CONTENTS

Executive Summary ………………………………………………………………………. ES-1
i. Spinal fusion implanted instrumentation market ………………………………………………………… ES–1
a. Selected market drivers and limiters……………………………………………………….. ES–5
b. Market leaders……………………………………………………………………………………… ES–5
ii. Methodology …………………………………………………………………………………………………………. ES–6

Exhibit ES-1: Spinal fusion instrumentation, combined market forecast, by segment, 2017-22……………………………………………………………………………………………………….. ES–3
Exhibit ES-2: Spinal fusion instrumentation, combined market forecast, by region ($m), 2017-22……………………………………………………………………………………………………….. ES–4

1. Clinical Overview …………………………………………………………………………1-1
1.1 Spinal anatomy……………………………………………………………………………………………………….. 1-3
1.2 Selected spinal disorders………………………………………………………………………………………….. 1-6
1.2.1 Disc herniation……………………………………………………………………………………. 1-6
1.2.2 Degenerative disc disease…………………………………………………………………….. 1-8
1.2.3 Abnormal curvature of the spine…………………………………………………………. 1-11
1.2.4 Spondylolisthesis……………………………………………………………………………….. 1-12
1.2.5 Stenosis……………………………………………………………………………………………. 1-12
1.2.6 Spinal tumors……………………………………………………………………………………. 1-13
1.2.7 Traumatic spinal injuries…………………………………………………………………….. 1-14
1.3 Spinal fusion …………………………………………………………………………………………………………. 1-14
1.3.1 Procedure volumes……………………………………………………………………………. 1-14
1.4 Bibliography………………………………………………………………………………………………………….. 1-19

Exhibit 1-1: Prevalence of lower back pain, per 100,000, Japan and the five major EU markets ………………………………………………………………………………………………… 1-1
Exhibit 1-2: Population-based projections for incidence of lower back pain, US …………………… 1-2
Exhibit 1-3: The human spine…………………………………………………………………………………………. 1-5
Exhibit 1-4: Estimated prevalence of osteoporosis, selected countries, 2017 …………………….. 1-10
Exhibit 1-5: Spinal fusion, procedure volumes forecast, 2016-22………………………………………. 1-16

2. Spinal Fusion: Implanted Instrumentation ……………………………………….2-1
2.1 Spinal fusion implanted instrumentation, combined market analysis…………………………….. 2-1
2.2 Anterior column plating systems……………………………………………………………………………….. 2-4
2.2.1 Products…………………………………………………………………………………………….. 2-5
2.2.2 Market analysis…………………………………………………………………………………… 2-7
2.2.3 Competitive analysis……………………………………………………………………………. 2-9
2.3 Interbody fusion devices………………………………………………………………………………………… 2-11
2.3.1 Products…………………………………………………………………………………………… 2-13
2.3.2 Market analysis…………………………………………………………………………………. 2-18
2.3.3 Competitive analysis………………………………………………………………………….. 2-20
2.4 Pedicle screws/posterior spinal fixation devices………………………………………………………… 2-22
2.4.1 Products…………………………………………………………………………………………… 2-23
2.4.2 Market analysis…………………………………………………………………………………. 2-27
2.4.3 Competitive analysis………………………………………………………………………….. 2-29
2.5 Corporate profiles and competitor growth strategies………………………………………………… 2-31
2.5.1 Physician-owned distributorships………………………………………………………… 2-32
2.6 Acquisitions ………………………………………………………………………………………………………….. 2-32
2.7 Meddevicetracker survey results…………………………………………………………………………….. 2-33
2.8 Bibliography………………………………………………………………………………………………………….. 2-35

Exhibit 2-1: Spinal fusion instrumentation, combined market forecast, by segment, 2017-22……… 2-3
Exhibit 2-2: Medtronic’s Atlantis Vision Elite anterior cervical plate system………………………………. 2-4
Exhibit 2-3: Classification of anterior column plates……………………………………………………………….. 2-5
Exhibit 2-4: Selected anterior column plating systems, 2017……………………………………………………. 2-6
Exhibit 2-5: Anterior column plates, market forecast, by region ($m), 2017-22………………………….. 2-8
Exhibit 2-6: Anterior column plates, share by supplier, 2017………………………………………………….. 2-10
Exhibit 2-7: DePuy Synthes’ BENGAL stackable cage system ………………………………………………….. 2-11
Exhibit 2-8: Selected minimally invasive interbody fusion systems …………………………………………. 2-15
Exhibit 2-9: Selected interbody fusion devices……………………………………………………………………… 2-16
Exhibit 2-10: Interbody fusion devices, market forecast, by region ($m), 2017-22 ……………………. 2-19
Exhibit 2-11: Intervertebral body fusion devices, share by supplier, 2017 ……………………………….. 2-21
Exhibit 2-12: Alphatec Spine’s Arsenal spinal fixation system…………………………………………………. 2-23
Exhibit 2-13: Selected thoracolumbar fixation/pedicle screw systems, 2017……………………………. 2-24
Exhibit 2-14: Selected posterior cervico-thoracic fixation systems, 2017…………………………………. 2-26
Exhibit 2-15: Pedicle screw/posterior fixation systems, market forecast, by region ($m), 2017-22………………………………………………………………………………………………………… 2-28
Exhibit 2-16: Pedicle screw/posterior fixation systems, share by supplier, 2017 ………………………. 2-30

APPENDIX: COMPANY LISTING …………………………………………………………………………………… A-1
KEY OPINION LEADER INSIGHT ……………………………………………………………………. B-2