Smaller, Safer, Faster

Several weeks ago I had the privilege of attending the North America Spine Society (NASS) meeting in Boston. This meeting is held annually and is the largest gathering of spine surgeons in the world.

It is also the largest gathering in the world of those who sell products to spine surgeons and hospitals. The 516,000 square foot exhibit hall, showcasing the latest technology, is a good window into the spine market.

Fifteen years ago the exhibit hall was filled with things – implants, screws, cages, plates, and so on, all designed to be permanently placed in the patient’s spine. Each company tried to explain that their product was better by pointing out small (and usually meaningless) differences between their product and their competitor’s. Once in a while something novel would appear but as the market matured, this was increasingly rare.

For many years, the products at the booths were no different than they were the year before.

However, things changed, slowly at first, but then quickly. The implants, which used to be front and center, are relegated to a back of the booth – if they are there at all, and have been replaced by “enabling technologies” such as navigation and advanced imaging / planning systems.  More recently the talk is all about “robots” a noisy but unscalable and unsustainable solution given the macro dynamics of healthcare.  All of these products are by design, intended to ensure that surgeons and hospitals become more and more reliant upon the company and its products much that way IBM and others worked to ensure that their main-frame computer solutions (remember the AS400?) would make corporations reliant on them.  Fortunately for the world, this flies in the face of human nature.

This transition from implantable objects to navigation platforms was made possible by advances in technology. Soon large, impressive, expensive navigation platforms were the star of the exhibition show. The platforms were usually comprised of an intraoperative CT scanner, one or more infrared cameras, and a large computer station all of which take up a great deal of real estate in an already crowded OR. Each company that sold a navigation platform also sold an impressive array of proprietary instruments that were needed in order to use these systems. Competitor’s instruments were by design useless.

Due to their cost and complexity, these systems are only available to the richest hospitals in the richest countries. They  are also expensive and complex to maintain and use. Though navigation platforms have become somewhat smaller and faster, the changes have been incremental, and today’s platforms are not much different than those from 5 or even 10 years ago.

So where will we be five years from now? Fortunately we have a roadmap. If we look at the progression of the computers and technology in general, we see the following trend: Large main frames to desktop computers to personal computers to laptops and now smartphones. Because of the exponential increase in computing power (see Moore’s Law), performance has not been sacrificed, in fact today’s iPhone is orders of magnitude more powerful than the largest mainframe from years past.

The navigation platforms, (and all enabling technology for that matter) will, like the smartphone, be smaller, more powerful, less expensive and widely available.

Because of this trend, enabling technologies, instead of being the exclusive purview of richest hospitals in the richest countries, will be available to in operating room setting in the US and perhaps more importantly to those outside the US. Smart phones have allowed citizens of third world countries to have access to the internet, banking, and many other previously unavailable services. Likewise, new navigation platforms, powered by smaller, faster, and less expensive computers, such as the iPhone, will give patients throughout the world access to the same level of care as those living in affluent countries.