Global Spine Surgery Finding Double Digit Growth from Innovation, Economics, and Clinical Trends According to MedMarket Diligence Report

[August 21, 2015 — Mission Viejo  CA — MedMarket Diligence has published its 2015 global report on spine surgery. For details, see link.]

Decades of clinical research and medtech innovation have combined to offer solutions for every segment of the spine.  Economics and innovation have also made spine surgery one of the strongest growth of all medtech markets. MedMarket Diligence’s new global report on spine surgery device markets reveals opportunities for established, emerging, and potential medtech players.

Screen Shot 2015-08-24 at 2.03.50 PM

Screen Shot 2015-08-24 at 2.10.34 PMThe $9.17 billion global market for cervical fusion, thoracolumbar Implants, MIS spine fusion, interbody fusion, and orthobiologics has evolved dramatically over the last several decades as a result of significant advances in the understanding of spinal biomechanics, the proliferation of sophisticated spinal instrumentation devices, surgical advances in bone fusion techniques, refinement of anterior approaches to the spine and the emergence and development of microsurgical, minimally invasive methods and robotics. As a result of these advances it is now possible to stabilize every segment of the spine successfully, regardless of the offending pathology. The global market for spine surgery devices is detailed in the MedMarket Diligence report, “Global Market for Medical Device Technologies in Spine Surgery, 2014-2021.” See Report #M540.

“While this market may be dominated by the bigs — Medtronic, DePuy, Stryker, Zimmer-Biomet, et al. – there remains more than enough business in spine technology to attract a remarkably large number of mid-tier and smaller market participants,” says Patrick Driscoll of MedMarket Diligence. “And there are ample participants who do not accept the status quo, by aggressively innovating and introducing clinical and economic improvement in spine surgery.”

Spine fusion is the fastest growing technology in spine surgery and with growth in spine surgery being fastest in the Asia-Pacific and Central/Latin America, the growth of spine fusion in those areas is double-digit. The improvements in spine surgery and technology development have produced steady growth in volumes of surgeries, supported by reimbursement and clinical outcomes (and the increasingly active aging population). Spine surgery, with its exponential growth, has been the answer to an orthopaedic industry seeking to optimize earnings and add value for shareholders.

The MedMarket Diligence report, “Global Market for Medical Device Technologies in Spine Surgery, 2014-2021: Established and Emerging Products, Technologies and Markets in the Americas, Europe, Asia/Pacific and Rest of World,” (report #M540) is a detailed market and technology assessment and forecast of the products and technologies in the management of diseases and disorders of the spine. The report describes the diseases and disorders of the spine, characterizing the patient populations, their current clinical management, and trends in clinical management as new techniques and technologies are expected to be developed and emerge.

The report details the currently available products and technologies, and the manufacturers offering them. The report details the products and technologies under development and markets for each in spine surgery. The report provides a current and forecast assessment by region/country of procedures and manufacturer revenues for, specifically, Americas (United States, Rest of North America, Latin America), European Union (United Kingdom, Germany, France, Italy, Spain, Rest of Europe), Asia-Pacific (Japan, China, India, Rest of Asia/Pacific) and Rest of World. The forecast addresses the product- and country-specific impacts in the market of new technologies through the coming decade.

The report profiles 38 of the most notable current and emerging companies in this industry, providing data on their current products, current market position and products under development. The products and activities of numerous additional startup and emerging companies are also detailed in the report.

The report is described in detail at and may be ordered for immediate download from

Until August 28, 2015, Report #M540 is available for $500 off the list price. See Spine Surgery 2015 (M540) $500 off early release

What is spine surgery?

What is spine surgery? Specifically it’s:

  • Anterior Lumbar Interbody Fusion (ALIF)
  • Anterior Cervical Corpectomy
  • Anterior Cervical Discectomy and Fusion (ACDF)
  • Axial Lumbar Interbody Fusion (AXiaLIF)
  • Cervical Laminaplasty
  • Cervical Posterior Foraminotomy
  • Direct Lateral Interbody Fusion (DLIF)
  • Discectomy
  • Endoscopic Surgery
  • eXtreme Lateral Interbody Fusion (XLIF)
  • Foraminotomy and Foraminectomy
  • Intradiscal Electrothermal Therapy (IDET)
  • Kyphoplasty
  • Laminectomy
  • Laminoplasty
  • Laminotomy
  • LASER Surgery
  • Microdiscectomy (Minimally Invasive Technique)
  • Oblique Lumbar Interbody Fusion (PLIF)
  • Posterior Lumbar Interbody Fusion (PLIF)
  • Scoliosis Correction
  • Spinal Decompression
  • Spinal Fusion
  • Spinal Instrumentation
  • Spinal Osteotomy
  • Thoracoscopic Release
  • Transforamenal Lumbar Interbody Fusion (TLIF)

These represent the range of options to address diseases and trauma of the spine. To varying degrees, these procedures can require multiple instruments and/or implants and other products, which encompass the following:

  • Cervical interbody cages or spacers
  • Anterior cervical plates
  • Artificial cervical discs
  • Thoracolumbar plate systems
  • Interbody fusion devices
  • Thoracolumbar screw/rod systems
  • Minimally invasive implants
  • Artificial disc replacement implants
  • Interspinous implants
  • Demineralized bone matrix
  • Synthetic bone graft substitutes

See pending Report #M540.

Minimally invasive and open spine surgery procedures

Drawn from the MedMarket Diligence report, "Spine Surgery: Products, Technologies, Markets & Opportunities, Worldwide, 2008-2017."

A traditional, “open” surgical spine procedure typically involves the surgeon making a long incision, from either an anterior or posterior approach, dissecting and retracting layers of tissue as needed to provide both visualization and access to the affected area. For many kinds of operations—instrumented spinal fusion the most notable—open procedures remain the norm due to the demands of positioning, attaching, and configuring fixation devices. A higher rate of patient postoperative complications and a longer recuperative time period are thought to result from many open procedures, however. These findings have helped to drive the development of minimally invasive techniques—and instrumentation—for certain kinds of operations; in the near future, new minimally invasive technologies and techniques will likely change the approach to operations currently performed with traditional means.

Traditional "Open" Spine Surgery Procedures


Name of Procedure

Clinical Indications to Perform Procedure

Anterior Cervical Discectomy and Fusion (ACDF)

An intervertebral disc in the cervical spine bulges or herniates, exerting pressure on an adjacent nerve root. Procedure also used to remove tumors, osteophytes, or vertebral fracture fragments from the spinal canal.

Anterior Lumbar Interbody Fusion (ALIF)

Herniated intervertebral disc in the lumbar spine.

Cervical Corpectomy

Narrowing of the cervical spinal canal due to growth of bone spurs or the ligament behind the vertebral bodies, where an anterior cervical discectomy does not address the entire area of neural compression.

Cervical Foraminotomy

Space through which a spinal nerve root branches off from the cervical spinal canal is too narrow, exerting pressure on the root

Cervical Laminoplasty

Cervical spinal canal is painfully restrictive due to injury or disease.

Decompressive Lumbar Laminectomy

Abnormal bone spurs or rough intervertebral disc edges exert pressure on spinal nerve roots or the cauda equina, a nerve root bundle at the end of the spinal cord.

Interbody Fusion with Cages

Performed to remove a damaged intervertebral disc and fuse the vertebrae above and below the disc space.

Posterior Lumbar Interbody Fusion (PLIF)

Herniated intervertebral disc in the lumbar spine.

Spinal Fusion

Indicated in a variety of instances to unite two or more bony segments so that they grow together

Posterolateral Gutter Spine Fusion

Indicated in a variety of instances to unite two or more bony segments so that they grow together. This approach has a high level of success due to the rich vascular network present in the posterolateral spinal region.

Transforaminal Lumbar Interbody Fusion (TLIF)

Performed to remove a damaged intervertebral disc and fuse the vertebrae above and below the disc space.

Source: MedMarket Diligence, report #M510

Minimally Invasive Procedures

While patient concerns remain a significant driver in the development of minimally invasive techniques, technological advances in surgical instrumentation have transformed the theoretical to the practical. Advanced fluoroscopy, or x-ray imaging during surgery, has markedly improved the accuracy of incisions made and hardware placed. A variety of endoscopes, camera-tipped wands, can be inserted through small incisions and provide the surgeon with excellent visualization of the operative site. New surgical instruments were developed to work in tandem with endoscopes. The past several years have brought numerous innovations to spine surgery. These innovations include the development of imaging systems that interpret anatomical data for three-dimensional display; the use of lasers, ultrasonic frequencies, and high-pressure water jets remove tissue; and new monitoring devices that help the surgeon to optimally position instrumentation as well as to warn of potentially damaging neural contact during a procedure. Spine operations that lend themselves particularly well to minimally invasive approaches are intervertebral disc decompressions and discectomies. Progress has been made in adapting certain kinds of spinal fusion procedures to a minimally invasive approach, and certain forms of scoliosis of the thoracic spine have been treated with minimally invasive surgery.

MIS has many enthusiastic supporters. However, caution needs to be exercised, as even though a technique is less traumatic, if the rate of successful spinal fusion is much lower, then there is really not an advantage. Also, it has yet to be demonstrated that minimally invasive spine fusion systems actually cause better outcomes than some other surgical techniques used in the traditional open approach.

Increasingly, minimally invasive techniques are becoming the preferred method for autologous bone graft procedures. Traditional procedures involve the surgeon making a 3- to 5-inch incision to harvest bone from the patient’s hip area, and some studies have shown that complications arise in nearly a third (31%) of these patients. These studies also show that about 27% of patients still feel pain in the hip area up to two years after the surgery.

Minimally Invasive Spine Surgery Procedures


Name of Procedure

Goal of Procedure


Performed to treat fractured or collapsed vertebra


Performed to lessen or eliminate pain due to an osteoporotic compression fracture of the vertebra

Microscopic Discectomy

Performed to relieve pressure on spinal nerve roots caused by a ruptured intervertebral disc

Disc Decompression

Performed to remove extruded portions of an uncontained herniated disc or to remove nuclear disc material causing a bulge in a contained herniation. Decompressing the disc relieves pressure on adjacent nerve roots.

Endoscopic Scoliosis Surgery

Performed to correct abnormal lateral curvature; this is an alternate procedure for certain forms of scoliosis appearing in the thoracic spine

Source: MedMarket Diligence, report #M510