Startups Search for Better Back Surgery

Some operations for patients with severe back pain could involve major incisions and nearly a week’s hospital stay. But startup San Francisco Bay Area medical device firms have developed far less invasive spinal surgeries they believe are revolutionizing the industry while improving patient care.

Companies such as Fremont-based Spine View Inc., Baxano Inc., SI-Bone Inc. and DFine Inc. of San Jose and Relievant Medsystems of Redwood City are honing in on spinal devices and noninvasive techniques to relieve spinal disorders.

Why all this attention on the backbone? It’s potentially big business.

Worldwide spending on spinal surgeries of all kinds was $7.3 billion in 2009, said William Plovanic, managing director of medical technologies at Canaccord Genuity, which follows the industry. That spending exceeds the amount spent on surgeries involving other major joints that can become troublesome, including knees and hips, Plovanic said.

The market for minimally invasive spine surgeries is relatively small, with spine surgeons slow to adopt the technique, according to the SAS Journal. But the market still amounted to $785 million in the United States alone last year, according to Kevin Flewwelling, manager of the orthopedics division at Toronto-based Millennium Research Group, which analyzes the medical device, pharmaceutical and biotechnology industries.

However, by 2013, spending on the minimally invasive spine surgery sector is expected to rise to $1.39 billion, according to Flewwelling. The number of surgeries performed using this technique is predicted to jump more than 50 percent to 204,850 during the same period, according to Millennium.

This form of repair work requires smaller incisions than those used in conventional operations. That means lower infection rates, reduced blood loss, shorter hospital stays, fewer blood transfusions and quicker recovery times for patients, said Choll Kim, a San Diego spine surgeon and executive director for the Society for Minimally Invasive Spine Surgery.

An aging population that is more prone to spinal problems but intent on remaining active is helping to drive the sector’s growth. "In California, I have 75-year-old patients who are vibrant and playing golf," Kim said. "I can’t tell them to get a cane or walker. We are constantly looking for ways to treat those patients."

While less invasive surgery for other parts of the body have been available for several years, there have been fewer innovations for the spine until recently, according to Roy Chin, Spine View’s CEO. "Spine surgery is the last frontier" when it comes to adopting new techniques, he said. Chin said his firm and others "will eventually take spine surgery to a higher level."

Here’s a look at what the new generation of privately held Bay Area spine surgery innovators have in store:

Baxano, founded in 2005, develops tools used to relieve pain associated with spinal stenosis, a progressive narrowing of the spinal canal that crowds nerves and causes back pain. The company’s product shaves away excess tissue and is now being used by surgeons in five regions of the United States whose clinical data will support a wider launch next year, said CEO Tony Recupero. The company recently closed a third round of funding with $30 million Series C led by new investor CMEA Capital. Other investors include Kaiser Permanente Ventures, Affinity Capital Management, Athenian Venture Partners, Prospect Venture Partners, Three Arch Partners and Kearny Venture Partners.

SI-Bone, founded in 2008, says its average patient is in their 40s and suffering the painful effects of car accidents or nasty falls that destabilized the sacroiliac joint in the lower back. The company’s surgical device immobilizes the joint, alleviating pain. Company officials expect the device, on the market in the United States since 2008, will receive clearance from European regulators this month. In August, SI-Bone received $11 million from new investor Skyline Ventures of Palo Alto and previous investors. Funds will go to hire more distributors and train more surgeons to use the device, said Mark Reiley, who invented the technology and is the company’s chief medical officer.

Spine View, founded in 2006, makes devices used to perform spinal decompression and fusion procedures through incisions that are just one-quarter-inch wide. The company will go from 55 employees to 75 within a year as it expands its sales and marketing team, said Roy Chin, Spine View’s CEO and founder. Chin declined to give details about the company’s financing. So far, doctors using a system developed by Fremont-based Spine View have performed more than 400 minimally invasive surgeries to relieve spinal disorders.

Relievant Medsystems, also founded in 2006, is developing a surgical treatment to end back pain with a minute needle that’s inserted into the affected vertebrae and uses a heat-tipped probe to destroy the pain-causing nerve. The procedure has alleviated serious back pain in 17 patients so far. President and CEO Paul Goeld said he expects to receive approval from U.S. regulators to begin widespread testing in 200 patients by early 2011. Canaan Partners, Onset Ventures and Morgenthaler Ventures have invested a total of $30 million in the company since 2006.

DFine, founded in 2004, makes devices to treat fractures of the vertebrae. The San Jose company reported revenue of $7.5 million last year and sells its devices in the United States and Germany. A recent $36.2 million round of equity financing led by new investors Split Rock Partners and OrbiMed Advisors will provide cash needed to expand domestic and international marketing efforts.

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