Proprio: Illuminating Machine-Guided Spinal Surgery

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Robotic technologies have historically been used in limited capacities in spinal surgery, though they have demonstrated utility in navigating the placement of implants as imaging capabilities improved. Now, Proprio’s solution, Paradigm, will offer surgeons 3D visualization of the operating field with real-time feedback and full data connectivity, bringing the spinal field into the digital age.

As a pioneer in the field of computer-assisted spinal surgery and has since focused exclusively on the spine, Tommy Carls is uniquely qualified to say that the baseline technology most companies use for navigating spinal implants has not changed much since the late 1990s. During that period, Carls, now vice president of product marketing for Seattle-based start-up Proprio, worked for early spinal-fusion products developer Sofamor Danek until it was acquired by Medtronic, where Carls subsequently spent the bulk of the 30-plus years of his orthopedic medical device career.

Many of the spinal surgery technologies that came to market in that time are robots that are “essentially glorified tool-holders,” according to Carls. Serving the role of a steady third hand that can hold a position accurately to maintain a procedural trajectory, these robots cannot perform active surgical functions like cutting bone. Another major innovation of that period is the O-arm, which enables intraoperative imaging and expedited navigation during the implantation process for pedicle screws, rods, and other spinal implants. By the time of his official retirement from Medtronic in 2020, Carls was responsible for the company’s global spinal product R&D, which is an approximately$3 billion business, and he was part of the leadership team that purchased the Mazor robotic guidance system two years prior.


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