Spinal Surgical Devices

Technologies and Global Markets

Product Code BCC00376
Publication Date August 2010
Publisher BCC Research
Product Type Report
Pages 282
ISBN Number not applicable
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Spinal Surgical Devices

Technologies and Global Markets

This Report Contains:

  • A focus on how nonfusion products, including dynamic stabilization (or motion-preservation) devices and total disc replacement (TDR) are becoming the treatments of choice, especially for younger, more-active patients
  • Analysis of the global spinal devices market, with data for 2008, estimates for 2009, and projections of compound annual growth rates (CAGRs) through 2014
  • A breakdown of end-user markets, including hospitals, research facilities, freestanding spinal care clinics, and outpatient centers
  • An overview of the history and current state of medical spinal fusion and nonfusion devices
  • Comprehensive patent analyses.

Introduction

Most people at one point or another have experienced back pain. The pain usually lasts for only a short duration and then resolves itself with little or no medical attention. For others, however, the pain is unresolving, chronic, and severe, and may involve neurological symptoms, including radiating pain or numbness down an arm or leg. For these relatively few sufferers, surgical intervention may be necessary.

As individuals age, the effects of wear and tear on the body accumulate. This is true of the spine. Degenerative changes, not a single traumatic blow, are the cause of most cases that result in spinal surgery. These degenerative changes can be evidenced radiographically in nearly all people, although only a small percentage of these changes will produce symptomatic conditions. The world's population is aging at an unprecedented rate, and as this continues, the rate of degenerative spinal conditions is also expected to escalate.

Surgical treatment of spinal conditions has been marred in controversy. Fusion, a treatment largely abandoned by other orthopedic disciplines because of the resulting limited range of motion, is still the treatment of choice for spinal surgical intervention. Innovation in both devices and techniques in spine surgery was largely stagnant in the 1980s and early 1990s. Technological advances in both surgical approaches and spinal implants, however, are once again flourishing, making spine the fastest-growing segment of the global orthopedics market.

This growth, although driven in part by escalating procedural volume, is also the result of excitement in emerging technologies in the non-fusion, or motion-preservation, segment. Initial euphoria has been dampened both by hardware durability issues and reimbursement challenges, but hope persists that the motion preservation market will drive future expansion in the spine industry through positive patient outcomes and economic efficiencies resulting from less-invasive surgeries. Biologics is another rapidly evolving segment of spinal orthopedics that is garnering great enthusiasm. Its growth prospects are high for making current techniques more effective and possibly altering the future landscape of spine surgery with the creation of technologies that actually regenerate spinal components.

Study Goals and Objectives

The technologies in this report-implantable spinal prosthetics and hardware-are pivotal to improving the quality of life for the tens of millions worldwide who suffer from back pain and neurological deficit resulting from common spinal conditions. Advances in these devices and their implantation techniques can improve the cost benefit of treatment of spinal conditions.

The objectives of this report are to present a comprehensive analysis of the market for these orthopedic products and forecast their commercial potential through 2015.

This report will:

  • Assess the prevalence of common spinal conditions and trends affecting their projected future incidence
  • Examine current procedure volumes and associated expenditures, as well as projected increases in demand by technique
  • Analyze the current market and forecast demand for implantable spinal surgical devices
  • Describe the regulatory framework and its effect on the Introduction of new devices into the spinal market both in the U.S. and abroad
  • Analyze trends in patent applications and issued patents for innovations that will be altering the spinal marketplace
  • Examine the drivers that will affect future utilization and rate of adoption of the implants, including demographic changes, reimbursement policy, clinical considerations, and R&D
  • Identify the product manufacturers that will drive innovation, their market share, and other industry players

Reasons for doing the study

The world's population is aging at an unprecedented rate. Aging populations face increased rates of arthritic and degenerative conditions. This trend is particularly pronounced upon examination of the prevalence of back pain and underlying spinal conditions.

The convergence of the following trends represents the motivation for this report:

  • The worldwide growth of the senior population will strain the capabilities of healthcare providers and the financial resources of healthcare payers.
  • Patients are increasingly less likely to accept ""aging pains"" as they wish to maintain a more active lifestyle even with advancing age.
  • Obesity, which is also increasing globally, will similarly contribute to higher rates of back pain and degenerative conditions.
  • Advances in biologics, materials, imaging techniques, and the biomechanical understanding of the spine will enable treatment of spinal conditions with a focus on preservation of natural range of motion.
  • To contain costs while simultaneously facing an increased procedural volume, focus is shifting toward improving instruments and techniques to reduce the invasiveness of surgery, thereby shortening hospital stays and hastening recovery.
  • Increased focus is being placed on the cost benefit of surgical procedures and implants.

Scope of Report

This report is a business analysis that has the primary purpose of examining trends in the market for spinal surgical devices, specifically arthroplasty products and implanted instrumentation hardware. The report includes sections on the following topics:

  • Current prevalence of common spinal problems, trend analysis, and factors influencing future incidence
  • Market analysis by surgical procedure, including annual incidence, trend analysis, and factors influencing future predicted surgical volume
  • Global demand by device and projected future trends by device category
  • Risk factors and other drivers that will affect the future incidence of spine surgery and related utilization of spinal surgical devices
  • U.S. and international regulation of spinal devices
  • Patent analysis
  • Market share and information on key device manufacturers

Intended Audience

This report is intended for anyone interested in better understanding the role of the rapidly growing spine segment of the broader orthopedic and biologic markets. Executives, consultants, trade associations, and marketing professionals in the medical device industry, health insurance industry, orthopedics and biologics fields, and ambulatory surgery and broader hospital sector would benefit from this report. Additionally, stock analysts, VC funders, and investors focused on the spine segment or those who are interested in expanding markets for orthopedic implants, minimally invasive surgical instrumentation and techniques, and biologic applications would also benefit. Manufacturers and distributors of the technology discussed in this report are also an Intended Audience.

Information Sources

BCC Research reviewed reports, white papers, technical product specifications, and studies produced by industry, trade associations, corporations, professional organizations, payers, governments, healthcare providers, and peer-reviewed journal articles. Various original data sources were analyzed. Data were compiled from the U.S. Census Bureau, U.S. Patent and Trademark Office, the Department of Health and Human Services, and sub-agencies, including the FDA medical device data registry, CMS, AHRQ, CDC, and the National Center for Health Statistics. International data sources included WHO, OECD, Eurostat, Spine Tango, and databases from various countries' federal statistics offices. Interviews were conducted with industry sources, consultants, manufacturers, surgeons, and researchers.

Analyst Credentials

Lori Solomon is a freelance medical reporter. She co-authored the BCC market research report Technologies for Long-term Care and Home Healthcare@@# Global Markets (HLC079A).

Contents

  • Chapter One: Introduction
    • Introduction
    • Study Goals and Objectives
    • Reasons for Doing the Study
    • Scope of Report
    • Intended Audience
    • Information Sources
    • Analyst Credentials
    • Related Bcc Reports
    • Bcc Online Services
    • Disclaimer
  • Chapter Two: Summary
    • Summary
    • Summary Table Global forecast Spinal Surgical
    • Devices by Category, through 2015 ($ Millions)
    • Summary Figure Global forecast Spinal Surgical
    • Devices by Category, 2008-2015 ($ Millions)
  • Chapter Three: Overview
    • Spinal Anatomy
    • Spinal Column
    • Intervertebral Discs
    • Boney Structures
    • Neural Elements
    • Supporting Structures
    • Table 1 Functional Role of the Spinal Column
    • Components
    • Back Pain
    • History of Back Pain and Early Treatment
    • Back Pain Today
    • Table 2 Global Sampling of Frequency of Back Pain, 2002-2009
    • Cost of Back Pain
    • Table 3 U.S. Medical Encounters by Setting for the Direct Treatment of Back Problems, 2007 (Thousands)
    • Table 4 Hospital Discharges by Back-Related Diagnosis in Select European Countries, through 2008
    • Table 5 U.S. Direct Medical Expenses for Back Problems, 2007 ($ Millions)
    • Table 6 U.S. Distribution of Direct Back-Related Medical Expenses by Payer, 2007 (%)
    • Table 7 U.S. Patients With Back Problems, through 2007 (Millions)
    • Table 8 U.S. Medical Expenditures for the Direct Treatment of Back Problems, through 2007 ($ Billions)
    • Disability From Back Pain
    • Identifying the Cause of Back Pain
    • Table 9 Distribution of Diagnosable Back Conditions (%)
    • Causes of Diagnosed Back Pain
    • Risk Factors for Back Pain
    • Risk Factors for Diagnosable Back Disorders
    • Genetics
    • Aging
    • Table 10 Projected Aging of the Global Population Age 65 and Older, through 2020 (Million)
    • Smoking
    • Obesity
    • Table 11 Global Prevalence of Obesity, 1995-2005 (%)
    • Osteoporosis
    • Table 12 Projected Aging of Global Female Population Age 60-99, through 2020 (Million)
    • Common Spinal Conditions
    • Table 13 Diagnosis-Related Icd 9 Codes for Spinal
    • Conditions
    • Table 14 U.S. Inpatients Diagnosed by Coded Back Conditions, 2008
    • Abnormal Spinal Curvatures
    • Table 15 U.S. Trend for Inpatient Diagnosis of All Abnormal Curvatures of the Spine, through 2015
    • Table 16 U.S. Inpatients With Abnormal Curvatures of the Spine, 2008
    • Kyphosis
    • Postural Kyphosis
    • Structural Kyphosis
    • Gibbus Deformity
    • Scheuermann's Disease
    • Congenital Kyphosis
    • Secondary Kyphosis
    • Treatment
    • Table 17 Global Frequency of Kyphosis
    • Table 18 U.S. Age Distribution for Inpatients Diagnosed With Kyphosis, 2008 (%)
    • Table 19 U.S. Trend of Hospital Inpatient Diagnosis of Kyphosis, through 2015
    • Lordosis
    • Treatment
    • Table 20 U.S. Trend for Hospital Inpatient Diagnosis of Lordosis, through 2015
    • Scoliosis
    • Congenital Scoliosis
    • Failure of Segmentation
    • Failure of formation
    • Treatment
    • Neuromuscular Scoliosis
    • Treatment
    • Degenerative Scoliosis
    • Treatment
    • Idiopathic Scoliosis
    • Treatment
    • Table 21 Global Frequency of Scoliosis
    • Table 22 U.S. Age Distribution for Inpatients Diagnosed With Scoliosis, 2008 (%)
    • Table 23 U.S. Trend for Hospital Inpatient Diagnosis of Scoliosis, through 2015
    • Arthritic Spinal Conditions
    • Table 24 U.S. Trend for Hospital Inpatients With Diagnoses of All Arthritis-Related Spinal
    • Conditions, through 2015
    • Table 25 U.S. Inpatients With Arthritis-Related Spinal Conditions, by Condition, 2008
    • Ankylosing Spondylitis
    • Table 26 Global Frequency of Ankylosing Spondylitis (%)
    • Rheumatoid Arthritis
    • Table 27 Global Frequency of Rheumatoid Arthritis (%)
    • Table 28 Age Distribution for Inpatients Diagnosed With Ankylosing Spondylitis/Rheumatoid Arthritis (%)
    • Table 29 U.S. Trend for Hospital Inpatient Diagnoses of Ankylosing Spondylitis/Rheumatoid Arthritis, through 2015
    • Osteoarthritis/Spondylosis
    • Table 30 U.S. Distribution of Spondylosis by Spinal Region, 2008
    • Treatment
    • Table 31 U.S. Age Distribution for Inpatients Diagnosed With Spondylosis, 2008 (%)
    • Table 32 U.S. Trend for Hospital Inpatient Diagnosis of Spondylosis, through 2015
    • Degenerative Disc Diseases
    • Table 33 U.S. Trend for Hospital Inpatient Diagnoses
    • With All Degenerative Disc Diseases, through 2015 (Thousands)
    • Table 34 U.S. Inpatients Diagnosed With Degenerative Disc Disorders, 2008
    • Disc Herniation
    • Table 35 U.S. Distribution of Disc Herniation by Spinal Region, 2008 (%)
    • Table 36 U.S. Age Distribution for Inpatients Diagnosed With Disc Herniation, 2008 (%)
    • Table 37 U.S. Trend for Inpatient Diagnosis of Disc Herniation, through 2015 (%)
    • Treatment
    • Disc Degeneration
    • Table 38 U.S. Distribution of Degenerative Diagnosis by Region of the Spine, 2008 (%)
    • Table 39 U.S. Age Distribution for Inpatients Diagnosed With Degeneration of the Intervertebral Discs, 2008 (%)
    • Table 40 U.S. Trend for Inpatient Diagnosis of Degeneration of the Intervertebral Disc, through 2015 (%)
    • Spinal Stenosis
    • Table 41 U.S. Distribution of Stenosis by Spinal Region, 2008 (%)
    • Table 42 U.S. Age Distribution for Inpatients Diagnosed With Spinal Stenosis, 2008 (%)
    • Table 43 U.S. Trend Inpatient Diagnosis of Spinal Stenosis, through 2015
    • Treatment
    • Spondylolisthesis
    • Table 44 U.S. Age Distribution for Inpatients Diagnosed With Spondylolisthesis, 2008 (%)
    • Treatment
    • Table 45 U.S. Trend in Inpatient Diagnosis of Spondylolisthesis, through 2015
    • Spinal Tumors
    • Treatment
    • Injury
    • Vertebral Fractures
    • Table 46 U.S. Inpatients With Vertebral Fracture Diagnosis, 2008
    • Table 47 U.S. and E.U. Vertebral Fractures by Type
    • Table 48 U.S. Age Distribution for Inpatients Diagnosed With Vertebral Fractures Without Spinal Cord Injury, 2008 (%)
    • Table 49 U.S. Trend for Inpatient Diagnosis of Vertebral Fracture, through 2015 (%)
    • Fracture Classification
    • Major/Minor
    • Stable/Unstable
    • Denis 3-Column Model
    • Break Type
    • Traumatic Spinal Injury
    • Trends in Frequency of Spinal Conditions
    • Table 50 U.S. forecast for Inpatient Diagnosis by Coded Spinal Condition, through 2015 (Thousands)
  • Chapter Four: Market Analysis
    • Market by Application Or Procedure
    • Table 51 U.S. Spinal Procedures by Volume, through 2015 (Thousands)
    • Table 52 U.S. Costs for All Spinal Procedures, through 2015 ($ Millions)
    • Table 53 U.S. Distribution of Spinal Surgery Procedures by Category, 2008 (%)
    • Table 54 U.S. Highest Mean Costs by Spinal Surgical Procedure, 2008 ($)
    • Table 55 Procedural Icd 9 Codes
    • Decompression
    • Table 56 U.S. forecast Volume for Decompression Procedures, through 2015
    • Table 57 U.S. forecast Total Costs for All Decompression Procedures, through 2015 ($ Millions)
    • Discectomy
    • Table 58 U.S. Age Distribution in Patients Admitted for Discectomies, 2008 (%)
    • Table 59 U.S. Reduction in Mean Length of Stay for Discectomies As Primary Procedure, 2000 and 2008 (Days)
    • Table 60 U.S. forecast Volume of Discectomies, through 2015
    • Table 61 U.S. forecast Mean Costs Per Discectomies, through 2015 ($)
    • Table 62 U.S. Comparison of Total Costs for All Discectomies, 2007-2015 ($ Millions)
    • Microdiscectomies
    • Percutaneous Discectomy Procedures
    • Percutaneous Automated Discectomy
    • Percutaneous Laser Discectomy
    • Percutaneous Arthroscopic Discectomy
    • Nucleoplasty
    • Chemonucleolysis
    • foraminotomy
    • Laminotomy/Laminectomy
    • Table 63 U.S. Age Distribution in Patients Admitted for Laminotomy/foraminotomy, 2008 (%)
    • Table 64 U.S. forecast Volume of Laminotomies/foraminotomies, through 2015
    • Table 65 U.S. forecast Mean Costs of Laminotomies/foraminotomies, through 2015 ($)
    • Table 66 U.S. Comparison of Total Costs for All Laminotomies/foraminotomies, 2007-2015 ($ Millions)
    • Post-Laminectomy Syndrome
    • Table 67 U.S. Age Distribution of Patients Admitted for Post-Laminectomy Syndrome, 2008 (%)
    • Table 68 U.S. Post-Laminectomy Syndrome Admissions by Spinal Region, 2008 (%)
    • Corpectomy
    • Table 69 U.S. Age Distribution in Patients Admitted for Corpectomies, 2008 (%)
    • Table 70 U.S. forecast Volume of Corpectomies, through 2015
    • Table 71 U.S. forecast of Mean Costs for Corpectomies, through 2015 ($ Thousands)
    • Table 72 U.S. Comparison of Total Costs for All Corpectomies, 2007-2015 ($ Millions)
    • Minimally Invasive Procedures
    • Interventional Spine Care
    • Fracture Repair
    • Table 73 U.S. Age Distribution for Fraction Repair Admissions, 2008 (%)
    • Table 74 U.S. forecast for Total Volume of Fracture Repair, through 2015
    • Table 75 U.S. forecast for Total Costs for All Fracture Repair, through 2015 ($ Millions)
    • Vertebroplasty
    • Table 76 U.S. forecast Volume of Admissions for Vertebroplasty, through 2015
    • Table 77 U.S. forecast of Mean Costs for Vertebroplasty, through 2015 ($)
    • Table 78 U.S. Comparison of Total Costs for All Vertebroplasty, 2007-2015 ($ Millions)
    • Kyphoplasty
    • Table 79 U.S. forecast Volume of Admissions for Kyphoplasty, through 2015
    • Table 80 U.S. forecast of Mean Costs for Kyphoplasty, through 2015 ($)
    • Table 81 U.S. Comparison of Total Costs for All Kyphoplasty, 2007-2015 ($ Millions)
    • Fusion
    • Table 82 U.S. forecast Volume of All Fusions, through 2015
    • Table 83 U.S. forecast of Total Costs for All Fusion Admissions, through 2015 ($ Millions)
    • Table 84 U.S. Total forecast Volume of Fusions by Level, through 2015
    • Table 85 U.S. forecast of Mean Fusion Costs by Level, through 2015 ($)
    • Table 86 U.S. forecast of Total Costs for All Fusions by Level, through 2015 ($ Millions)
    • Figure 1 Comparison of Total Costs for All Fusion, 2007-2015 ($ Millions)
    • Table 87 U.S. Age Distribution for All Fusions, 2000 and 2008 (%)
    • Table 88 U.S. Trends for Complex Fusions by Age, through 2008
    • Table 89 U.S. Comparison of Age Distribution for Complex Fusion, 2006 and 2008
    • Table 90 U.S. forecast of Fusion Volume by Complexity Level, through 2015
    • Table 91 U.S. Distribution of All Fusions by Spinal Level, 2008
    • Table 92 U.S. Fusions by Approach, 2008
    • Instrumented Fusion
    • Pedicle Screw Fixation
    • Anterior Cervical Plate System
    • Interior Fusion Devices
    • Vertebral Body Replacement
    • Lumbar Interbody Fusion Devices
    • Table 93 U.S. Total Volume for Ibfd and Fusion, through 2008
    • Table 94 U.S. Projected Volume for Ibfd, through 2015
    • Table 95 U.S. Projected Mean Cost of Ibfd, through 2015 ($)
    • Table 96 U.S. Projected Total Cost for All Ibfd, through 2015 ($ Millions)
    • Figure 2 U.S. Comparison Total Costs for All Ibfd, 2007-2015 ($ Millions)
    • Table 97 U.S. Age Distribution for Ibfd, 2008 (%)
    • Posterior Lumbar Interbody Fusion
    • Transforaminal Lumbar Interbody
    • Fusion
    • Anterior Lumbar Interbody Fusion
    • Extreme Lateral Interbody Fusion and Direct Lateral Interbody Fusion
    • Bone Grafts
    • Autograft
    • Table 98 Annual Frequency of Use of Biologics
    • Worldwide
    • Osteoconductive Substitutes
    • Allograft
    • Bone Graft Substitute
    • Osteoinductive Substitutes
    • Demineralized Bone Matrix
    • Platelet Helpers
    • Growth Factors
    • Future of Biologics
    • Complications of Spinal Fusion
    • Revision Surgery
    • Table 99 U.S. Distribution of Revision Surgeries by Level, 2008
    • Table 100 U.S. Projected Volume of Revision Surgeries by Level, through 2015
    • Table 101 U.S. Projected Mean Cost of Revision Surgery by Level, through 2015 ($)
    • Table 102 U.S. Total Costs for All Revision Surgeries by Level, through 2015 ($ Millions)
    • Figure 3 U.S. Comparison of Total Costs for All Revision Surgeries, 2007-2015 ($ Millions)
    • Non-Fusion/Motion Preserving Surgeries
    • Posterior Motion Preservation
    • Table 103 U.S. Total Volume of Posterior Motion Preservation, 2008
    • Interspinous Process Spacers
    • Table 104 U.S. forecast of Total Volume Interspinous Process Spacers, through 2015
    • Table 105 U.S. forecast of Mean Cost Interspinous Process Spacers, through 2015 ($)
    • Table 106 U.S. forecast of Total Cost Interspinous Process Spacers, through 2015 ($ Thousands)
    • Posterior Dynamic Stabilization
    • Table 107 U.S. Total Volume of Posterior Dynamic Stabilization, through 2008
    • Facet Replacement
    • Anterior Motion Preservation
    • Arthroplasty
    • Total Disc Replacement
    • Table 108 U.S. Total Disc Replacement Volume by Spinal Level 2007 and 2008
    • Disc Nucleus Replacement
    • Table 109 U.S. Volume Nucleus Replacement, 2008
    • Market by Device
    • Table 110 Global forecast for Spinal Surgical Devices, through 2015 ($ Millions)
    • Table 111 Global forecast for Fusion Devices, through 2015 ($ Millions)
    • Table 112 Global forecast for Fracture Repair, through 2015 ($ Millions)
    • Table 113 Global forecast for Non-Fusion Devices, through 2015 ($ Millions)
    • Table 114 Global forecast for Arthroplasty, through 2015 ($ Millions)
    • Trends Affecting Utilization of Spinal Surgical
    • Devices
    • Technological Changes
    • Economic Considerations
    • Outpatient Surgical Centers
    • Regulation
    • Industry Structure
    • Regulation
    • U.S. Regulation
    • Device Regulation
    • Food and Drug Administration
    • 510(K) Clearance
    • Table 115 Frequently Fda-Cleared Spinal Implants, by Device, 2000-2009
    • Table 116 510(K) Filings by the Largest Spine Companies, 2000-2009
    • Premarket Approval
    • Investigational Device Exemption
    • Humanitarian Device Exemption
    • European Regulation
    • Ce Mark
    • European Commission
    • International Standards Organization
    • Tissue Regulation
    • American Association of Tissue Banks
    • Accredited Processers of Allograft
    • Clinical Trials
    • Table 117 Active Clinical Trials for Spinal Surgery Devices
    • Patent Evaluation
    • Table 118 Spine-Related Patent Sub-Classifications
    • Table 119 Spinal Patents Issued and Applied by Year, 2001-june 1, 2010
    • Table 120 Patents Issued and Applied by Subclass 2001-June 1, 2010
    • Players
    • Table 121 Major Players by Revenue, 2009 ($ Millions)
    • Table 122 Spinal Surgical Device Company Bankruptcies, 2009
  • Chapter Five: Industry Players
    • Fusion
    • Posterior Pedicle Screw Fusion Systems
    • Aesculap
    • Alphatec Spine, Inc
    • Amedica Corp
    • Biomet Spine
    • Cardo Medical, Inc
    • Choice Spine, Lp
    • Co-Ligne Ag
    • Depuy Spine, Inc
    • Eden Spine, Llc
    • Exactech, Inc
    • Globus Medical, Inc
    • Innovasis, Inc
    • Integra Spine
    • Interventional Spine, Inc
    • Lanx, Inc
    • Ldr Médical
    • Life Spine
    • Medicrea International
    • Medtronic, Inc
    • Neuro France Implants
    • Nuvasive, Inc
    • Ortho Development Corp
    • Orthofix International N.V
    • Orthofix ... (Continued)
    • Pioneer Surgical Technology
    • Scient'x Group S.A.S
    • Seaspine, Inc
    • Signus Medizintechnik Gmbh
    • Sintea Biotech, Spa
    • Specialty Spine Products, Llc
    • Spine Network (Eurosurgical)
    • Spinevision Sa
    • Stryker Spine
    • Stryker Spine (Continued)
    • Synthes Inc
    • Ulrich Gmbh & Co. Kg
    • Vertiflex, Inc
    • X-Spine Systems, Inc
    • Zimmer Spine, Inc
    • Cable Systems
    • Biomet Spine
    • Depuy Spine, Inc
    • Pioneer Surgical Technology
    • Anterior Cervical Plate Systems
    • Aesculap
    • Alphatec Spine, Inc
    • Amedica Corp
    • Apollo Spine
    • Biomet Spine
    • Cardo Medical Inc
    • Choice Spine, Lp
    • Depuy Spine, Inc
    • Exactech, Inc
    • Globus Medical, Inc
    • Innovasis, Inc
    • Integra Spine
    • Lanx, Inc
    • Life Spine
    • Nuvasive, Inc
    • Ortho Development Corp
    • Orthofix International N.V
    • Pioneer Surgical Technology
    • Scient'x Group S.A.S
    • Seaspine, Inc
    • Signus Medizintechnik Gmbh
    • Sintea Biotech, Spa
    • Spinevision Sa
    • Stryker Spine
    • Synthes Inc
    • Ulrich Gmbh & Co. Kg
    • X-Spine Systems, Inc
    • Zimmer Spine, Inc
    • Other Anterior Fixation Devices
    • Alphatec Spine, Inc
    • Depuy Spine, Inc
    • Eminent Spine
    • Globus Medical, Inc
    • Life Spine
    • Medicrea International
    • Nuvasive, Inc
    • Scient'x Group S.A.S
    • Seaspine, Inc
    • Stryker Spine
    • Synthes Inc
    • X-Spine Systems, Inc
    • Ulrich Gmbh & Co. Kg
    • Zimmer Spine, Inc
    • Interbody Fusion Devices
    • Vertebral Body Replacement
    • Aesculap
    • Alphatec Spine, Inc
    • Biomet Spine
    • Co-Ligne Ag
    • Depuy Spine, Inc
    • Depuy .... (Continued)
    • Eden Spine, Llc
    • Globus Medical, Inc
    • Innovasis, Inc
    • Integra Spine
    • Ortho Development Corp
    • Orthofix International N.V
    • Pioneer Surgical Technology
    • Scient'x Group S.A.S
    • Signus Medizintechnik Gmbh
    • Spinevision Sa
    • Spine Wave, Inc
    • Stryker Spine
    • Synthes, Inc
    • Ulrich Gmbh & Co. Kg
    • Verticor, Ltd
    • Metallic Interbody Fusion Devices
    • Aesculap
    • Life Spine
    • Osteotech, Inc
    • Medtronic, Inc
    • Rsb Spine Llc
    • Scient'x Group S.A.S
    • Sintea Biotech, Spa
    • Spineselect, Llc
    • Stryker Spine
    • Titan Spine, Llc
    • Trans1, Inc
    • Ulrich Gmbh & Co. Kg
    • Vertebration, Inc
    • Zimmer Spine, Inc
    • Polymer Interbody Fusion Devices
    • Aesculap
    • Alphatec Spine, Inc
    • Amedica Corp
    • Biomet Spine
    • Centinel Spine, Inc
    • Choice Spine, Lp
    • Co-Ligne Ag
    • Depuy Spine, Inc
    • Eminent Spine
    • Globus Medical, Inc
    • Innovasis, Inc
    • Integra Spine
    • Ldr Médical
    • Lanx, Inc
    • Medicrea International
    • Neuro France Implants
    • Nuvasive, Inc
    • Orthofix International N.V
    • Scient'x Group S.A.S
    • Seaspine, Inc
    • Signus Medizintechnik Gmbh
    • Sintea Biotech, Spa
    • Spinal Elements
    • Spinesmith
    • Synthes Inc
    • Ulrich Gmbh & Co. Kg
    • Vertebral Technologies, Inc
    • Verticor, Ltd
    • Vertiflex, Inc
    • X-Spine Systems, Inc
    • Zimmer Spine, Inc
    • Structural Spinal Allografts
    • Allosource
    • Alphatec Spine, Inc
    • Biomet Spine
    • Lanx, Inc
    • Ortho Development Corp
    • Osteotech, Inc
    • Scient'x Group S.A.S
    • Stryker Spine
    • Synthes, Inc
    • Zimmer Spine, Inc
    • Bone Grafts
    • Demineralized Bone Matrix (Dbm)
    • Alphatec Spine, Inc
    • Biomet Spine
    • Citagenix, Inc
    • Etex Corp
    • Exactech, Inc
    • Integra Spine
    • Osteotech, Inc
    • Synthes, Inc
    • Wright Medical Technology, Inc
    • Bone Graft Substitutes
    • Amedica Corp
    • Biocomposites, Ltd
    • Citagenix, Inc
    • Depuy Spine, Inc
    • Etex Corp
    • Globus Medical, Inc
    • Innovasis, Inc
    • Integra Spine
    • Ldr Médical
    • Medicrea International
    • Medtronic, Inc
    • Nuvasive, Inc
    • Orthovita
    • Progentix Orthobiology Bv
    • Scient'x Group S.A.S
    • Signus Medizintechnik Gmbh
    • Synthes, Inc
    • Wright Medical Technology, Inc
    • Wright ... (Continued)
    • Zimmer Spine, Inc
    • Platelet Helpers
    • Stem Cells
    • Allosource
    • Nuvasive, Inc
    • Growth Factors (Rhbmp)
    • Biomimetic therapeutics, Inc
    • Medtronic, Inc
    • Stryker Spine
    • Non-Fusion
    • Interspinous Process Spacers
    • Eden Spine, Llc
    • Globus Medical, Inc
    • Interventional Spine, Inc
    • Medtronic, Inc
    • Paradigm Spine, Llc
    • Privelop Ag
    • Replication Medical, Inc
    • Vertiflex, Inc
    • Dynamic Stabilization
    • Applied Spine Technologies, Inc
    • Bio-Spine Corp
    • Disc Motion Technologies
    • Eden Spine, Llc
    • Paradigm Spine, Llc
    • Scient'x Group S.A.S
    • Spinevision Sa
    • Ulrich Gmbh & Co. Kg
    • Vertiflex, Inc
    • Zimmer Spine, Inc
    • Arthroplasty: Cervical
    • Aesculap
    • Globus Medical, Inc
    • Ldr Médical
    • Medicrea International
    • Medtronic, Inc
    • Nuvasive, Inc
    • Orthofix International N.V
    • Paradigm Spine, Llc
    • Scient'x Group S.A.S
    • Signus Medizintechnik Gmbh
    • Spinal Kinetics
    • Spinal Motion
    • Stryker Corp
    • Synthes Inc
    • Arthroplasty: Lumbar
    • Aesculap
    • Axiomed Spine Corp
    • Depuy Spine, Inc
    • Disc Motion Technologies
    • Eden Spine, Llc
    • Fournitures Hospitalieres Orthopedics
    • Integra Spine
    • Ldr Médical
    • Pioneer Surgical Technology
    • Ranier Technology, Ltd
    • Spinal Motion
    • Synthes Inc
    • Zimmer Spine, Inc
    • Nucleus Replacement
    • Cryolife Inc
    • Gentis Inc
    • Replication Medical, Inc
    • Spine Wave, Inc
    • Trans1, Inc
    • Vertebral Technologies, Inc
    • Facet Replacement
    • Facet Solutions, Inc
    • Impliant, Inc
    • Interventional Spine, Inc
    • Spinal Elements
    • Vertebral Column Fracture
    • Alphatec Spine Inc
    • Arthocare Corp
    • Benvenue Medical
    • Biomet Spine
    • Bone Solutions, Inc
    • Bonesupport Ab
    • Carefusion
    • Depuy Spine, Inc
    • Dfine, Inc
    • Doctors Research Group, Inc
    • Mathys, Ltd. Bettlach
    • Medtronic, Inc
    • Orthovita
    • Sintea Biotech, Spa
    • Spinealign Medical, Inc
    • Stryker Corp
    • Vexim Sas
    • Annulus Repair
    • Anulex Technologies, Inc
    • Intrinsic therapeutics, Inc
    • Magellan Spine Technologies, Inc
  • Chapter Six: References
    • References