulled up the draping covering the patient's genitalia and used his iPhone to take "one or more" photos while the patient was under anesthesia, according to a lawsuit filed March 15, 2018 in Anchorage Superior Court alleges Dr. Kralick photographed the genitalia of a patient undergoing spine surgery at Providence Alaska Medical Center in Anchorage. Dr. Kralick signed a letter of apology.


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