Globus Medical, Inc.’s ExcelsiusGPS® and Medtronic’s Mazor X with StealthStation are the two most commonly purchased robotic assist platforms for spine and neurosurgeons in the United States.
Virtually every major spinal implant company (Zimmer Biomet, NuVasive, Inc., Stryker Corporation, JNJ Synthes and others) have or will soon announce their own spine surgery robot and, no doubt, hustle to catch up to the market leaders.
Neither Globus nor Medtronic plc release robot unit sales numbers but two of Wall Street’s top medical device research departments (Wells Fargo Securities and Needham and Co.) estimate that between 140-200 Mazor X and ExcelsiusGPS systems have been sold so far in the United States.
The total available market is probably 2,000 units spread among 1,250 U.S. hospitals and clinics, so robotics have only penetrated about 8% of the market.
Last January 2018, we checked in with New York University Langone Orthopedic Hospital’s Chief of Spine Service for Education and Director of the Spine Fellowship Jeffrey Goldstein, M.D. about his new robotic system which, as it turned out, was Globus’s ExcelsiusGPS. Although he’d only used it in a couple cases and his colleagues were still coming up to speed, he was a happy customer as he explained to OTW:
“Robotic assist systems allow you to enter through smaller incisions with greater precision. I had a good level of confidence using fluoroscopy in minimally invasive surgery. With robotic assistance I have a higher level of confidence. And it’s faster.”
“I think the robotic assist system maintains my precision but with significantly less radiation exposure. Since its image guided, I can watch the screw being placed through the monitor and see that screw is going along the path I designed. I am more confident that the screw is precisely where I want it in the pedicle.”
But what happens after the post-purchase honeymoon period ends? What strengths or weaknesses do these systems reveal after extended day-to-day use?
This time, we checked in with both an orthopedic spine surgeon (Andrew Manista, M.D. at Capital Medical Center in Olympia, Washington) and a neurosurgeon (Scott Kutz, M.D. at Medical City Frisco in Dallas, Texas) each of whom had experience with BOTH the Mazor and ExcelsiusGPS systems.
The Neurosurgeon: Precision and Accuracy
Scott Kutz, M.D. is a Plano, Texas-based neurosurgeon who’s specializes in percutaneous techniques, neuro navigation, artificial disc replacement and treating SI [sacroiliac] joint disorders. His Bachelor of Science degree is from the University of Illinois at Urbana-Champaign, his M.D. is from University of Illinois at Chicago, his surgical internship and neurosurgical residency was at Louisiana State University in New Orleans, and, finally his stereotactic and functional neurosurgery fellowship was at Rush in Chicago.
Dr. Kutz, who’s had Globus’ Excelsius GPS for more than year, told OTW that he’s very satisfied with the capabilities of his system and thinks it is a particularly robust platform for his purposes. He’d used both the Mazor Renaissance and the Mazor X in his clinic and actually waited a while before taking the plunge into a combination navigation and robotics platform. He settled on Globus’ Excelsius because, in his view, it had the most robust features—specifically, the way it married navigation to robotics.
“Robotics used to operate in isolation to navigation so that instruments were delivered precisely, but not necessarily accurately. Without the visual feedback that comes with navigation, it’s possible to find yourself somewhere you don’t want to be” he explained.
With the Excelsius, “I can see in three dimensions, which significantly reduces the risk of misplacement. I see in real time where I am. My revision rates using the navigation with robotics is exceedingly low—1% versus about 8-10%, which is the rate mentioned in the literature for free-hand pedicle screw placement.”
