Devices, Global Markets and Opportunities in Spine Surgery

The MedMarket Diligence report #M520, "Worldwide Spine Surgery: Products, Technologies, Markets and Opportunities 2010-2020" reveals the worldwide current and emerging market and opportunities for spine surgery devices. The report also provides an overview of the disease states treated by spine surgery, an overview of the related technologies, and the geographical markets for spine surgery devices. Summaries are provided for several spine surgery-related clinical trials, and new and emerging products and technologies in development are described. Both market-leading companies and those with promising products in development are profiled, and contact details are listed for all companies named in this report.

The global market for spine surgery devices is projected to reach approximately $23.90 billion by 2020, and although exhibiting only a modest growth rate, is expected to eclipse growth many medtech markets during this period. The device segments considered in this report are:

  • Posterior Pedicle Screw Fusion Systems
  • Anterior Cervical Plate Systems
  • Anterior Thoracolumbar Plate Systems
  • Anterior Lumbar Interbody Fusion (ALIF) devices
  • Transforaminal Lumbar Interbody Fusion (TLIF) devices
  • Posterior Lumbar Interbody Fusion (PLIF) devices
  • Axial Lumbar Interbody Fusion (AxiaLIF) devices
  • Interspinous Process Spacer (ISP)
  • Cervical Artificial Discs
  • Lumbar Artificial Discs
  • Vertebroplasty
  • Balloon Kyphoplasty
  • Allografts
  • Demineralized Bone Matrix (DBM)
  • Bone Morphogenetic Proteins (BMPs)

This growth will be driven by a number of factors, including:

  • The aging population worldwide
  • Increasing incidence of obesity
  • A growing middle class in developing countries, with the ability to pay out of pocket for spine surgery
  • Improving worldwide economy
  • Technological device enhancements, leading to improved surgical results
  • Developments in minimally invasive spine surgery (MISS) devices driving a strong increase in MISS, with its numerous advantages
  • In the US, improvements in reimbursement as clinical trials demonstrate the efficacy of treatments using the devices
  • US healthcare reform leading to medical insurance coverage for more people, allowing those suffering from intractable back pain to receive surgical treatment

Based on the CAGR (2011-2020), the fastest growing segment is forecast to be a lumbar interbody fusion devices, and followed by Cervical Artificial Discs, Lumbar Artificial Discs with a CAGR of 10.9%. The overall lumbar disc market is driven by improved discs, an increased number of orthopedic surgeons trained and experienced in total disc replacement (TDR), and the growth of baby-boomer and younger patients who wish to remain active and seek treatment for degenerative disc disease (DDD).

The largest single segment in 2010 was Posterior Pedicle Screw Fusion Systems, followed by Demineralized Bone Matrix (DBM). In 2020, Posterior Pedicle Screw Fusion Systems is predicted to continue to be the largest single segment, followed by Cervical Artificial Discs.

In 2010 (Exhibit shown in Report #M520), the largest segment was Posterior Pedicle Screw Fusion Systems, which accounted for around 21.5% of the total market. This was followed by DBM, Allografts and Bone Morphogenetic Proteins (BMPs). The other product segments accounted for decreasing percentages of the entire global market. 

By 2020 this picture is predicted to change dramatically. Although the largest segment in terms of revenue will continue to be Posterior Pedicle Screw Fusion Systems, by the end of the forecast period the runner-up is expected to be Artificial Cervical Discs with almost half the market revenues. Cervical Discs will be followed by DBM, then Allografts. BMPs, which accounted for a significant share of the 2010 revenues, will fall in share substantially by 2020. 

Because their markets are much larger, the CAGRs for Cervical Artificial Discs and for Lumbar Artificial Discs are of greater interest to current and potential market particiopants. Together, these segments will see significant growth during the forecast period as the technology improves and as surgeons become trained in and accustomed to the procedures and devices.

There are several conditions which are often treated using spine surgery. Degenerative spinal conditions indicate gradual deterioration of tissues or structures over time.  The following table presents four commonly diagnosed degenerative diseases of the spine.

One of the largest in terms of sheer numbers is degenerative disc disease (DDD.)  The stresses and microtraumas associated with lumbar degenerative disk disease (LDDD) degrade the many structures that stabilize the spine, from the bony architecture to the intervertebral discs to the complex array of supporting muscles and ligaments. The back pain associated with DDD occurs with equal frequency among men and women, with peak incidence occurring around the age of 40. The condition accounts for more lost productivity than any other, with estimates running around 89 million lost work days per year. According to the US National Center for Health Statistics, 14.3% of new patient visits to primary care physicians are for lower back pain, and about 13 million physician visits are made in connection with back pain complaints.

Osteoporosis is another disease which often leads to some spine surgery procedure. Osteoporosis, a systemic skeletal disorder characterized by low bone mass and loss of bone tissue, leads to weak and fragile bones. People with osteoporosis are at increased risk of fractures, especially in the hip, spine, and wrist. Women make up 80% of all osteoporosis sufferers. A collapsed vertebra might manifest itself in severe back pain, loss of height, or in spinal deformities such as the stooped posture characteristic of kyphosis. Worldwide, according to the International Osteoporosis Foundation, the disease affects about 1 in 3 women and about 1 in 8 men. In Type I and Type II osteoporosis, women are affected more often than men. Both sexes exhibit equal incidence for Type III.

According to figures supplied by the National Osteoporosis Foundation, the estimated national direct expenditures for osteoporosis totaled $17 billion in 2001. By 2020, the cost of fall injuries is projected to reach $32.4 billion. The incidence of osteoporotic fractures—and the costs associated with them—increase with age. As life expectancy increases for much of the world’s population, these costs are expected to multiply exponentially.

US Census Bureau estimates show that, in 2010, about 14% of the US population, or about 39.7 million people, had reached the age of 65 or older. By 2030, this percentage is forecast to increase to about 20% of the population, or approximately 70.3 million. By 2050, the forecast predicts nearly 82 million people in the USA will be 65 or older.

In terms of share of global revenues (and as illustrated in Report #M520), Medtronic leads with [a commanding share] of the overall market. For the products considered in this report, Synthes (now owned by JNJ) and DePuy (JNJ) follow, with about 15% and 13% share, respectively. Stryker follows with 12%. Zimmer has about 9% of the 2010 market, while NuVasive is fast coming up and currently registers about 2% of the market. Cook also holds about 2% share of the markets included in this report. There are hundreds of other companies which together account for the remaining 4% of this market.





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