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Over two decades as a spine surgeon, entrepreneur and investor, Jeffrey Roh, M.D., has helped expand surgical techniques, launch companies, commercialize technologies and navigate acquisitions. That experience has given him a unique perspective on why some medtech startups become industry leaders while others never reach the market.
Dr. Roh, Founder and CEO of IntuitiveX, a digital health, biotech and medtech incubator, outlined what separates successful startups from failed ones and shared which technologies he believes will drive the next wave of innovation in spine.
Why Do Good Ideas Sometimes Fail?
The biggest misconception in orthopedic innovation is that great technology is enough. “I’ve seen great ideas die by the wayside, and I’ve seen mediocre ideas become billion-dollar companies. Why is that?” Dr. Roh said. “There’s a gap in execution.”
Dr. Roh said successful startups consistently excel in three areas: team, technology and timing.
Building a Team. Startups need business, clinical and engineering expertise. “You need all three,” he said. “I’ve seen plenty of companies have one or two of those, and those companies typically fail.”
Examine your team to make sure these three areas are accounted for among the leadership, he said. The second-best step to take is to ensure that someone on your team or advising your team has successfully exited another company. The experience is invaluable and increases a company’s chance of success.
Developing a Technology. New products must solve meaningful problems for surgeons and patients, but their validation alone isn’t enough. Startups also need to think early about intellectual property and reimbursement — two areas Dr. Roh said are frequently overlooked.
Once your technology is substantiated to meet hospital, surgeon and patient needs, startups must quickly move to secure IP for their design. Neglecting IP can cause chaos later in the commercialization process if it’s found that the design infringes on a competitor’s technology. Rather than viewing patents as a legal exercise, companies should use the IP strategy to evaluate the scalability, platform potential and long-term value of their device.
“Don’t focus on whether your technology can get one patent,” Dr. Roh said. “Can you get a portfolio of intellectual property? A portfolio of patents acts as a moat around the technology.”
When it comes to reimbursement, make sure you understand the payment coverage for your technology, Dr. Roh said. Companies must understand how their technology will be reimbursed long before they reach commercialization. Without a viable pathway, strong innovation can struggle to gain adoption.
“Companies don’t think about this,” Dr. Roh said. “If you come out to the marketplace and there’s no pathway to reimbursement, how is your company going to succeed? It won’t.”
Understanding the Timing. How does your technology fit into the market landscape today and in the future? Startups can misinterpret product market fit by entering the market too early or too late, Dr. Roh said. Both cases could lead to adoption rates that are lower than expected.
He compared ideal market timing to the inflection point of a hockey-stick growth curve—the moment when adoption begins to accelerate. If the market shifts during the technology development process, you need to reassess whether you’re entering the market at an ideal time.
“Companies need to be agile enough to make important decisions on the fly,” Dr. Roh said. “If you realize you’re going in the wrong direction, you need to ask questions and listen to learn why.”
What Innovations Will Drive Growth?
While execution determines whether startups survive, Dr. Roh believes several technology shifts will determine which ones will thrive over the next decade. As a surgeon focused on tech and endoscopic surgery, perhaps there’s little surprise that Dr. Roh said AI, ASCs, enabling technology, and endoscopy represent the biggest opportunities for disruption.
Endoscopic Surgery. As an early adopter of endoscopic spine surgery, Dr. Roh predicted that open surgery would be considered barbaric in the coming years as more surgeons are trained on minimally invasive techniques. “We have to embrace endoscopic spinal technology,” he said. “That’s where the market will go—guaranteed.”
Amplify Surgical is one of IntuitiveX’s portfolio companies. Amplify Surgical’s dualPortal solution is a two-portal endoscopic approach that is designed to help surgeons perform a broader range of lumbar spine procedures than with the traditional single-portal technique. The marrying of an endoscopic procedure with an expandable cage will allow surgeons to perform an ALIF-like footprint without the downsides of a traditional ALIF approach, Dr. Roh said.
Personalized Surgery. Carlsmed is another IntuitiveX portfolio company. Carlsmed’s combines Al-enabled software with 3D-printed implants to deliver a personalized approach to cervical and lumbar procedures. Following its $100 million IPO in 2025, Dr. Roh believes the company is an attractive acquisition target for one of the major spine companies.
ASC Growth. Current market dynamics are such that cutting-edge technology rarely makes it into a hospital unless it’s part of the largest spine companies’ portfolios, Dr. Roh said. He advocates that surgeons start their own ASCs to have greater autonomy in deciding which technology to use, and encourages startups with novel implants to target outpatient settings.
Dr. Roh co-founded Excel Health, which focuses on minimally invasive and endoscopic spine surgery in California, Hawaii and Seattle. The removal of many spine procedures from CMS’ inpatient-only list provides clear direction for where surgeries will be performed in the future, he said.
“ASCs, with the advent of endoscopic and robotic surgery––that’s where spine is going,” he added.
Whether discussing startup strategy or the future of orthopedic innovation, Dr. Roh stressed that innovation alone isn’t enough. Companies that pair differentiated technology with the right team, market timing and execution will be the ones that shape the next era of the industry.
Over two decades as a spine surgeon, entrepreneur and investor, Jeffrey Roh, M.D., has helped expand surgical techniques, launch companies, commercialize technologies and navigate acquisitions. That experience has given him a unique perspective on why some medtech startups become industry leaders while others never reach the market.
Dr....
Over two decades as a spine surgeon, entrepreneur and investor, Jeffrey Roh, M.D., has helped expand surgical techniques, launch companies, commercialize technologies and navigate acquisitions. That experience has given him a unique perspective on why some medtech startups become industry leaders while others never reach the market.
Dr. Roh, Founder and CEO of IntuitiveX, a digital health, biotech and medtech incubator, outlined what separates successful startups from failed ones and shared which technologies he believes will drive the next wave of innovation in spine.
Why Do Good Ideas Sometimes Fail?
The biggest misconception in orthopedic innovation is that great technology is enough. “I’ve seen great ideas die by the wayside, and I’ve seen mediocre ideas become billion-dollar companies. Why is that?” Dr. Roh said. “There’s a gap in execution.”
Dr. Roh said successful startups consistently excel in three areas: team, technology and timing.
Building a Team. Startups need business, clinical and engineering expertise. “You need all three,” he said. “I’ve seen plenty of companies have one or two of those, and those companies typically fail.”
Examine your team to make sure these three areas are accounted for among the leadership, he said. The second-best step to take is to ensure that someone on your team or advising your team has successfully exited another company. The experience is invaluable and increases a company’s chance of success.
Developing a Technology. New products must solve meaningful problems for surgeons and patients, but their validation alone isn’t enough. Startups also need to think early about intellectual property and reimbursement — two areas Dr. Roh said are frequently overlooked.
Once your technology is substantiated to meet hospital, surgeon and patient needs, startups must quickly move to secure IP for their design. Neglecting IP can cause chaos later in the commercialization process if it’s found that the design infringes on a competitor’s technology. Rather than viewing patents as a legal exercise, companies should use the IP strategy to evaluate the scalability, platform potential and long-term value of their device.
“Don’t focus on whether your technology can get one patent,” Dr. Roh said. “Can you get a portfolio of intellectual property? A portfolio of patents acts as a moat around the technology.”
When it comes to reimbursement, make sure you understand the payment coverage for your technology, Dr. Roh said. Companies must understand how their technology will be reimbursed long before they reach commercialization. Without a viable pathway, strong innovation can struggle to gain adoption.
“Companies don’t think about this,” Dr. Roh said. “If you come out to the marketplace and there’s no pathway to reimbursement, how is your company going to succeed? It won’t.”
Understanding the Timing. How does your technology fit into the market landscape today and in the future? Startups can misinterpret product market fit by entering the market too early or too late, Dr. Roh said. Both cases could lead to adoption rates that are lower than expected.
He compared ideal market timing to the inflection point of a hockey-stick growth curve—the moment when adoption begins to accelerate. If the market shifts during the technology development process, you need to reassess whether you’re entering the market at an ideal time.
“Companies need to be agile enough to make important decisions on the fly,” Dr. Roh said. “If you realize you’re going in the wrong direction, you need to ask questions and listen to learn why.”
What Innovations Will Drive Growth?
While execution determines whether startups survive, Dr. Roh believes several technology shifts will determine which ones will thrive over the next decade. As a surgeon focused on tech and endoscopic surgery, perhaps there’s little surprise that Dr. Roh said AI, ASCs, enabling technology, and endoscopy represent the biggest opportunities for disruption.
Endoscopic Surgery. As an early adopter of endoscopic spine surgery, Dr. Roh predicted that open surgery would be considered barbaric in the coming years as more surgeons are trained on minimally invasive techniques. “We have to embrace endoscopic spinal technology,” he said. “That’s where the market will go—guaranteed.”
Amplify Surgical is one of IntuitiveX’s portfolio companies. Amplify Surgical’s dualPortal solution is a two-portal endoscopic approach that is designed to help surgeons perform a broader range of lumbar spine procedures than with the traditional single-portal technique. The marrying of an endoscopic procedure with an expandable cage will allow surgeons to perform an ALIF-like footprint without the downsides of a traditional ALIF approach, Dr. Roh said.
Personalized Surgery. Carlsmed is another IntuitiveX portfolio company. Carlsmed’s combines Al-enabled software with 3D-printed implants to deliver a personalized approach to cervical and lumbar procedures. Following its $100 million IPO in 2025, Dr. Roh believes the company is an attractive acquisition target for one of the major spine companies.
ASC Growth. Current market dynamics are such that cutting-edge technology rarely makes it into a hospital unless it’s part of the largest spine companies’ portfolios, Dr. Roh said. He advocates that surgeons start their own ASCs to have greater autonomy in deciding which technology to use, and encourages startups with novel implants to target outpatient settings.
Dr. Roh co-founded Excel Health, which focuses on minimally invasive and endoscopic spine surgery in California, Hawaii and Seattle. The removal of many spine procedures from CMS’ inpatient-only list provides clear direction for where surgeries will be performed in the future, he said.
“ASCs, with the advent of endoscopic and robotic surgery––that’s where spine is going,” he added.
Whether discussing startup strategy or the future of orthopedic innovation, Dr. Roh stressed that innovation alone isn’t enough. Companies that pair differentiated technology with the right team, market timing and execution will be the ones that shape the next era of the industry.
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Patrick McGuire is an ORTHOWORLD Contributor.
