October marked my first trip to the NASS (North American Spine Society) annual meeting. While I attended the AAOS (American Academy of Orthopaedic Surgeons) annual meeting earlier in 2016, this was the first time I was going to an event that was focused solely on the spine and the devices to treat it. I had some idea of what to expect, but was still surprised by the make-up of the expo floor. It quickly became clear just how significant spinal fusion was for this sector of the orthopedic industry. And by that, I mean it virtually IS the skeletal spine device industry (differentiating it from any display of spinal cord/nerve related technologies, which I thought could be a part of this event; I was wrong). Spinal fusion seems to be, by far, the primary technology focus for this event.

While there were a number of different technologies presented that are used for spinal fusion procedures, they all essentially functioned in the same way. An insert was placed in the space where a disc had previously existed to address a clinical concern the patient was experiencing. Some of the devices were hinged, others allowed for better graft fill in the space, while still others had surfaces that triggered an osteogenic response to enable a better fusion outcome. There were even debates over materials—was PEEK still a viable option? Will titanium return as the material of choice? Is a hybrid of the two the best option? Regardless of what type of product a manufacturer was presenting, the performance of the device was essentially the same.

In spite of this overwhelming display of spinal fusion technologies presented before me, one thought remained as I traversed the event over the three days. That is, this industry is going to be significantly different in a relatively short period of time. Is a 10-year timeframe realistic or foolishly optimistic for that change to take place? Will it be even quicker than that? I’m not sure, but I do believe the NASS annual meeting will be radically different in 2026.

And what will that change be? Perhaps the replacement of PEEK- and metal-based hardware with much more naturally performing biologic alternatives that are further enhanced through personalized manufacturing processes. Essentially, an implant that looks, acts, and responds as close to a natural disc as possible, restoring more natural motion to a patient’s spine. Again, perhaps 10 years is overly optimistic for such an advancement, but I think, without question, that’s where we’re headed.

Fortunately, I’m not the only one looking at biologics as a natural evolutionary step for the spine industry. In an article on Spine-health.com, Dr. Jeffrey Wang, chief of the UCLA Spine Service, director of the UCLA Spine Surgery Fellowship, and a thought leader in this healthcare segment, said, “Ten years ago, the field was 75 percent traditional rods and plates and 25 percent biologics. Now it has reversed and we are in a transition period where we’re focusing more on biologics than devices. This is in part because people are increasingly aware of the potential impact of biologics. Even in educational courses, we used to relegate biologics to a small section at the end of the course or lecture and people were generally bored by it. The lectures were dry and back then, the clinical applications were too far in the future for people to get their heads around it.”

Biologics are pervasive throughout the orthopedic industry. While it may not seem as prominent a technology shift on the expo floor of NASS this year, there were companies who were certainly promoting more “natural” solutions. These included non-biologic solutions such as Medicrea’s personalized implants that are based on a patient’s actual anatomy and developed with the use of their imaging scans. The company also made headlines by announcing a lifetime warranty for its patient-specific UNiD constructs, a first in the spinal fusion sector. I was able to catch up with a firm I was introduced to during the aforementioned AAOS event—Bioventus—a company focused exclusively on offering orthobiologic-based solutions for bone repair and healing. They are becoming a player in the spine space now. 

These represent modest steps in the direction of companies who will eventually offer true, naturally-based alternatives for disc replacement, putting today’s spinal fusion technologies into the history books. Whether my 10-year predication is realistic or not will remain to be seen, but as we go forward, demand for more natural and/or personalized solutions for disc replacement will be demanded by both surgeons and their patients. Its up to technology providers serving this space to address this coming demand now through investment in R&D. Hopefully, they’re already putting forth this effort (not like any of you would tell me for certain on the record).