SuMO: a French digital predictive therapy for surgery of disabling lumbar pathologies

Developed by Cortexx Medical Intelligence, the SuMO solution for "Surgery Medical Outcome" integrates the personal data of each patient to ensure personalized follow-up and thus guarantee them better chances of long-term recovery. An initial predictive study to evaluate the solution began in June 2021 in collaboration with Malakoff Humanis Innovation Santé and the Ramsay and Elsan Groups. Focus on this new therapy that could improve the daily lives of many patients.

Low back pathologies, a major public health issue

Every year in France, more than 200,000 patients undergo surgery for disabling lumbar diseases. These surgeries concern lumbar canal compression, herniated discs or arthritis. These musculoskeletal disorders, osteoarthritis, back pain and also joint pathologies are ranked as the most disabling pathologies. With our sedentary lifestyles, they are on the increase and are one of the main reasons for consulting a general practitioner. Surgery is a solution but patient referral remains a problem. Indeed, according to a study1, 36% of patients who have undergone surgery have only limited benefit from it, and they remain in pain despite medication and their quality of life is altered. Surgery for lumbar pathologies is therefore a major public health issue, particularly in terms of quality of life for patients and medico-economic costs for the healthcare system. To anticipate the prognosis of a successful lumbar surgery, Cortexx has developed SuMO, a mobile solution for the patient, allowing him to be an actor of his health, and to evaluate in a precise and concrete way the patient engaged in a spine surgery. The artificial intelligence developed by Cortexx enables the prediction of long-term surgical results based on the personal characteristics of each patient (physiological, clinical, socio-professional) with an accuracy of 80% in order to guarantee the best chances of recovery.

SuMO - Instructions for use

SuMO is a medical device and a digital therapy that offers a complete evaluation of the patient involved in a spinal surgery. At the first consultation with a surgeon, the surgeon prescribes SuMO to the patient. Patients who are offered surgery download the application directly to their mobile phone. Gradually, during the course of the patient's health care, the patient must answer various guided and intuitive questionnaires, which collect 74 standardized key points on his medical and socio-professional data (his symptoms, personal history, psychological data, radiology images, environment, lifestyle, profession or even heredity). Depending on the answers processed, SuMO proposes 3 possible diagnoses of evolution:

• The green zone corresponds to patients with a good prognosis,
• The orange zone, which means that the prognosis requires individualized support,
• And finally, the red zone, which indicates patients with a poor prognosis for long-term evolution.

From the moment of the first consultation with the surgeon, before the operation, and up to 6 months after it, the patient receives personalized pre- and post-operative support, depending on the diagnosis of evolution in which he or she is. This allows patients whose prognosis is not optimal to prepare for surgery and to put themselves in a position to succeed postoperatively and, if necessary, to postpone surgery for high-risk patients, who are currently unidentifiable. Another advantage is that the surgeon, thanks to this information, will be able to optimize his or her management strategy by benefiting from an additional dedicated web platform. The web-practitioner solution offers him a vision of all his patients as well as the details of the criteria conditioning the diagnosis of the patient's evolution. In the post-surgery phase, the patient continues to fill in the model and thus improve the quality of care.

An initial study to be launched in June 2021 to evaluate the predictive tool in collaboration with Malakoff Humanis, Ramsay and Elsan

The clinical study conducted by Cortexx aims to analyze the use of the SuMO application in real time and verify its suitability for patients, surgeons and the care episode. It will also test the development of a personalized support program associated with the patient (green, orange or red patient). It is being conducted in two centres, the Geoffroy Saint Hilaire clinic in Paris (Ramsay) and the Jean Villar Polyclinic in Bordeaux (Elsan). The study should also be able to establish a personalised profile for each patient by establishing the modifiable and non-modifiable risk factors likely to influence the outcome of the surgery and to assess the medico-economic impact of using this method and the actual use of the recommendations provided. Results are expected in the 3rd quarter of 2021. A first retrospective study, published in Global Spine Journal in January 2021, confirmed the use of the SuMO algorithm to predict the clinical outcome of patients undergoing lumbar surgery.

New perspectives

Today SuMO is used in lumbar pathologies but its scope could be extended to orthopaedic pathologies. Its business model is very simple. It is based on the improvement of the medical service rendered and an overall reduction in costs related to hospitalization, as well as a lower consumption of drugs. ¹ Iderberg, H., Willers, C., Borgström, F., Hedlund, R., Hägg, O., Möller, H., ... & Tullberg, T. (2019).Predicting clinical outcome and length of sick leave after surgery for lumbar spinal stenosis in Sweden: a multi-register evaluation. European Spine Journal, 28(6), 1423-1432. Translated from SuMO : une thérapie digitale prédictive française de la chirurgie des pathologies lombaires invalidantes