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.
INTRODUCTIONn
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.
Global Surgical Equipment Industry
Chapter- 1: INTRODUCTION -- Complimentary
INTRODUCTION 1
STUDY GOALS AND OBJECTIVES 2
REASONS FOR DOING THE STUDY 2
SCOPE OF REPORT 3
INTENDED AUDIENCE 3
INFORMATION SOURCES 4
ANALYST CREDENTIALS 4
RELATED BCC REPORTS 4
BCC ONLINE SERVICES 4
DISCLAIMER 5
Chapter-2: SUMMARY
SUMMARY 6
SUMMARY TABLE GLOBAL FORECAST SPINAL SURGICAL DEVICES BY CATEGORY, THROUGH 2015 ($ MILLIONS) 7
SUMMARY FIGURE GLOBAL FORECAST SPINAL SURGICAL DEVICES BY CATEGORY, 2008-2015 ($ MILLIONS) 7
Chapter-3: OVERVIEW
SPINAL ANATOMY 8
SPINAL COLUMN 8
Intervertebral Discs 8
Boney Structures 9
NEURAL ELEMENTS 9
SUPPORTING STRUCTURES 9
TABLE 1 FUNCTIONAL ROLE OF THE SPINAL COLUMN COMPONENTS 10
BACK PAIN 10
HISTORY OF BACK PAIN AND EARLY TREATMENT 10
BACK PAIN TODAY 11
TABLE 2 GLOBAL SAMPLING OF FREQUENCY OF BACK PAIN, 2002–2009 12
Cost of Back Pain 12
TABLE 3 U.S. MEDICAL ENCOUNTERS BY SETTING FOR THE DIRECT TREATMENT OF BACK PROBLEMS, 2007 (THOUSANDS) 12
TABLE 4 HOSPITAL DISCHARGES BY BACK-RELATED DIAGNOSIS IN SELECT EUROPEAN COUNTRIES, THROUGH 2008 13
TABLE 5 U.S. DIRECT MEDICAL EXPENSES FOR BACK PROBLEMS, 2007 ($ MILLIONS) 14
TABLE 6 U.S. DISTRIBUTION OF DIRECT BACK-RELATED MEDICAL EXPENSES BY PAYER, 2007 (%) 14
TABLE 7 U.S. PATIENTS WITH BACK PROBLEMS, THROUGH 2007 (MILLIONS) 15
TABLE 8 U.S. MEDICAL EXPENDITURES FOR THE DIRECT TREATMENT OF BACK PROBLEMS, THROUGH 2007 ($ BILLIONS) 15
Disability from Back Pain 15
Identifying the Cause of Back Pain 16
TABLE 9 DISTRIBUTION OF DIAGNOSABLE BACK CONDITIONS (%) 16
Causes of Diagnosed Back Pain 16
Risk Factors for Back Pain 17
Risk Factors for Diagnosable Back Disorders 17
Genetics 17
Aging 17
TABLE 10 PROJECTED AGING OF THE GLOBAL POPULATION AGE 65 AND OLDER, THROUGH 2020 (MILLION) 18
Smoking 18
Obesity 19
TABLE 11 GLOBAL PREVALENCE OF OBESITY, 1995–2005 (%) 19
Osteoporosis 20
TABLE 12 PROJECTED AGING OF GLOBAL FEMALE POPULATION AGE 60–99, THROUGH 2020 (MILLION) 20
COMMON SPINAL CONDITIONS 20
TABLE 13 DIAGNOSIS-RELATED ICD 9 CODES FOR SPINAL CONDITIONS 21
TABLE 13 (CONTINUED) 22
TABLE 14 U.S. INPATIENTS DIAGNOSED BY CODED BACK CONDITIONS, 2008 22
ABNORMAL SPINAL CURVATURES 22
TABLE 15 U.S. TREND FOR INPATIENT DIAGNOSIS OF ALL ABNORMAL CURVATURES OF THE SPINE, THROUGH 2015 23
TABLE 16 U.S. INPATIENTS WITH ABNORMAL CURVATURES OF THE SPINE, 2008 23
Kyphosis 23
Postural Kyphosis 24
Structural Kyphosis 24
Gibbus Deformity 24
Scheuermann’s Disease 24
Congenital Kyphosis 24
Secondary Kyphosis 24
Treatment 25
TABLE 17 GLOBAL FREQUENCY OF KYPHOSIS 25
TABLE 18 U.S. AGE DISTRIBUTION FOR INPATIENTS DIAGNOSED WITH KYPHOSIS, 2008 (%) 26
TABLE 19 U.S. TREND OF HOSPITAL INPATIENT DIAGNOSIS OF KYPHOSIS, THROUGH 2015 26
Lordosis 26
Treatment 27
TABLE 20 U.S. TREND FOR HOSPITAL INPATIENT DIAGNOSIS OF LORDOSIS, THROUGH 2015 27
Scoliosis 27
Congenital Scoliosis 27
Failure of Segmentation 28
Failure of Formation 28
Treatment 28
Neuromuscular Scoliosis 28
Treatment 29
Degenerative Scoliosis 29
Treatment 29
Idiopathic Scoliosis 29
Treatment 30
TABLE 21 GLOBAL FREQUENCY OF SCOLIOSIS 30
TABLE 22 U.S. AGE DISTRIBUTION FOR INPATIENTS DIAGNOSED WITH SCOLIOSIS, 2008 (%) 30
TABLE 23 U.S. TREND FOR HOSPITAL INPATIENT DIAGNOSIS OF SCOLIOSIS, THROUGH 2015 31
ARTHRITIC SPINAL CONDITIONS 31
TABLE 24 U.S. TREND FOR HOSPITAL INPATIENTS WITH DIAGNOSES OF ALL ARTHRITIS-RELATED SPINAL CONDITIONS, THROUGH 2015 31
TABLE 25 U.S. INPATIENTS WITH ARTHRITIS-RELATED SPINAL CONDITIONS, BY CONDITION, 2008 32
Ankylosing Spondylitis 32
TABLE 26 GLOBAL FREQUENCY OF ANKYLOSING SPONDYLITIS (%) 32
Rheumatoid Arthritis 33
TABLE 27 GLOBAL FREQUENCY OF RHEUMATOID ARTHRITIS (%) 33
TABLE 28 AGE DISTRIBUTION FOR INPATIENTS DIAGNOSED WITH ANKYLOSING SPONDYLITIS/RHEUMATOID ARTHRITIS (%) 34
TABLE 29 U.S. TREND FOR HOSPITAL INPATIENT DIAGNOSES OF ANKYLOSING SPONDYLITIS/RHEUMATOID ARTHRITIS, THROUGH 2015 34
Osteoarthritis/Spondylosis 34
TABLE 30 U.S. DISTRIBUTION OF SPONDYLOSIS BY SPINAL REGION, 2008 35
Treatment 35
TABLE 31 U.S. AGE DISTRIBUTION FOR INPATIENTS DIAGNOSED WITH SPONDYLOSIS, 2008 (%) 35
TABLE 32 U.S. TREND FOR HOSPITAL INPATIENT DIAGNOSIS OF SPONDYLOSIS, THROUGH 2015 36
DEGENERATIVE DISC DISEASES 36
TABLE 33 U.S. TREND FOR HOSPITAL INPATIENT DIAGNOSES WITH ALL DEGENERATIVE DISC DISEASES, THROUGH 2015 (THOUSANDS) 37
TABLE 34 U.S. INPATIENTS DIAGNOSED WITH DEGENERATIVE DISC DISORDERS, 2008 37
Disc Herniation 37
TABLE 35 U.S. DISTRIBUTION OF DISC HERNIATION BY SPINAL REGION, 2008 (%) 38
TABLE 36 U.S. AGE DISTRIBUTION FOR INPATIENTS DIAGNOSED WITH DISC HERNIATION, 2008 (%) 39
TABLE 37 U.S. TREND FOR INPATIENT DIAGNOSIS OF DISC HERNIATION, THROUGH 2015 (%) 39
Treatment 39
Disc Degeneration 40
TABLE 38 U.S. DISTRIBUTION OF DEGENERATIVE DIAGNOSIS BY REGION OF THE SPINE, 2008 (%) 40
TABLE 39 U.S. AGE DISTRIBUTION FOR INPATIENTS DIAGNOSED WITH DEGENERATION OF THE INTERVERTEBRAL DISCS, 2008 (%) 40
TABLE 40 U.S. TREND FOR INPATIENT DIAGNOSIS OF DEGENERATION OF THE INTERVERTEBRAL DISC, THROUGH 2015 (%) 41
Spinal Stenosis 41
TABLE 41 U.S. DISTRIBUTION OF STENOSIS BY SPINAL REGION, 2008 (%) 41
TABLE 42 U.S. AGE DISTRIBUTION FOR INPATIENTS DIAGNOSED WITH SPINAL STENOSIS, 2008 (%) 42
TABLE 43 U.S. TREND INPATIENT DIAGNOSIS OF SPINAL STENOSIS, THROUGH 2015 42
Treatment 42
Spondylolisthesis 42
TABLE 44 U.S. AGE DISTRIBUTION FOR INPATIENTS DIAGNOSED WITH SPONDYLOLISTHESIS, 2008 (%) 43
Treatment 44
TABLE 45 U.S. TREND IN INPATIENT DIAGNOSIS OF SPONDYLOLISTHESIS, THROUGH 2015 44
SPINAL TUMORS 44
Treatment 45
INJURY 45
Vertebral Fractures 45
TABLE 46 U.S. INPATIENTS WITH VERTEBRAL FRACTURE DIAGNOSIS, 2008 45
TABLE 47 U.S. AND E.U. VERTEBRAL FRACTURES BY TYPE 46
TABLE 48 U.S. AGE DISTRIBUTION FOR INPATIENTS DIAGNOSED WITH VERTEBRAL FRACTURES WITHOUT SPINAL CORD INJURY, 2008 (%) 46
TABLE 49 U.S. TREND FOR INPATIENT DIAGNOSIS OF VERTEBRAL FRACTURE, THROUGH 2015 (%) 47
Fracture Classification 47
Major/Minor 47
Stable/Unstable 47
Denis 3-Column Model 48
Break Type 48
Traumatic Spinal Injury 49
TRENDS IN FREQUENCY OF SPINAL CONDITIONS 50
TABLE 50 U.S. FORECAST FOR INPATIENT DIAGNOSIS BY CODED SPINAL CONDITION, THROUGH 2015 (THOUSANDS) 50
Chapter-4: MARKET ANALYSIS
MARKET BY APPLICATION OR PROCEDURE 51
TABLE 51 U.S. SPINAL PROCEDURES BY VOLUME, THROUGH 2015 (THOUSANDS) 51
TABLE 52 U.S. COSTS FOR ALL SPINAL PROCEDURES, THROUGH 2015 ($ MILLIONS) 52
TABLE 53 U.S. DISTRIBUTION OF SPINAL SURGERY PROCEDURES BY CATEGORY, 2008 (%) 53
TABLE 54 U.S. HIGHEST MEAN COSTS BY SPINAL SURGICAL PROCEDURE, 2008 ($) 53
Chapter-5: INDUSTRY PLAYERS Spinal Surgical Devices, Spinal Surgical Devices markets, technology Spinal Surgical Devices, spinal market , spinal devices, spinal surgery, orthopedic products, orthopedic products market, orthopedic devices, back surgery devices, implantable spinal surgical devices, spinal implants, spinal implants market, spinal implants technology, Spinal Devices manufacturers, HLC075A, Lori Solomon This report examines trends in the market for spinal surgical devices, specifically arthroplasty products and implanted instrumentation hardware. Includes forecasts through 2015.
FUSION 112
POSTERIOR PEDICLE SCREW FUSION SYSTEMS 112
Aesculap 112
Alphatec Spine, Inc. 113
Amedica Corp. 114
Biomet Spine 115
Cardo Medical, Inc. 116
Choice Spine, LP 117
Co-Ligne Ag 117
DePuy Spine, Inc. 117
DePuy Spine, Inc. (Continued) 118
DePuy Spine, Inc. (Continued) 119
Eden Spine, LLC 120
Exactech, Inc. 120
Globus Medical, Inc. 121
Innovasis, Inc. 122
Integra Spine 123
Interventional Spine, Inc. 124
Lanx, Inc. 125
LDR Médical 125
Life Spine 126
Medicrea International 127
Medtronic, Inc. 127
Neuro France Implants 128
NuVasive, Inc. 129
Ortho Development Corp. 129
Orthofix International N.V. 130
Orthofix … (Continued) 131
Pioneer Surgical Technology 132
Scient’X Group S.A.S. 132
SeaSpine, Inc. 133
Signus Medizintechnik GmbH 134
Sintea Biotech, SpA 134
Specialty Spine Products, LLC 135
Spine Network (Eurosurgical) 135
SpineVision SA 136
Stryker Spine 137
Stryker Spine (Continued) 138
Synthes Inc. 139
Ulrich GmbH & Co. KG 140
VertiFlex, Inc. 141
X-Spine Systems, Inc. 141
Zimmer Spine, Inc. 142
CABLE SYSTEMS 143
Biomet Spine 143
DePuy Spine, Inc. 144
Pioneer Surgical Technology 145
ANTERIOR CERVICAL PLATE SYSTEMS 145
Aesculap 145
Alphatec Spine, Inc. 146
Amedica Corp. 147
Apollo Spine 147
Biomet Spine 148
Cardo Medical Inc. 149
Choice Spine, LP 149
DePuy Spine, Inc. 150
Exactech, Inc. 151
Globus Medical, Inc. 151
Innovasis, Inc. 152
Integra Spine 152
Lanx, Inc. 153
Life Spine 154
NuVasive, Inc. 154
Ortho Development Corp. 155
Orthofix International N.V. 155
Pioneer Surgical Technology 156
Scient’X Group S.A.S. 157
SeaSpine, Inc. 157
Signus Medizintechnik GmbH 158
Sintea Biotech, SpA 158
SpineVision SA 158
Stryker Spine 159
Synthes Inc. 159
Ulrich GmbH & Co. KG 160
X-Spine Systems, Inc. 161
Zimmer Spine, Inc. 161
OTHER ANTERIOR FIXATION DEVICES 162
Alphatec Spine, Inc. 162
DePuy Spine, Inc. 162
DePuy Spine, Inc. (Continued) 163
Eminent Spine 164
Globus Medical, Inc. 164
Life Spine 165
Medicrea International 165
NuVasive, Inc. 165
Scient’X Group S.A.S. 166
SeaSpine, Inc. 167
Stryker Spine 167
Synthes Inc. 168
X-Spine Systems, Inc. 169
Ulrich GmbH & Co. KG 170
Zimmer Spine, Inc. 170
INTERBODY FUSION DEVICES 171
Vertebral Body Replacement 171
Aesculap 171
Alphatec Spine, Inc. 171
Biomet Spine 172
Co-Ligne Ag 173
DePuy Spine, Inc. 173
DePuy …. (Continued) 174
Eden Spine, LLC 175
Globus Medical, Inc. 175
Innovasis, Inc. 176
Integra Spine 176
Ortho Development Corp. 177
Orthofix International N.V. 178
Pioneer Surgical Technology 179
Scient’X Group S.A.S. 180
Signus Medizintechnik GmbH 180
SpineVision SA 181
Spine Wave, Inc. 182
Stryker Spine 182
Synthes, Inc. 183
Ulrich GmbH & Co. KG 184
Verticor, Ltd. 185
Metallic Interbody Fusion Devices 185
Aesculap 185
Life Spine 186
Osteotech, Inc. 186
Medtronic, Inc. 186
RSB Spine LLC 187
Scient’X Group S.A.S. 188
Sintea Biotech, SpA 188
SpineSelect, LLC 189
Stryker Spine 189
Titan Spine, LLC 190
TranS1, Inc. 190
Ulrich GmbH & Co. KG 191
Vertebration, Inc. 192
Zimmer Spine, Inc. 192
Polymer Interbody Fusion Devices 193
Aesculap 193
Alphatec Spine, Inc. 193
Amedica Corp. 194
Biomet Spine 195
Centinel Spine, Inc. 196
Choice Spine, LP 197
Co-Ligne AG 197
DePuy Spine, Inc. 198
Eminent Spine 199
Globus Medical, Inc. 199
Innovasis, Inc. 200
Integra Spine 201
LDR Médical 202
Lanx, Inc. 203
Medicrea International 203
Neuro France Implants 204
NuVasive, Inc. 205
Orthofix International N.V. 206
Scient’X Group S.A.S. 207
SeaSpine, Inc. 208
Signus Medizintechnik GmbH 209
Sintea Biotech, SpA 210
Spinal Elements 210
SpineSmith 211
Synthes Inc. 211
Ulrich GmbH & Co. KG 212
Vertebral Technologies, Inc. 213
Verticor, Ltd. 213
VertiFlex, Inc. 213
X-Spine Systems, Inc. 214
Zimmer Spine, Inc. 214
Structural Spinal Allografts 215
AlloSource 215
Alphatec Spine, Inc. 215
Biomet Spine 216
Lanx, Inc. 216
Ortho Development Corp. 217
Osteotech, Inc. 217
Scient’X Group S.A.S. 218
Stryker Spine 218
Synthes, Inc. 219
Zimmer Spine, Inc. 220
BONE GRAFTS 221
Demineralized Bone Matrix (DBM) 221
Alphatec Spine, Inc. 221
Biomet Spine 221
Citagenix, Inc. 222
Etex Corp. 223
Exactech, Inc. 223
Integra Spine 224
Osteotech, Inc. 225
Synthes, Inc. 226
Wright Medical Technology, Inc. 226
BONE GRAFT SUBSTITUTES 227
Amedica Corp. 227
Biocomposites, Ltd. 227
Citagenix, Inc. 228
DePuy Spine, Inc. 228
Etex Corp. 228
Globus Medical, Inc. 229
Innovasis, Inc. 230
Integra Spine 230
LDR Médical 231
Medicrea International 231
Medtronic, Inc. 232
NuVasive, Inc. 232
Orthovita 233
Progentix Orthobiology BV 233
Scient’X Group S.A.S. 234
Signus Medizintechnik GmbH 234
Synthes, Inc. 235
Wright Medical Technology, Inc. 235
Wright … (Continued) 236
Zimmer Spine, Inc. 237
PLATELET HELPERS 237
Stem Cells 237
Allosource 237
NuVasive, Inc. 238
Growth Factors (rhBMP) 238
BioMimetic Therapeutics, Inc. 238
Medtronic, Inc. 239
Stryker Spine 240
Non-Fusion 240
Interspinous Process Spacers 240
Eden Spine, LLC 240
Globus Medical, Inc. 241
Interventional Spine, Inc. 241
Medtronic, Inc. 242
Paradigm Spine, LLC 243
Privelop AG 243
Replication Medical, Inc. 243
VertiFlex, Inc. 244
Dynamic Stabilization 244
Applied Spine Technologies, Inc. 244
Bio-Spine Corp. 245
Disc Motion Technologies 245
Eden Spine, LLC 246
Paradigm Spine, LLC 246
Scient’X Group S.A.S. 247
SpineVision SA 247
Ulrich GmbH & Co. KG 248
VertiFlex, Inc. 248
Zimmer Spine, Inc. 249
Arthroplasty: Cervical 250
Aesculap 250
Globus Medical, Inc. 251
LDR Médical 251
Medicrea International 252
Medtronic, Inc. 252
NuVasive, Inc. 253
Orthofix International N.V. 253
Paradigm Spine, LLC 254
Scient’X Group S.A.S. 254
Signus Medizintechnik GmbH 255
Spinal Kinetics 255
Spinal Motion 256
Stryker Corp. 256
Synthes Inc. 257
Arthroplasty: Lumbar 257
Aesculap 257
AxioMed Spine Corp. 258
DePuy Spine, Inc. 259
Disc Motion Technologies 259
Eden Spine, LLC 259
Fournitures Hospitalieres Orthopedics 260
Integra Spine 260
LDR Médical 261
Pioneer Surgical Technology 262
Ranier Technology, Ltd. 262
Spinal Motion 263
Synthes Inc. 263
Zimmer Spine, Inc. 264
Nucleus Replacement 264
CryoLife Inc. 264
Gentis Inc. 265
Replication Medical, Inc. 265
Spine Wave, Inc. 266
TranS1, Inc. 266
Vertebral Technologies, Inc. 267
Facet Replacement 267
Facet Solutions, Inc. 267
Impliant, Inc. 268
Interventional Spine, Inc. 268
Spinal Elements 268
Vertebral Column Fracture 269
Alphatec Spine Inc. 269
ArthoCare Corp. 269
Benvenue Medical 270
Biomet Spine 270
Bone Solutions, Inc. 271
BoneSupport AB 272
CareFusion 272
DePuy Spine, Inc. 273
DFine, Inc. 273
Doctors Research Group, Inc. 274
Mathys, Ltd. Bettlach 274
Medtronic, Inc. 275
Orthovita 275
Sintea Biotech, SpA 276
SpineAlign Medical, Inc. 276
Stryker Corp. 277
Vexim SAS 277
Annulus Repair 278
Anulex Technologies, Inc. 278
Intrinsic Therapeutics, Inc. 278
Magellan Spine Technologies, Inc. 279
Chapter-6: REFERENCES
REFERENCES 280
REFERENCES (CONTINUED) 281
REFERENCES (CONTINUED) 282
