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Medtronic’s recent success in spine is backed by the company’s focus on enabling technology through the complete continuum of care. The company’s growing AiBLE ecosystem includes navigation, robotics, data and AI, imaging, software and implants, which collect intelligence to help the company and surgeons make more informed decisions.
“The evidence of the approach is in the company’s results over the last three years,” said Skip Kiil, Medtronic’s President of Cranial and Spinal Technology. He added that Medtronic continues to take market share from its competitors, increasing its lead as the largest company in spine by revenue. We project Medtronic’s 2024 calendar year revenue to be $3.3 billion for implants, biologics and enabling technology associated with spine surgery.
Medtronic has about 10,000 capital units placed globally and continues to eye expansions to its AiBLE ecosystem. The company recently formed a global partnership that integrates Siemens Healthlineers’ Multitom Rax imaging system with AiBLE to provide preoperative scanning capabilities.
Mr. Kiil stressed that innovation must take place across enabling technology, implants and biologics for the company’s feedback loop to be successful, but our conversation with him and Michael Carter, General Manager of Spine and Biologics, veered toward the importance of preoperative planning for spinal surgery. Medtronic’s UNiD platform, acquired from Medicrea in 2020, is foundational to how the company expects spine surgeons to perform procedures in the future.
How does the AiBLE platform provide value to surgeons and end users?
Mr. Kiil: We offer preoperative planning with our UNiD platform, which we then import into our Stealth and Mazor platforms. We make sure that surgeons are delivering on the plan that they created ahead of the procedure. While a surgeon is performing a case, they can do an intraoperative CT scan to gain feedback on precisely what they’re doing. Then, they can post-operatively do a scan to see how their work aligned with what they said they were going to do. Ultimately, it’s going to reduce variability in patient outcomes.
Mr. Carter: Spine surgery has always had significant variability. The feedback loop we provide throughout the entire process decreases the cognitive load for surgeons. The point of dexterity is equalized information so that procedures are a lot better across the board. Less variability means fewer revisions and better patient outcomes.
How did the relationship with Siemens come about?
Mr. Kiil: There were pre-existing relationships on the executive teams, and we started to talk about the influence of technology on spine surgery. Also, we’ve prioritized collaborations and partnerships; everything doesn’t need to be invented inside Medtronic. When you look at the global footprint of Siemens and Medtronic, there was natural synergy and opportunity to think about something bigger and broader.
Mr. Carter: We often discuss where the continuum of care begins and ends and what we can do to expand the AiBLE system. Our UNiD platform satisfied the need for preoperative planning, and the Siemens partnership closed our gap in preoperative scanning.
How does your focus on the continuum of care impact the outpatient setting?
Mr. Kiil: In the simplest terms, preoperative planning informs the surgeon about what type of implants and screws they need in surgery. The typical hospital case might have 14 to 20 trays. Preoperative planning allows us to enter the O.R. with exactly what the surgeon predicted they would need through planning. We expect this to become the standard of care for every procedure, no matter the setting.
How have surgeons’ thoughts evolved about preoperative planning?
Mr. Kiil: It’s typically a generational topic. Preoperative planning is often used by surgeons who learn it early in their professional journey. That’s not always the case, though. A surgeon with 40 years of experience told us he could perform surgery plus or minus 4% of lordosis and spine correction. When we started measuring what he was delivering vs. what he thought he was delivering, it was different. Now, he uses preoperative planning regularly. This is arguably one of the top spine surgeons in the history of the industry who has adopted technology to provide feedback because he’s focused on continuous improvement.
Mr. Carter: When we show UNiD to surgeons, they see planning in a different way. They’ll say, ‘I’ve been thinking like this my entire career, but now I see tangible evidence of its benefits.’
Will innovation be driven more through the enabling technology side of the business than the implant side moving forward?
Mr. Kiil: You must innovate with enabling technology and implants; you can’t have one without the other. A third of our industry is made up of small companies that are focused on the metal side of the business, and our perspective is that there’s not a lot of utility in that. You need enabling technology, including navigation, robotics, AI, machine learning and big data, as well as implants.
Mr. Carter: As we gather more data, we’re able to perform finite element analysis and digital twins to take things that are in the physical form and play with them in the digital space. We can develop algorithms that inform the design of our implants.
Mr. Kiil: Our enabling technology investments are allowing us to gather more information and inform our implant designs at a faster rate and higher level than before. We’re able to make better decisions and get through the design process quicker. We’re focused on the work associated with the procedure, not necessarily just the implant. As Carter said, it’s the form factor of creating physics in a virtual environment that allows us to fast-track our ideas and quickly iterate with surgeons. With UNiD, we can perform an intraoperative CT scan and know exactly what we’ve accomplished from the preoperative plan. We’re no longer changing the spine to fit the implant; we’re correcting the spine.
How would you describe the health of the spine market?
Mr. Kiil: It’s growing in the mid-to- low-single digits. The pent-up procedure demand post-Covid has normalized in the U.S. Technology adoption has flattened the opportunity for surgical candidates, bringing more patients into the funnel. We’re going to see a durable market, which is exciting because spine was a low-growth, no-growth space for years. We need to bring data and technology into the workplace and in partnership and collaboration with surgeons who are delivering quality care. We feel we’re much better positioned than anyone else in the industry.
Are you seeing a similar situation outside the U.S.?
Mr. Kiil: The approach to solving spine cases differs from market to market. Large Western European markets have a capitative funding methodology where technology adoption will lower the overall cost burden in those healthcare systems. We’re seeing technology adoption pick up outside the United States, which is an early indicator of a healthy growth profile because you’re moving beyond just plastics and metals and into a procedural workflow that includes the digitization of spinal procedures. Our data makes us feel confident that we’re moving in the right direction and the global marketplace will be stable for the next five-plus years.
Medtronic’s recent success in spine is backed by the company’s focus on enabling technology through the complete continuum of care. The company’s growing AiBLE ecosystem includes navigation, robotics, data and AI, imaging, software and implants, which collect intelligence to help the company and surgeons make more informed decisions.
“The...
Medtronic’s recent success in spine is backed by the company’s focus on enabling technology through the complete continuum of care. The company’s growing AiBLE ecosystem includes navigation, robotics, data and AI, imaging, software and implants, which collect intelligence to help the company and surgeons make more informed decisions.
“The evidence of the approach is in the company’s results over the last three years,” said Skip Kiil, Medtronic’s President of Cranial and Spinal Technology. He added that Medtronic continues to take market share from its competitors, increasing its lead as the largest company in spine by revenue. We project Medtronic’s 2024 calendar year revenue to be $3.3 billion for implants, biologics and enabling technology associated with spine surgery.
Medtronic has about 10,000 capital units placed globally and continues to eye expansions to its AiBLE ecosystem. The company recently formed a global partnership that integrates Siemens Healthlineers’ Multitom Rax imaging system with AiBLE to provide preoperative scanning capabilities.
Mr. Kiil stressed that innovation must take place across enabling technology, implants and biologics for the company’s feedback loop to be successful, but our conversation with him and Michael Carter, General Manager of Spine and Biologics, veered toward the importance of preoperative planning for spinal surgery. Medtronic’s UNiD platform, acquired from Medicrea in 2020, is foundational to how the company expects spine surgeons to perform procedures in the future.
How does the AiBLE platform provide value to surgeons and end users?
Mr. Kiil: We offer preoperative planning with our UNiD platform, which we then import into our Stealth and Mazor platforms. We make sure that surgeons are delivering on the plan that they created ahead of the procedure. While a surgeon is performing a case, they can do an intraoperative CT scan to gain feedback on precisely what they’re doing. Then, they can post-operatively do a scan to see how their work aligned with what they said they were going to do. Ultimately, it’s going to reduce variability in patient outcomes.
Mr. Carter: Spine surgery has always had significant variability. The feedback loop we provide throughout the entire process decreases the cognitive load for surgeons. The point of dexterity is equalized information so that procedures are a lot better across the board. Less variability means fewer revisions and better patient outcomes.
How did the relationship with Siemens come about?
Mr. Kiil: There were pre-existing relationships on the executive teams, and we started to talk about the influence of technology on spine surgery. Also, we’ve prioritized collaborations and partnerships; everything doesn’t need to be invented inside Medtronic. When you look at the global footprint of Siemens and Medtronic, there was natural synergy and opportunity to think about something bigger and broader.
Mr. Carter: We often discuss where the continuum of care begins and ends and what we can do to expand the AiBLE system. Our UNiD platform satisfied the need for preoperative planning, and the Siemens partnership closed our gap in preoperative scanning.
How does your focus on the continuum of care impact the outpatient setting?
Mr. Kiil: In the simplest terms, preoperative planning informs the surgeon about what type of implants and screws they need in surgery. The typical hospital case might have 14 to 20 trays. Preoperative planning allows us to enter the O.R. with exactly what the surgeon predicted they would need through planning. We expect this to become the standard of care for every procedure, no matter the setting.
How have surgeons’ thoughts evolved about preoperative planning?
Mr. Kiil: It’s typically a generational topic. Preoperative planning is often used by surgeons who learn it early in their professional journey. That’s not always the case, though. A surgeon with 40 years of experience told us he could perform surgery plus or minus 4% of lordosis and spine correction. When we started measuring what he was delivering vs. what he thought he was delivering, it was different. Now, he uses preoperative planning regularly. This is arguably one of the top spine surgeons in the history of the industry who has adopted technology to provide feedback because he’s focused on continuous improvement.
Mr. Carter: When we show UNiD to surgeons, they see planning in a different way. They’ll say, ‘I’ve been thinking like this my entire career, but now I see tangible evidence of its benefits.’
Will innovation be driven more through the enabling technology side of the business than the implant side moving forward?
Mr. Kiil: You must innovate with enabling technology and implants; you can’t have one without the other. A third of our industry is made up of small companies that are focused on the metal side of the business, and our perspective is that there’s not a lot of utility in that. You need enabling technology, including navigation, robotics, AI, machine learning and big data, as well as implants.
Mr. Carter: As we gather more data, we’re able to perform finite element analysis and digital twins to take things that are in the physical form and play with them in the digital space. We can develop algorithms that inform the design of our implants.
Mr. Kiil: Our enabling technology investments are allowing us to gather more information and inform our implant designs at a faster rate and higher level than before. We’re able to make better decisions and get through the design process quicker. We’re focused on the work associated with the procedure, not necessarily just the implant. As Carter said, it’s the form factor of creating physics in a virtual environment that allows us to fast-track our ideas and quickly iterate with surgeons. With UNiD, we can perform an intraoperative CT scan and know exactly what we’ve accomplished from the preoperative plan. We’re no longer changing the spine to fit the implant; we’re correcting the spine.
How would you describe the health of the spine market?
Mr. Kiil: It’s growing in the mid-to- low-single digits. The pent-up procedure demand post-Covid has normalized in the U.S. Technology adoption has flattened the opportunity for surgical candidates, bringing more patients into the funnel. We’re going to see a durable market, which is exciting because spine was a low-growth, no-growth space for years. We need to bring data and technology into the workplace and in partnership and collaboration with surgeons who are delivering quality care. We feel we’re much better positioned than anyone else in the industry.
Are you seeing a similar situation outside the U.S.?
Mr. Kiil: The approach to solving spine cases differs from market to market. Large Western European markets have a capitative funding methodology where technology adoption will lower the overall cost burden in those healthcare systems. We’re seeing technology adoption pick up outside the United States, which is an early indicator of a healthy growth profile because you’re moving beyond just plastics and metals and into a procedural workflow that includes the digitization of spinal procedures. Our data makes us feel confident that we’re moving in the right direction and the global marketplace will be stable for the next five-plus years.
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Carolyn LaWell is ORTHOWORLD's Chief Content Officer. She joined ORTHOWORLD in 2012 to oversee its editorial and industry education. She previously served in editor roles at B2B magazines and newspapers.
