Hello everyone, and thank you all for joining us during the Lytham Partners Spring 2025 Investor Conference. My name is Adam Lowensteiner, Vice President of Lytham Partners. This discussion comes from Aurora Spine, ticker symbol ASAPF on the OTCQX and ASG on the Toronto Venture Exchange. Joining us from the company today is its President and CEO, Trent Northcutt, and Matt Goldstone, Chief Commercial Officer. Today, Trent, Matt, and I will engage in a fireside chat-like Q&A session. One final item before we jump into the discussion, I want to remind everyone that Aurora Spine is available for one-on-one meetings. If you have not already signed up, please send me an email at lowensteiner@lythampartners.com. With that said, let's now turn to today's discussion with Aurora Spine. Welcome, Trent and Matt.
Thank you, Adam. Appreciate you having us here on the show.
First of all, thanks so much for taking the time and participating in this conversation. We appreciate it. Now let's expand upon a few topics here. To start the conversation, can you tell us something about yourself and your backgrounds? I'd say Trent first and then to Matt.
Thank you, Adam. It's a pleasure to be here. I am the Co-founder and President and CEO of Aurora Spine. My background has been in spine primarily, but as you know, Aurora Spine is focused on ortho-neuro and the interventional pain market. I was involved with companies such as AlphaTech, Lynx, and Spineart in my career. Early on, I was involved in sports medicine with a company called Arthrex. I've been in the industry for over 25 years.
Matt, how about yourself?
Yeah, I mean, my passion has always been about being part of cutting-edge technology and bringing that to market and commercialization. I've been very fortunate to be part of about five different technologies that were groundbreaking at their time and getting them truly commercialized and brought to market where, you know, patients that have the right indications would get access to those therapies. It has been an amazing opportunity to join Trent and the team here. They've done a phenomenal job of creating some of the best in-class technology for each class of product that they have. It's really now, you know, become my passion to help them bring that commercialization in each market.
How about tell us a little bit about Aurora Spine and briefly discuss maybe the proprietary product platforms the company has developed, especially in the recent years?
Thank you. Yeah, we've been really, really fortunate to be able to work on technologies that we think are true game-changing technologies. On my screen, I'm actually going to have a couple of videos that are going to play and show. For people who are just listening in, they're going to have to look it up. We focused on a series of inventions and patented technologies that were going to be minimally invasive approach to spine surgery. Our goal is to make the smallest incision, the less amount of blood loss, lower morbidity, lower risk of infection, and really with a focus and onus on outpatient surgery center procedures and products that work in those outpatient surgery centers. We focus from your upper neck all the way to your lower back out to your SI joint.
Those technologies are the ZIP, the DEXA, the Silo, Silo TFX, and newest attachment to our technology has been the Osteo Onyx and the new AERO system that just got FDA approved.
Since we have the pleasure of having Matt join us for the conversation, I'd like to focus on something the company has embarked on nearly a year and a half ago, and that is to build an internal sales team. That was an interesting pivot for the company. Can you maybe explain the reasoning behind that decision?
Absolutely. I mean, all physicians need great support, but the support of those distributors also need great support. That comes down to everything from product knowledge to access to trays and everything on the ground that you can't do from an office, right? What we wanted to do is build a hybrid sales team of regional directors that would be out there carrying the flag. Really, that's something that Trent has done such a phenomenal job of. When he selects somebody for employment at Aurora Spine, it's someone who really is passionate about what they do, sees and believes in the vision of what we're working to accomplish. That changes, I think, the impact that each person has. In each market, there's all sorts of distributors and direct reps out there.
If they're kind of humming and hawing about different products or different physicians, it usually doesn't go very far. If you have someone that's truly knowledgeable, has those relationships and is passionate about it, and those relationships could be with the physician or with the distributor, that really has an impact on what they pull out of the bag when they have that conversation and the knowledge that gets imparted to those physicians about the features and benefits and the true reason why this product would be the best for that patient. I think that's really become part of what we wanted to accomplish, to have regional support of every market. That could be a state or two or maybe even four or five states depending on population density and opportunity.
We really are filling out the country with support so that everybody and every patient ultimately gets the best access to therapy.
You're still using distributors. Is that correct?
That is correct. We have had a very large distribution network over the growth of this company. We have not gone away from those people at all. I mean, they have been the face of the organization in a lot of markets, and they have done really well by us, and we want to do really well by them. At no point are we cutting them out of the equation. The regional directors do take some accounts that are unrelated to distributors direct with the company, but then those same RSDs support those distributors that are out there already carrying the bag and have accounts. It is a, I call it a hybrid type of sales arrangement, but we do both. Those directors are helping those guys as well as taking business direct at the same time.
So you've built a little bit of an internal sales team now. What is that comprised of? How many people?
We have over 15 direct sales reps spread across the country. I mean, I always kind of think of it, you know, you're somewhere between 5%-10% of a population density. In some markets, like I was saying, it could be a few states. In other places, it could be more than a few states. It really comes down to their history as an individual work person, like how much regions have they covered in the past, what are their relationships, what is their ability to manage that size of a dirt. With that, we make the best choice in those given markets to support the business we have and the business we want to grow.
What's the sales cycle like? Maybe you could discuss what happens when a salesperson meets a potential customer or doctor. What typically transpires? How long does it take to get the doctor to start using an Aurora product? Once they do, how often do they use the products?
I guess you have a few different variables there. If you're meeting a spine surgeon that happens to already use a very similar cage plate option for ACDF, right? The next question is, are we in that facility already? Aurora has done a phenomenal job of getting access to a lot of the national contracts, but it could be a one-off university somewhere. Assuming we have access, it could be the next day, right? Like you could be like, "Oh, I got cases next week. Please have trays there. We'll get you in quickly." That's not always the case, though. Sometimes there is a time that you have to go through their VAC processes. That could be a variable there. If it's more on the interventional side, the question is, what are they currently offering for their patients?
What is the opportunity to access their staff and get everyone educated and trained and then integrate that therapy into their treatment algorithm? Sometimes it can be very quick, and other times it can be a little longer. I always say it's about three months by the time you talk to somebody and then you have the throughput to the other side of the equation to whatever variables are in between there.
Can you take some time and discuss who's your target market? Maybe explain to investors, is it ortho-neurosurgeons or interventionalists or both?
It is both. I would say it's anyone that's really focused on innovative technology. And in different circumstances, it's who's focused on the MIS version of innovative technology. But we do have OsteoOnyx, which is a phenomenal pedicle screw system that does offer MIS, open, and also full deformity. So we do have that full spectrum of products in our portfolio. It really comes down to analyzing the opportunity with that physician and seeing if they have an opportunity that fits with our portfolio.
Can you discuss how your products get into the hands of doctors and into patients? How quickly does a doctor adopt using your products and what needs to happen for that to occur? Maybe explain the training process and then getting them comfortable with your products.
We do offer national training labs for anyone that really wants to see and experience the products firsthand before they ultimately use it with their patients. At the same time, a lot of physicians, I would never be so bold to say a neurosurgeon would need that, right? If neurosurgeons are like, "I love the DEXA technology. I have patients with osteoporosis. I'm currently using a cage plate option, and I would love to switch that over to something that could help those patients with potential subsidence, fusion rates, and the opportunity to really have the best outcome," those physicians could turn on quicker. As we all know, I mean, you get a connection with somebody, you have a conversation. That conversation could have been a week later. By the time you have that conversation, then they put you at the facility.
That could be two weeks later by the time you then get through their process. As I was kind of inferring, there's often where by the time you meet somebody, sometime you get in the OR with somebody could be about two to three months just because of the normal cycle of communication and getting all of the ducks in a row to make sure everything is organized correctly, all the documents and legal is handled, and then you are set up in a way where everyone in the equation is properly trained, educated. That way, the whole process is smooth and you have the best outcomes possible.
Assuming a doctor starts using Aurora products and they use them regularly, how should investors view that win? Meaning, are there a set amount of procedures that are done each week, each day, each month? Maybe you can educate us regarding the ebbs and flows of the industry, so to speak.
Absolutely. I mean, all practices look very different. I would not want to be so bold to generalize any practices. Some of them are busier than others, and some have different structures than others. I mean, obviously on the neuro-ortho side of the customers, you have physicians that operate once a week or three times a week. There can be quite a range of variables there. From my standpoint, my ask or my hope, I guess, is if they're using a product that we were their primary choice for that given indication or product class, right? It'd be like, "Are we getting what percentage share of that physician's business in that product class?" We believe we have the best in class for each one of those.
If they see that, we would want to say, "Hey, they are a good partner to us as we are to them." It really comes down to what percentage of the market share in that practice do we see? And then what is their normal volume? We always want to work with them to make sure that if a patient's in their practice that could benefit from one of our products, that they are getting presented that option. Sometimes that could be educating the staff or the advanced practitioners in their practice so that they think about what options would be great for those patients as they come into the clinic. I mean, it is a very tough job being a nurse practitioner or a physician assistant. They get a lot thrown onto them.
If a patient's in that clinic saying, "I have this issue," what comes to mind first and what does get presented back to them? Obviously education is key there. We do offer programs across the advanced practitioner market as well as the physicians. That way they feel comfortable and confident talking about the features and benefits as well as all the rationale on why a given product would be the best one for a patient. Aurora has also done just a phenomenal job of investing into data. Data is so key in this market for insurance carriers as well as evidence-based medicine. Evidence-based medicine is the future. It is the only way we continue to survive and show that what we're doing out there is for a reason, right? We want to show good pain improvement scores.
We want to show good functional improvement scores. With that, do that over as long a period as we can in order to show that these patients are going to benefit from these therapies for a long time. That way the insurance carriers know that it is a good use of their resources to provide these therapies to their patients.
How many more salespeople are you looking to add this year? How many next year?
I want to go as fast and as big as possible. That makes sense, right? Obviously, you can't scale too fast because then you can't infrastructurally build it as quick as someone would want to. We're adding numerous people this year, and I'd like to add quite a bit more next year, but I want to do it in a thoughtful, organized manner so that way we can train them all appropriately, get them integrated into their markets appropriately. As there is a scaling tiers, I'd like to have the whole country covered this year.
Given markets are doing so well right now that I would like to add additional people in markets where we already have people, the institutional knowledge of the people in that market makes the scalability much more achievable because there is somebody in there that already knows the accounts, knows the politics in that market, knows what is kind of going on there. You can bring somebody in that can bolster that and add to that, but then is not kind of figuring it out from scratch. I think as we put those scalable tiers in there, it makes our ability to grow even faster.
Territories, how many do you cover and how many more are out there? Where are some that you like to add sooner than later?
Yeah. So we have hired two people in the recent month. That would be in the Mid-Atlantic and a Great Lakes region. I would say with that filled in, we have about two-thirds of the dirt of the U.S. covered right now. There's about another third that I want to finish before the end of this year and have regional directors covering the entire scope of the U.S. With that, then we would be bringing in account managers and territory managers in those markets in order to have even a more focused approach in individual cities or individual states rather than a multi-state, larger regional manner.
In your opinion, what are some key catalysts that investors should be focused on in the future? How should they view or how do you view success?
Success always starts at the sales numbers. I mean, I come from a sales background, so we always live and die by the success of those numbers and the growth that we're providing to our organizations. When you're looking at the individual factors that are going to contribute to that, having somebody in an individual market is going to, where especially there hasn't been direct support in the past, that's going to change the ability to impact that market. Putting someone new into a market, we have an algorithm in which we've tracked everyone's ramp-up periods from previous hires. We have a pretty good sense on what it's going to look like when somebody new joins the team, how much revenue they can contribute in what period of time. That's obviously a key factor to growth to the top line revenue.
Additionally, Aurora has been in for the last four to five years a very heavy R&D phase, which means we are developing products. It's not always a new product out in left field. It's a product that meshes with other products we have. It's like if you're doing an interbody, do you have the screws to go on the other side of it? If you're doing a cervical cage, do you have the plate that goes with it? Having these procedural solutions, being able to maximize an individual procedure where you don't want to have just the cage and then give away the plate, right? It's a one-to-one type of procedure that you want to be able to do all through one organization. Most of the physicians wouldn't want two distributors or reps in the same OR at the same time for such an individual procedure.
Being able to round that out gives us such a better impact with our physicians we do have. We have two major product launches coming out this year that are going to be very impactful to not only the opportunity from procedural solutions, but also to industry and growth for what our portfolio looks like.
Matt, you mentioned about new product launches. Can you go into a little bit more detail about that? Also, maybe explain how having more product and more IP that is able to be levered into your sales team and sales efforts?
Sure. There's, I would say, two major product launches we're having, and they are very different, right? The first one that I'm going to talk about is called AERO, which is our facet fusion product. This is a product that can be used in both the interventional space because of the simplicity of the tool design as well as the neuro ortho space, and they can use it in even a much more advanced manner due to their surgical skills and expertise. On the interventional side, you really want to think about the algorithm of patient selection and where this falls into that. There's the, you walk into a clinic and you've got some back or leg pain. What happens first, right? There's PT, there might be meds, and then there might be an injection, right? Those things come really early on.
The next step is how far in the degenerative cascade of spine are you at that point? If you're very early on, even if you get referred into a neuro or ortho office, they're most likely going to say, "You don't need surgery yet." Where does that patient land in getting relief and care? This fits into that opportunity for the right indications earlier on in the algorithm and really can help those patients. It expands the opportunity with current call points and really gives them a better tool in their bag to treat certain indications. That's really key on that side. That is, I think, a big opportunity that doesn't have a lot of product or competition out there today.
With that, it's really going to differentiate Aurora in those offices and give us a great opportunity to engage those clinics and really help a lot of patients. The second one that we're really looking at is an advancement or the next step in our DEXA line. The original step into DEXA once we developed the product or the material and had that IP in place was a cervical cage. The cervical cage is a small price point, and it's usually a kind of a very important part of a surgeon's practice, but it's a small part of a surgeon's practice as well. Their lumbar business is a key, much larger part of their surgical share, if you want to say, or procedural share that they offer. We're coming out with the lumbar version for DEXA. It's a standalone ALIF.
That in itself is going to be a huge opportunity to really take DEXA to the next level. We are very hopeful about our Alpha launch there. We have numerous physicians that have already expressed interest in it and want to engage on that product. Both of those are really large attainable markets that we are now getting best-in-class products for that are going to be an opportunity for Aurora to really see success in the back half of this year.
Anything else you want to add before we conclude the discussion?
I've done a lot of talking. Let me maybe pass it over to Trent for a minute and see what he has to add, and then I'm happy to contribute more.
I've enjoyed listening to Matt tell you the same thing that I've been telling investors for quite some time, but it's good to hear another voice share their excitement and how exciting it really is here at Aurora Spine. The things that we're working on have been nothing less than magnificent. We've been doing such great work internally with our engineering, with our regulatory and quality, getting those FDA approvals, getting to the company where it stabilizes itself to where it can be a profitable company. These are all the landmarks that Aurora has been promising shareholders and what Aurora has been executing on, not just in the field, but also here internally in the office, and of course, getting that message out to the street. It is very important to us. We think there's never been a better time for everyone to jump in with Aurora.
We ask you all to go along with us because we really think that there's a real benefit to sticking with us and showing how Aurora can make a difference in patient care, doctor care, and of course, in the sense of business and doing all the right things with cutting-edge technology that's making a big change. Matt, you want to add anything?
No, I appreciate that. With these products coming out, I really feel like to Trent's point about the most optimal time, we are exiting that R&D phase. Now it is about really building the commercial teams to deliver the impact in the market, which ultimately delivers top-line revenue, profitability, and all the things that we have all been talking about will be coming when this happens. Now those things have happened, and that is where we are focusing. It is really in the next six months, I intend to see a huge inflection in all aspects of growth because of the advancements in the team, the advancements in the portfolio, and getting to realize the success that we have built through building best-in-class products.
Great. Thank you, Trent and Matt, for your time today. Thank you for the discussion. Really appreciate it. To anyone out there who has not already signed up for a one-on-one, again, please send me an email at lowensteiner@lythampartners.com. If you'd like to learn more about Lytham Partners, you can visit our website at lythampartners.com or follow us on LinkedIn and stay connected about future events. We hope you all enjoy the rest of the conference and have a great day.