NASS 2026: Ten Companies Worth a Closer Look

Spend enough time in the exhibit hall and the booths start to blur: another bolt-on, me-too, or minor tweak with a major launch. What keeps the floor interesting is the occasional idea that breaks the pattern: a product that changes what a surgeon can do, where it can be done, what it costs or who gets paid. Sometimes it’s new evidence that a promised improvement actually holds up. Of NASS 2026’s 246 exhibitors, we chose 10 for a closer look: seven from the main exhibit hall and three from Spine Venture Village.

From the Main Exhibit Hall

Robotron: Another Way Into the Canal

Status: Prototype; no clearance; SpineHawk sold to VB Spine January 2026

Why it's interesting: A robot that enters through the sacral hiatus and decompresses stenosis from inside the canal, so nothing in the back gets cut.

Robotron is taking the access problem literally: change the route to the pathology. Its BISHEP concept enters through the sacral hiatus and advances a miniature robotic system inside the spinal canal, aiming to decompress lumbar stenosis while preserving posterior structures that conventional exposure may disturb. Endoscopic vision, robotic control and AI-assisted anatomical recognition are intended to make that approach workable in a space with little tolerance for error. Clinical validation remains ahead, but the company, led by Holo Surgical co-founder Kris Siemionow, MD, PhD, also has separate commercial news: VB Spine announced an agreement in January to acquire its SpineHawk visualization platform and related intellectual property. BISHEP and SpineHawk are distinct projects, linked by an interest in improving what surgeons can see and reach. The robot earns attention because it proposes changing the surgical approach itself, with tissue preservation built into the choice of entry.

Cerapedics: Faster Fusion Meets the Hospital Budget

Status: Label expanded to the major lumbar interbody approaches January 2026; Medicare NTAP effective October 1

Why it's interesting: The only bone graft with an FDA-approved claim of faster fusion than the patient's own bone, and Medicare now helps pay for it.

Cerapedics came to NASS with something for the surgeon and something for the purchasing committee. PearlMatrix's pivotal lumbar study, 293 patients at 33 sites with about 60% high-risk, showed more than twice as many patients fused at six months compared with local autograft, and a new Medicare add-on payment took effect October 1 for qualifying inpatient cases. That gives the company two useful arguments in a market where clinical enthusiasm still has to survive a budget meeting. The graft uses P-15, a peptide bound to anorganic bone mineral particles, to provide attachment sites for bone-forming cells. Expanded indications announced in January broadened its use across lumbar interbody approaches. The labeling also notes a higher rate of index-level secondary surgical interventions in the TLIF study, 9.1% versus 2.7% at 24 months, even as the composite endpoint favored PearlMatrix. Hospitals weighing adoption now have a financial consideration alongside the clinical one, making PearlMatrix a particularly timely conversation at this year's meeting.

See All AI: Two Images, a Much Bigger Ambition

Status: In development; not FDA cleared; $33 million raised May 2025

Why it's interesting: The man who invented the O-arm is building software to make it unnecessary, using X-rays the OR already takes.

Having helped bring the O-arm and Airo into surgery, Gene Gregerson is now working on a way to make dedicated 3D imaging hardware less necessary. His company, See All AI, says its technology can reconstruct a sliceable 3D volume from as few as two fluoroscopic images. Led by CEO Eric Major, who founded K2M and sold it to Stryker, the company is also developing machine vision to recognize and track instruments without the usual reflective-marker assemblies, and plans to sell per case rather than as capital equipment. The potential consequences extend across equipment requirements, setup and access to navigation. See All remains in development without FDA clearance, and demonstrating consistently trustworthy reconstruction across real surgical anatomy is a tall order. Gregerson helped establish the equipment category whose hardware requirements he is now trying to rethink.

Empirical Spine: Giving Decompression Some Backup

Status: PMA approved February 12, 2026; first U.S. cases April 30, 2026

Why it's interesting: The first approved device that sits between decompression alone and instrumented fusion for Grade I spondylolisthesis, and most trial patients went home the same day.

Adding stability after decompression usually comes with a substantial hardware commitment. Empirical Spine's LimiFlex Dynamic Sagittal Tether offers selected patients with Grade I degenerative spondylolisthesis and lumbar stenosis another option: support the segment while preserving motion and leaving the pedicles alone. The tension-band implant attaches around adjacent spinous processes to restrain excessive flexion after decompression. February's FDA approval moved what the company describes as more than two decades of development into U.S. commercialization, supported by a concurrently controlled pivotal study reporting noninferior two-year clinical outcomes compared with instrumented fusion. Procedures were shorter, two-thirds of LimiFlex patients went home the same day, and nearly half were treated in ambulatory or outpatient surgery centers. For surgeons weighing decompression alone against the additional burden of fusion, the appeal is immediate. LimiFlex puts an additional tool into a decision that has long required balancing how much surgery a patient needs against how much surgery that patient can reasonably avoid.

Mainstay Medical: An Implant With a Restorative Assignment

Status: Two-year RESTORE results published in The Spine Journal, September 2026; Highmark coverage effective July 27

Why it's interesting: A stimulator that retrains a back muscle instead of masking pain, and patients keep improving in year two.

Mainstay Medical's ReActiv8 has a long-term assignment: repeatedly activate the lumbar multifidus to help restore function in selected patients with intractable mechanical chronic low back pain who are not candidates for spine surgery. This year brought more evidence that the approach can sustain its effects, along with another coverage decision. Two-year RESTORE results published ahead of NASS reported sustained improvements in the original treatment group, which at one year had shown a 3.6-point reduction in back pain against 0.6 for optimized medical management. After the one-year assessment, 83% of control patients elected to cross over, with subsequent improvement following treatment. The durability case runs longer still: the ReActiv8-B trial, the US IDE study behind the device's approval, has published five-year follow-up reporting durable effectiveness. Highmark also established positive coverage for eligible patients in July, joining Anthem and several state-affiliated Blue Cross Blue Shield plans. A therapy built around rehabilitation has to demonstrate what happens over time, and patients need a practical way to access it. Mainstay is advancing both arguments.

Vertera Health: Following the Patient Home

Status: Apps live on iOS and Android; access by care-team referral; no outcomes data

Why it's interesting: Someone is finally watching the six weeks between discharge and the follow-up visit.

The patient goes home with the results of the operation and a fresh set of questions. Vertera Health is building around those weeks between appointments, combining clinician-reviewed education and rehabilitation guidance with symptom tracking, adherence information and scheduled patient-reported outcomes. A care-team dashboard brings that information back into view. Founder Joel Proskewitz approaches the problem as both a spine rehabilitation professional and someone who has undergone spine surgery himself. The draw is concrete: patients get guidance when questions arise, and clinicians get more than a retrospective account of how recovery has gone. Whether that translates into better outcomes or less administrative work still needs evidence. But the company is addressing a large part of the surgical experience that takes place far from the operating room.

Companion Spine: DIAM's Long-Awaited American Chapter

Status: PMA approved December 15, 2025; US launch now underway

Why it's interesting: The newest posterior motion-preserving device FDA has approved, and it's for the patient nobody has a good answer for: back pain worse than leg pain, no stenosis, six months of failed conservative care.

After nearly three decades of international use, DIAM finally has an American opening. Companion Spine's posterior motion-preserving implant received FDA approval in December 2025 for the treatment of moderate to severe primary low back pain secondary to degenerative disc disease at a single lumbar level (L2-L5) in patients who remain symptomatic after at least six months of nonoperative care. The important distinction is the patient: back pain must exceed leg pain, giving DIAM a different job from posterior devices associated primarily with lumbar spinal stenosis. Developed by Dr. Jean Taylor and used internationally since 1997, the implant also brings a randomized trial reporting composite clinical success at 24 months in 67.4% of treated patients versus 11.9% with nonoperative care, a difference of more than 55 percentage points, with no device migrations or failures through an average of 11.5 years in the long-term cohort. A long-running overseas chapter has become a new U.S. option for patients who have exhausted conservative treatment.

Spine Venture Village

New this year, Spine Venture Village gave early-stage companies their own section of the floor and a daily innovation forum. Three stood out.

Spark Spine: The Patient Supplies the Power

Status: Preclinical; patent allowance January 2026; veterinary partnership February 2026

Why it's interesting: An implant with no battery that makes its own current every time the patient takes a step.

Spark Spine's proposed power source comes with the patient. Its Electro-Mechanical Polymer technology uses the piezoelectric effect to turn mechanical loading into local electrical signals intended to encourage bone formation, without a battery or external power unit. The attraction is the simplicity of the idea: forces the implant already experiences could help generate a biological stimulus. Demonstrating a meaningful, reproducible benefit in human spinal fusion is still to come for a three-person company still in preclinical work. A February partnership with Invictos Orthopedics adds a development route through veterinary applications, including canine orthopedic implants, while the human spine use will require its own evidence. In an industry accustomed to adding components to gain capabilities, Spark is exploring what the material itself can do. That puts the technology on the watch list even at this early stage.

Neuralytix: Giving the Nerve a Say

Status: 510(k) cleared June 26, 2025; full US commercial availability August 4, 2026

Why it's interesting: Tells the surgeon whether the nerve is actually responding better after decompression, without a monitoring tech in the room.

A nerve can look decompressed without telling the surgeon much about how it is functioning. Neuralytix's FDA-cleared iD3 system adds a quantitative readout through mechanomyography, measuring the mechanical muscle response to nerve stimulation during the procedure. Surface sensors capture that response, and the system is surgeon-directed without requiring its own dedicated technician or neurophysiologist. Full U.S. commercial availability was announced in August 2026, following an initial release the previous year. The measurement adds information to surgical judgment; it does not independently certify that decompression is adequate. Its relevance is nevertheless plain. Considerable technology spending goes toward showing surgeons the anatomy more clearly. Neuralytix is working on the complementary problem of assessing function while the surgeon is still in position to do something with the information.

Lenoss Medical: Bone in Place of Cement

Status: 500-plus procedures as of September 2026; prospective study enrolling

Why it's interesting: Vertebral augmentation that leaves bone behind instead of cement.

Lenoss Medical is bringing bone to a procedure long associated with cement. Its OsteoPearl product is a monolithic piece of osteoconductive cortical allograft processed into a pearl and link implant for vertebral augmentation, designed to provide structural support and a surface for the ongrowth and/or ingrowth of newly formed bone. The company reported passing 500 procedures in September, with more than half performed during the preceding year, giving the concept an adoption story as well as a material story, and a prospective single-center study began enrolling in March. Avoiding PMMA removes cement-specific leakage and curing concerns, and the comparative evidence has started to arrive: a Hospital for Special Surgery group published a retrospective series in NASSJ in September, covering 55 patients and 80 vertebrae, with mean pain scores falling from 8.08 to 3.23 at one to three months, vertebral height maintained or improved in most treated levels, and no venous extravasation at one year. The authors concluded that impaction grafting kyphoplasty appears to be a viable and safe alternative to cement kyphoplasty. Longer-term clinical results will determine how well the implant delivers on stabilization and healing. For now, the reason to stop and look is straightforward: Lenoss is changing what is left inside the fractured vertebral body, replacing permanent cement with a repair meant to become part of the patient's bone.