Conference Report: Congress of Neurological Surgeons (CNS)

This is the latest conference report from our Senior Advisor Dick Emmitt, who attended the Congress of Neurological Surgeons (CNS) annual meeting last week.

Venue:  George R. Brown Convention Center, Houston, Texas

Focus:  Neurosurgery, Spine Surgery, Brain Oncology, Neurologic Disease, Stroke, etc.

Attendees:  Approximately 2500 Neurosurgeons (90% U.S.)

Commercial Sponsors:  Approximately 100

Strategic Overview:  Attendance at the CNS has been trending down over the past 5 years (from approximately 3000 in 2012) as the Conference has been trying to expand its traditional brain/spine agenda in order to respond to advances in technology and the encroachment of “adjacent” medical specialists on the turf of neurosurgeons

Clinical Take-Homes:

• The number of traditional open brain and spine surgical procedures are flat to down as advances in technology facilitate less-invasive and minimally invasive procedures
• Non neurosurgeons benefitting from technology advances include: orthopedic surgeons, interventional radiologists, neuroradiologists, neurologists, ENT surgeons, and pain specialists.
• New technologies permitting other medical specialists to encroach on neurosurgeon turf:
  • Imaging: MRI, fluorescence, ultrasound
  • Access: Endoscopic, percutaneous, transcutaneous
  • Robotics, navigation and image guidance
  • Tissue Ablation/Stimulation: Radiosurgery (SRS), (SRS), radiofrequency, laser, ultrasound, magnetic
• New technologies focused on clinical applications/needs not served well, or at all, by traditional open surgery or by biotech pharma:
  • Brain tumors (primary glioblastoma and metastatic)
  • Tumors in the spine and other anatomies such as the sinuses
  • Neurovascular disorders (aneurysms and stroke)
  • Movement Disorders (Epilepsy, Parkinson’s, etc.)
  • Chronic Neurologic Pain (opiate avoidance)
  • Other Chronic conditions such as depression

Market Take-Homes:

• Neuro Market remains one of the biggest and fastest growing medical device markets
• Medtronic’s neuro & neurosurgery businesses (“Restorative Therapies”) represent the company’s fastest growing major sector; sales up 8% and annualized at approximately $8 billion in recent quarter despite lost share in recent years in large sectors (such as spine) and growth sectors (such a neurovascular and spinal cord stimulation)
• Medtronic and Stryker leading neurosurgery and image guidance acquisition race
  • Medtronic: Mazor, Vision Sense
  • Stryker: K2M, Novadaq, Invuity
• Literally dozens of small/mid cap public and private companies remain at the tip of the innovation spear
• Robotic/Image Guidance/Navigation
  • IMRIS (Intraoperative MRI)
  • MRI Innovations (MRI Guidance for Minimally Invasive Access)
  • 7D Surgical (Navigation)
  • Synaptive (Navigation)
• Ablation/Stimulation
  • Nevro (spinal cord stimulation for pain)
  • Accuray and Elekta (Stereotactic Radio Surgery for tumors)
  • Monteris (Laser for brain tumors and epilepsy)
  • Profound and Sonacare (high intensity focused ultrasound)
  • Novocure (Magnetic fields for brain tumors)
  • Neuronetics (Magnetic stimulation for Depression)
  • NeuroPace (Brain Stimulation for Epilepsy)
  • Diros Technology (Radiofrequency stimulation for pain)
• Access
  • NICO (endoscopic for small tumors and hemorrhage)
  • Penumbra (percutaneous for aneurysms and stroke)