In a perfect world, a person who is a hundred years old would have the same quality of life as someone who is 40. But this does not exist right now. What does, however, are technologies that allow us to compound human strength, to work differently, to assist us as our bodies grow old. One of those are Exosuits or Exoskeletons; and in this conversation, we are joined by not one but two guests: Orthopaedic and Spine Surgeon Dr. Isador Lieberman and Healthcare Sales Executive Scott Gunnigle. Together, they talk about how this technology works, particularly how it operates through the brain and spine connection. Dr. Lieberman and Scott dive deep into the process that bridges the interface between the brain and spine and how we can get these technologies to be consumer products. For more great insights on the future of surgery and the technology that impacts our health and quality of life, tune in to this great conversation!

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Exosuits And Spinal Connections With Dr. Isador Lieberman and Scott Gunnigle

In this episode, we have Scott Gunnigle and Isador Lieberman. Dr. Lieberman is a spinal surgeon and pioneering some new technology that will be very interesting to talk about, and Scott Gunnigle is helping him do that. He’s been in medical devices for a very long time. We’re going to be talking about the connection between the brain and the spine. Dr. Lieberman, I’d like for you to introduce yourself a little bit. Scott, I want to know about your life and what brought you to work with Dr. Lieberman. We’re going to talk about some interesting topics, including the way that the brain communicates with the spine. Dr. Lieberman, please introduce yourself.

Thank you very much and for hosting the show. I’m excited about it. This has a lot of potential for disseminating information. I’m an orthopedic and spine surgeon. I’ve been at this for many years now. I started my career in Toronto, Canada. I was recruited to the Cleveland Clinic, where I worked there for thirteen years, then was subsequently recruited to the Texas Back Institute, where I’ve now been for many years. I principally do deformity, revision and tumor work, and high acuity spinal reconstruction.

Over the years, I’ve been involved in a number of different startups, initiatives, and development projects without elevating my stature beyond anything. I don’t deserve multiple patents. I started a couple of companies. We have another company now that we’re working on. I have done some work on the brain-spinal cord connection and exoskeleton work as well. There’s a lot of insight that I’m looking forward to sharing.

Scott, tell us a little bit about your history of medical devices.

Thank you. I’ve been in medical devices for many years, primarily in emerging technologies from brain stimulation to innovation in the spinal cord. That’s where Dr. Lieberman and I met so many years ago. I was compelled to assist and come alongside this company called Agada Medical with this exciting platform that we’re developing.

I’m excited to talk with you about the way that the brain communicates with the spinal cord. Specifically, exosuits, which, when I think about the future, I think about exosuits. It is the idea of our mecha from anime able to tear through a town, or you’re looking at Aliens and Sigourney Weaver has this giant exosuit that she’s fighting. All of us want to know how we get there. That’s something that I want to talk to you about because I love exosuits. It’s such a cool, interesting vision, but I want to know how to get there.

I’ve been involved in a number of initiatives, looking at exoskeletons, essentially empowering them, and coordinating the gate properly. There are multiple exoskeletons that are already in use now, particularly for industrial use, much like Sigourney Weaver in Aliens, where you’re moving heavy bits. Essentially, you’re taking a forklift, wrapping it around a human, and using that to move objects.

Clearly, what we were most interested in, and this was many years ago, was getting paralyzed patients up and walking. It did prove much more difficult than we anticipated for multiple reasons, but the two biggest reasons were bridging that interface between the brain, spinal cord, and essentially the extremities. How do you get the signal down there? That was the first thing, and then also the biomechanics behind it. We did not have the technology many years ago that we had nowadays, the battery power, the gearing that was required, and the polymers that were needed to make something lightweight that you could get on and off a paralyzed patient.

There were a lot of limitations early on, but we had to take that first step, and this is what it is. Over the years, there are a couple of exoskeletons that are out there now that are being used predominantly for medical rehab for stroke purposes. They’re just not practical yet to get people with spinal cord injuries walking. Having said that, the future is not exoskeletons. The future is going to be neural links with microprocessors that are going to be implanted in the brain and lower extremities or wherever it may be.

There are a lot of smart people. I’m not involved in that, but I’ve tried to keep up with what they’re doing. Microprocessors can send that electronic signal to keep the muscles and joints going through their full range of motion. The step beyond that that is even more exciting is neural regeneration, recreating and rebuilding that link.

I have been involved in some of these projects. One of these analogies is evolution. If you look at a salamander in the middle of the Serengeti in Africa, and he goes running across the Serengeti, when a hyena comes up and grabs that salamander by the tail, rips his tail off, the salamander takes off. The salamander regrows the tail. He survives. The salamander is way down on that evolutionary tree. Now you take a human. You take one of us. We go running across the Serengeti, and here comes that lion. The lion bites us in the Achilles tendon and grabs us, but we’re strong enough. We fight off and scare the lion away.

We’re sitting there with a ripped-up leg. We can’t regrow that leg because we’re way up on that evolutionary tree. What do we do? We heal with scarring. The trick here is to make the healing process more like the salamander, where you can regrow with native tissue as opposed to scarring. A number of my colleagues and friends, particularly at the Cleveland Clinic, have done that with heart muscle already.

There’s no doubt in my mind that we’re going to be doing that with spinal cord tissue. It’s just a matter of time to figure out the biology, physiology, and chemistry behind doing that. We’ve gone from exoskeletons to microprocessors linking to the ultimate answer, which is regrowth regeneration of the spinal cord itself.

There are a couple of things that I wanted to talk about. One, I still think there’s a place for exosuits. The idea of compounding human strength is something that would be valuable for society like what we’re talking about with the ability to pick up large loads. As a human being, I’m limited in the amount that my muscles can tolerate, but if I had the ability to use an exoskeleton to take those large loads, it would allow us to work differently. It would be very influential for quality of life because, as we get older, we can supplement the muscles that are failing. In a perfect world, we would have the same quality of life when we’re 100 years old as we are when we’re 40 years old, but that doesn’t exist.

What I’m looking at is somebody that is 100 years old and is still able to pick up the groceries without any difficulty because they’re wearing an exoskeleton that takes the majority of the load off of them. Two, the idea of regeneration is a very significant metabolic process. The amount of metabolic energy that is required to regrow the loss of a limb would be prohibitive based on our current understanding of biology if it was like a severing of a spinal cord, like a slice in the C2 level. That would be something that regenerative technology could easily fit. You would attach everything together, you put on whatever regenerative technology, and then everything gets done together such that the patient regains the ability to communicate from the brain to the muscles.

What I think is important is that I would love to have something like for orthopedics, where you cut off an arm, and rather than spend the metabolic energy to recreate that arm, you have the ability to plug something in that still gives that patient the same function without having to waste the metabolic requirements to go there. There’s a lot of still potential for exoskeletons in humanity to become better, but I still think that there are ways to go to understand how the brain communicates with the spinal cord. We understand it, and that’s something that I wanted to talk with you about, but give me a layman’s version of how the brain communicates with the spinal cord so that everybody can be on the same page.

Let’s take this down to the basic root of life itself. Why are we alive? Why are we even here? We are here to make sure that the next generation is here. We’re here to survive and propagate. The brain is designed to have us interact with the environment so that we can propagate, protect ourselves, move, and do all these other things. The brain itself can’t do that on its own. That’s why we have a trunk, a body, arms, and legs. The brain has to send that signal.

Every signal that the brain sends, there’s a reciprocal signal coming back. It knows where everything is in three-dimensional space. It sees your eyes see and a threat. The arm knows how to respond to that threat. The brain is the central processing unit of it, but it’s a huge highway of information going back and forth and up and down for the sole purpose of staying alive long enough so that we can propagate the next generation. That’s what it’s all about.

From a basic level, the brain sends information to our muscles that move our skeletal system. That wiring is present from this part of our body down. If you have an injury in your cervical spine, the information is also not able to go back up and down. The fact of the matter is that it’s not doing any of the processing of the movement and the understanding, like the feeling sensations. The processing happens up here, and the signals are sent down here. Is that correct?

Probably, 85% or 90% of it. There are some reflex loops and arcs in the spinal cord itself. You can effectively sever the spinal cord at the C2 levels you said, but you’ll still get a reflex arc. If you protect the axons, which are those fibers that go down to the muscle, through the cycle of the injury, and you can somehow map them out and link them, you can keep those muscles moving indefinitely. You don’t need the brain. That’s where the microprocessors are.

What I’m saying is that you have the ability now in animal models to move a muscle with electrical technology. There’s Neuralink by Elon Musk. I’m sure that you’ve seen the video where he’s able to either have a monkey play pong with an implanted circuit in mind, or the ability to understand sheep’s or pig’s electrical activity.

The fact of the matter is that in the animal model, you can connect something to the animal’s brain that allows you to move muscles. Is it as complex and elegant as the way that we were designed? It’s not, but there is some ability in technology in 2023 that allows us to move a muscle from the animal kingdom by using electrical technology. My question to you is now that we have that technology that’s available, how do we get that ability to be a consumer product? Maybe Scott might be somebody we can talk to about that.

Loads of animal data are going to be necessary for human trials that are occurring and will continue to occur, then frankly, public acceptance. Ultimately, when you were talking about exoskeletons, what came to my mind on the business side is, “Who pays for the exoskeleton for a 100-year-old patient?” That’s a real conversation that occurs at many different levels about who in society is worth that investment. There are a lot of sociological questions that are born out of technological evolution.

Taking the financing of it aside and focusing on the science of it, we have the ability to send signals from the brain through the spine to a muscle endpoint, and it allows some movement. Now, it’s only the animal models. How long of a jump is that from animal models to human models? When we’re looking at the future, is this a technology that will make that leap over the course of a decade? How long from a regulatory process or just a testing process do you go from an animal model to a human model?

There are exemptions for extreme cases that are given. I’m sure that these technologies are being utilized in extreme cases with exemptions. From a business standpoint, it’s a disease state opportunity for companies to make their investments. As quickly as they see an opportunity, investors will start putting money into that solution and we’ll move on from there. Much of it around the world as everybody on this show understands comes from Department of Defense development. I’m sure the DARPA and groups like that are intimately interested in this technology.

There are exoskeletons that they’re designing now for soldiers so that they can run further and lift heavier objects. I’m sure there’s a component of it that is built for offensive capabilities as well. Even nowadays, Boston Dynamics has animal model-like movement robots.

I only see them dance.

There are animals on there that they’re using in the military that carries a pack for however many yards or whatever, which, from an offensive capability standpoint, is huge. If you can carry an artillery gun with you across the Afghan desert, that’s going to allow you to go places where you were never able to go before. Regardless, I feel like we could go down the rabbit hole of all the potential applications. What I want to do is I want to talk about how we make this happen from the neurologic standpoint.

There are two things that we have to make happen to get the technology from the bench to the bedside effectively. The first is patient advocacy and resources. We need people to speak up and donate to provide those resources to do all this work. A close friend of mine, an orthopedic surgeon by the name of Rex Marco, unfortunately, sustained a devastating cervical spine injury and is paralyzed. He had to shut down his career. He just now rebuilt his life in combination with the Reeve Foundation and he’s got The Rex Marco Foundation and a number of us are helping him out trying to increase the exposure to this devastating problem because it is solvable. It’s not curable yet. The first thing is patient advocacy.

To get the technology from the bench to the bedside effectively we first need patient advocacy and resources. We need people to speak up.

The second thing that we need is to somehow streamline the burdensome regulatory process. It’s not just the FDA. It’s the whole environment that that we work in. It is the medical-legal liability, regulatory liability, and insurance components of it. Getting something done now is so much more difficult than it was many years ago.

Yet our technology is better, what we’ve done is we’ve created this massive amount of great technology, but it’s sitting on the shelf because we can’t use it because of the obstructions that we have. It’s like we’ve got these beautiful high-end racing cars sitting at the starting line of a racing track, but there’s a big barricade in front that’s not letting us go down the racing track to do what we need to do with this. We’ve got to streamline the regulatory, bureaucratic, medical, and legal processes to get this done. It’s across all aspects of medicine. It’s not just spinal cord injury and getting patients walking.

Spinal cord injury is the lowest hanging fruit of all of this because one of the things that you mentioned is a stroke. You lose the ability to do the processing up here. I feel like that’s a very difficult thing to regain, reconstructing that processing power, and the brain being such a sensitive tissue and such a difficult-to-understand tissue. When we get down to the spinal level, we understand how that works.

The electrochemical neuron gradient passes an electric signal to a muscle and the muscle contracts. That is something that a high schooler learns. When we’re talking about spinal injury, let’s say it’s just a slice. If you can bypass that juncture that is injured, I feel like that’s something that would be profound for people who have spinal cord injuries. The information going this way is I feel more difficult to understand the information going that way. Is that something that you agree with?

Sending the motor signal is a relatively straightforward physiologic process. The issue, even if it’s just a single slice, is that you’ve got hundreds of millions of those nerve fibers, those axons running up and down and you’d have to line them all up perfectly or you’d have to bridge them across that sliced gap perfectly to get the motor signal down. That is still a relatively straightforward thing.

The sensory arc was coming back up that involves the proprioception. Your brain knows where the muscle is or where the limb is in three-dimensional space, how it feels, the force against it, and that joint. There is so much more information going back up to the brain than going down. We may be able to get that motor signal down, but someone wants to scratch their head. They’re not going to have a nice slow movement here. It’s going to be up. That’s what we have to learn how to do. That’s going to be much more difficult, but I think it can be done. We’ve got enough computing power and smart people doing it. If you line up all those axons going down and going up, you should be able to recreate it.

The argument that I always hear about the potential for electronic technology to bridge this gap, the idea that, “If you don’t have the sensory perception, then you’re going to do this weird, clunky movement,” my pushback against that is I still think that there’s value in just the information going from the brain down and irrespective of the information going from the body up.

Let’s say you’re a construction worker like Sigourney Weaver’s front loader, where she had the ability to pick something up and put it there. That technology exists in other settings, like for example, surgical robotics. It’s all of us sending information to these little things that mimic our hand movements. There’s no haptic technology that’s coming backward. The ability to do complex movements irrespective of the sensory component of feeling proprioception are things that are still of value.

It’s all of the value but isolated. Is it functional? We have to differentiate value from function. The example I’ll give you is someone with a diabetic foot. Very often, that diabetic foot ends up in an amputation because the foot is not of value anymore. The patient’s much more functional with a prosthetic than with a dead infected foot. We have to differentiate value and function in that regard. There is some value to sending the motor signal down, but if it’s not functional, if every time you go to scratch your head and poke yourself in the eye, that doesn’t do you any good.

We have to differentiate value from function.

Some of the applications for what we call telerobotic technology, where you have a setup and you’re controlling something from a far distance, are not based on any need for the body to have proprioception. It would be a much more intimate and elegant way to do it if there was a way where we could use the signals that go from our brain to those instruments, like for example, the monkey that’s playing pong.

I’m going to challenge you a bit on that. All the robotic platforms out there, and I’ve designed two robotic platforms for spinal surgery, have integrated into their design haptic alignment and proprioceptive abilities. On top of that, particularly with some of the surgeon extensions or cobots, you’re using the surgeon as the surrogate for the proprioception. It’s in the system there. You’re getting all that. In laparoscopic or endoscopic surgery, you know where the tip of your scope is by virtue of where your elbow or wrist is and how your hand is positioned. You’re learning that. You’re acting as a surrogate for the proprioceptive feedback that the instrument itself doesn’t have.

I didn’t know that that was available. Let’s say for proprioception, like the ability of pressure. When I push into a pillow versus I push into a concrete wall, I can tell the difference between the amount of give that happens. How is that translated into telerobotics?

The robotic arms that I’ve been involved in their design have pressure sensors. If you deviate from the axis of where your tool is or if you bend a little bit, you will get alarms that tell you, “You’re bending a little bit too far on this,” and it won’t let you go beyond that spot. If you force it, you get a shoulder shift in one of the technologies, and the system shuts down immediately. It does not let you operate if you’ve lost your registration and you have a shoulder shift on there. They have the inherent electronics and the sensors to know when they’ve gone beyond their reach, their working volume, or if they’re pushing on a piece of bone versus pushing on a piece of soft tissue.

When I’m retracting and I push into a bone of the face, I have that tactile sense that, “I’m stopping.” I feel like if I can have a robot arm, I hear a pressure alarm go off. Is that how it happens?

There are multiple technologies that we’ve worked on and designed. We’ve got ultrasonic bone-cutting technology now. That is phenomenal.

I use the bone scalpel also.

We’ve got that on the end of a robotic arm. Depending on the pressure and the impedance, we can tell, “Are we cutting bone or soft tissue?” As soon as that impedance drops off, “Let’s go.” It stops right away.

It’s a kill switch.

It knows. It can sense a lot of this stuff. The beauty is that ultrasonic technology doesn’t cut soft tissue. It just puts a little pressure on it. If it’s too much pressure, it may char the soft tissue, but it doesn’t cut it like a rotating burn and oscillating saw wood. It’s much safer when you’re using it with a robotic arm that can sense the pressure and feel the resistance.

Just like a table saw, it has a finger sensor. I’ve never tried putting my finger into a table saw. How good is that technology? Have you ever gone too far and you’re like, “This thing was supposed to go off,” and it didn’t?

It’s good enough that we’re at the FDA with some of these projects now. It has not been used clinically yet.

That’s super interesting. Is there objective information out there in the literature or the science nowadays to tell the difference in pressure, impedance, or whatever between cutting through bone and cutting through soft tissue? Do the electrical engineers that are making this stuff know where like, let’s say a hypothetical number, “If I get to a value of 34, that means I’m in bone, but if a value of like 72, that means I’m in soft tissue. The cutoff is going to be this.” Do we have that information out there?

I’m not an electrical or mechanical engineer. I know enough to be dangerously stupid, but my understanding is they do know that. Hanging around with those guys is building these tools for us. If they don’t know, they’ve been able to figure it out very quickly.

Artificial intelligence, especially when we have all of this data when this stuff is being used, it’s going to be a very small leap to plug that data into an artificial intelligence algorithm and for them to give us objective information. One of the great things about being on the cusp of this technology now is that people like us who have surgical expertise, that’s something that would be the fail-safe for that.

We know that, “If I’m putting like this thing 3 centimeters in this direction, I’m going to hit the carotid artery.” You can know not only from a computer telling me that this is dangerous but just from an understanding of the system, knowing your expertise, and that this is also dangerous. There’s a lot of job security for people like us in medicine, which is nice. What I look forward to with something that you’re working on, and I’d love for you to comment on it, is artificial intelligence telling us the ability to make something strong enough versus something weak, giving us guidance in the creation of something.

It’s all of medicine nowadays. We’ve got diagnostic tools. We know clinical indications, and we have, on the other hand, the execution tools. We’ve got the robots, navigations, radiation oncology, chemotherapy, we’ve got cardiac and different interventions. What we don’t have is the bridge between the diagnostics, indications, and execution. That’s still the art of medicine and surgery. It’s still a heuristic process.

It’s trial and error. I’m in the operating room, and I think this size implant is the most appropriate. I put it in. It wobbles a little, “I need a little bigger implant.” I put it in, “That’s too tight. What I need is the one in the middle.” “We don’t have the one in the middle.” That’s the art of surgery what we need to do is get beyond the art of surgery, with the science of surgery, with predictive prescriptive analytics.

What we need to do is get beyond the art of surgery with the science of surgery with predictive prescriptive analytics. 

“I want to be able to see a patient that has this problem. This anthropometric data is 6’4, 250 pounds, is a high-level football player, and has this spine issue. I want to know what’s the right operation for that individual. Here is the technology to execute it.” That’s why we, with Scott and our team, and we’ve got a brilliant team of engineers, developed this AI platform that takes us from the art to the science by analyzing the biomechanics along the full length of the spine.

We create a digital twin. We create the patient’s actual spine morphologically, meaning the way it looks and functionally because we layer in the muscles, the ligaments, and how that spine moves. We know what it’s functioning like in the pathologic or native state, then we can simulate whatever surgery we anticipate needs to be done. We execute the most appropriate surgery. Prospectively over time, we collect and amass 100,000 or millions of patient data points so that we use the deep learning neural network, the machine learning, and the predictive analytics to know with a feedback loop that the next patient coming down the road with the same type of pathology to ensure a successful outcome.

That’s what we’re doing at Agada-Medical. We’ve got our software built. The platform is built with three components, the human modeling component, the biomechanical analysis component, and the integrated artificial intelligence at multiple aspects. Every point of the process has some form of AI work, recognizing the spine, recognizing the pathology, analyzing the muscle density, and the ligament attachments, building it, putting it together, simulating the biomechanics of various things, and measuring the bone density. There’s so much that’s layered into this. This is five years of work that I’m trying to describe in about 30 seconds. That ultimately gives us the most appropriate, least invasive, highly predictable, and successful surgical solution for that patient.

I can appreciate the trajectory of the technology that you’re talking about because it is based on stuff that I have an interest in. Anthropometric data to me is something that’s interesting. I don’t feel like we’ve tapped into that. A lot of which is because it has these ties to unpopular philosophies like comparing races and things like that. For example, in the face. There’s this ideal of beauty. It’s based on the ideal of beauty that compares mainly to Caucasian people. It doesn’t happen to a lot of African-American people in the population.

Regardless, what I want to talk about is the idea of taking all of this information that is available from many decades of research and using artificial intelligence to make sense of that data. That’s something that is a new industry that a lot of people want to know about. For example, they have this large set of data. Maybe I can have Scott comment on this. How do I get some artificial intelligence to analyze that data? Are you guys hiring an artificial intelligence engineer? Who are the people that we need to talk to about artificial intelligence?

We’ve been very blessed because a number of our engineering capabilities now are international with relationships all over the world. It’s an international data pool of software engineers that have a deep understanding of building these neural networks. As we inform these individual neural networks to inform the aggregate platform, we’re going to be able to build that bridge that Dr. Lieberman described to be able to inform better through experience on these various data points.

You have an engineer overseas that you tell them that this is the type of analysis that we want and then they build a neural network to give you that information?

It’s not an or. It’s an and because we tell them what we need them to build, and then they bring with them experiences from other builds and areas that they inform us of what they’re capable of building. We determine a business plan, then customers come to us. We’ve got customers asking us for some specific builds to power their platforms.

Another controversial thing that we should talk about is the idea of using artificial intelligence to tell us what to do. This is something that you’re using as a model to give prescriptive information. 1) Is that something that is regulated at all by the FDA? I know that FDA has medical device regulations. How is that regulated? 2) Does that give us any slippery slope where the surgeon overlies on this information, and then that can lead to poor outcomes?

It’s very concerning. I don’t think anybody, society, or the world knows yet. That’s why there’s so much controversy around ChatGPT and where we go with this technology that we’re building. Are we ready and capable? In our narrow segment of Agada Medical, what we’re building is a platform to provide empirical data to support and inform the ultimate decision. The clinician’s still going to have control over what comes to bear or the procedure that he or she decides to do, but it’s going to be basis thousands of very specific analogs to determine that pathway.

As Scott has mentioned, this is a decision support tool. That’s the regulatory bucket that the FDA uses. The decision is not made by the software. The decision is made by the surgeon on the basis of the different options that the software can provide the surgeon. One of the things that I learned in the work we’ve been doing the last years with Agada is the epically overwhelming amount of biomechanical information that we’re able to generate. There is no way that my two neurons can assimilate that to come up with the ideal surgical plan here. This is why we need AI, the computing power, the neural network that can learn beyond what we can assimilate just by looking at an X-ray effectively. That’s what we’ve built at Agada. We’ve got some brilliant engineers that have helped us with this throughout.

It’s primarily software or do you guys have any hardware component to this at all?

We’ve got the hardware, but the hardware is not our focus. The software is the magic. This whole show that we’ve done is clear. The future and the processing of information is the central theme here. We can design any implant we want. That is very simple to do. That is basic first-year university engineering stuff.

That’s like the fun stuff. That’s like hardware. That’s like this huge giant robot shows up and a human steps out of it. There’s very little science fiction that is based around a software program that goes haywire.

My second favorite movie is 2001: A Space Odyssey, software and how the computer went berserk.

I won’t disagree with you, but when you looked at how, when you saw that red light, that thing brought a chill down your spine. It’s the actual physical thing that you can touch that gets people going. I would also disagree because of the volume of science fiction media that’s out there. There are 100 robot movies. Granted, 2001 is a masterpiece and, clearly, quality versus quantity is an argument that we could go down. The quantity of information is like everybody loves seeing two Mexico addicts, especially if they’re controlled by human beings.

Let me ask you this. You go to the fireworks show. Do you listen to Tchaikovsky’s 1812 Overture or watch those things blow up in the sky?

Obviously, you watch the fireworks blow up in the sky.

If you saw the fireworks without any noise, would they be as exciting as if you had that music behind them? It’s the combination. It’s everything wrapped up together. The software is the drive of it. The visual effect and hardware part of it were there, but that’s easy to do. You can blow up anything in the sky.

I would go with another analog, Jarvis and Iron Man.

I disagree. Iron Man is what brings people to their seats. You see Robert Downey Jr. in his exosuit fighting villains. That’s what I’m interested in.

The exosuit does anything without Jarvis.

We’ve reached an hour. We can agree to disagree that you guys can think the software is great, but the audience knows the truth of this situation is that the hardware is what brings people to their seats. It was nice speaking with both of you. Join us next time at the show, where we have a more in-depth conversation about the future. It was nice speaking with Dr. Lieberman and Mr. Gunnigle. We’ll see you soon. Have a good one.

Thank you very much.

Important Link

• Scott Gunnigle and Isador Lieberman

About Isador Lieberman

I am a fellowship trained Orthopaedic and Spinal Surgeon who currently works at the Texas Back Institute. I am board certified by the American Board of Orthopaedic Surgery, and hold specialist certification from the Royal College of Physicians and Surgeons of Canada. I completed Medical school and residency at the University of Toronto. I completed Spine surgery and Trauma surgery fellowships at the Toronto Hospital in Canada and at Queen’s Medical Center in Nottingham, England. I held a full-time academic appointment at the University of Toronto and was on the Academic staff of the Toronto Hospital up to my 1997 recruitment to the Cleveland Clinic.

In 2002 I obtained my Masters degree in Business Administration from Cleveland State University. Shortly after I was appointed to the faculty of the Cleveland Clinic Lerner College of Medicine at the rank of Professor of Surgery. In 2007 I transitioned my clinical and administrative duties to Cleveland Clinic Florida where I was appointed Chairman of the Spine Department. In 2010 I was recruited to the Texas back Institute and to the Texas Health Presbyterian Hospital Plano to be the director of the scoliosis and spine tumor program as well as the chairman of the Department of Orthopaedics. In 2018 I was elected President of the medical staff at Texas Health Plano Hospital. Also in 2018 I was elected to be the President of Texas Back Institute PA.