Table of Contents

Executive Summary………………………………………………………………………….ES-1
i. Spinal fusion implanted instrumentation market …………………………………………………………..ES-1
a. Selected market drivers and limiters………………………………………………………….ES-4
b. Market leaders………………………………………………………………………………………..ES-4
ii. Methodology ……………………………………………………………………………………………………………ES-5

Exhibit ES-1: Spinal fusion instrumentation, combined market forecast, by segment, 2019-24………………………………………………………………………………………………………….ES-2
Exhibit ES-2: Spinal fusion instrumentation, combined market forecast, by region ($m), 2019-24………………………………………………………………………………………………………….ES-3

1. Clinical Overview………………………………………………………………………….. 1-1
1.1 Spinal anatomy……………………………………………………………………………………………………….. 1-3
1.2 Selected spinal disorders………………………………………………………………………………………….. 1-7
1.2.1 Disc herniation……………………………………………………………………………………. 1-7
1.2.2 Degenerative disc disease…………………………………………………………………….. 1-8
1.2.3 Abnormal curvature of the spine…………………………………………………………. 1-12
1.2.4 Spondylolisthesis……………………………………………………………………………….. 1-13
1.2.5 Stenosis……………………………………………………………………………………………. 1-14
1.2.6 Spinal tumors……………………………………………………………………………………. 1-14
1.2.7 Traumatic spinal injuries…………………………………………………………………….. 1-15
1.3 Spinal fusion …………………………………………………………………………………………………………. 1-15
1.3.1 Procedure volumes……………………………………………………………………………. 1-16
1.4 Bibliography………………………………………………………………………………………………………….. 1-20

Exhibit 1-1: Low back pain prevalence in the US, Japan, and five major European markets, 2010 and 2017 ………………………………………………………………………………………………….. 1-1
Exhibit 1-2: Low back pain, disability-adjusted life years, in the US, Japan, and five major European markets, 2017…………………………………………………………………………………….. 1-2
Exhibit 1-3: Neck pain prevalence in the US, Japan, and five major European markets, 2010 and 2017 ………………………………………………………………………………………………….. 1-3
Exhibit 1-4: The human spine ……………………………………………………………………………………………….. 1-6
Exhibit 1-5: Osteoarthritis prevalence in the US, Japan, and five major European markets, 2010 and 2017…………………………………………………………………………………………………. 1-10
Exhibit 1-6: Forecast for prevalent cases of osteoporosis in the US, Japan, and five major European markets, by country, 2019–24…………………………………………………………….. 1-12
Exhibit 1-7: Spinal fusion, procedure volumes forecast, in the US, Japan, and five major European markets, 2019–24……………………………………………………………………………… 1-17

2. Spinal Fusion: Implanted Instrumentation Market……………………………… 2-1
2.1 Spinal fusion implanted instrumentation, combined market analysis…………………………….. 2-1
2.2 Spinal plating systems……………………………………………………………………………………………… 2-5
2.2.1 Products…………………………………………………………………………………………….. 2-6
2.2.2 Market analysis…………………………………………………………………………………… 2-9
2.2.3 Competitive analysis………………………………………………………………………….. 2-12
2.3 Interbody fusion devices………………………………………………………………………………………… 2-14
2.3.1 Products…………………………………………………………………………………………… 2-15
2.3.2 Market analysis…………………………………………………………………………………. 2-21
2.3.3 Competitive analysis………………………………………………………………………….. 2-23
2.4 Pedicle screws/posterior spinal fixation devices………………………………………………………… 2-25
2.4.1 Products…………………………………………………………………………………………… 2-26
2.4.2 Market analysis…………………………………………………………………………………. 2-31
2.4.3 Competitive analysis………………………………………………………………………….. 2-31
2.5 Spinal fusion implanted instrumentation market, competitive analysis ……………………….. 2-34
2.5.1 Medtronic ………………………………………………………………………………………… 2-34
2.5.2 DePuy Synthes/Johnson & Johnson……………………………………………………… 2-37
2.5.3 Stryker……………………………………………………………………………………………… 2-38
2.5.4 Other leading competitors………………………………………………………………….. 2-39
2.6 Bibliography………………………………………………………………………………………………………….. 2-43

Exhibit 2-1: Spinal fusion instrumentation, combined market forecast, by segment, 2019–24……… 2-4
Exhibit 2-2: Classification of anterior column plates………………………………………………………………… 2-5
Exhibit 2-3: Selected spinal plating systems……………………………………………………………………………. 2-6
Exhibit 2-4: Medtronic’s Atlantis Vision Elite anterior cervical plate system……………………………….. 2-9
Exhibit 2-5: Spinal plating systems, market forecast ($m), by region, 2019–24 …………………………. 2-11
Exhibit 2-6: Spinal plating systems, share by supplier, 2019……………………………………………………. 2-13
Exhibit 2-7: DePuy Synthes’ BENGAL stackable cage system…………………………………………………… 2-14
Exhibit 2-8: Selected minimally invasive interbody fusion systems………………………………………….. 2-17
Exhibit 2-9: Selected interbody fusion and spacer devices……………………………………………………… 2-18
Exhibit 2-10: Interbody fusion devices, market forecast ($m), by region, 2019–24……………………. 2-22
Exhibit 2-11: Intervertebral body fusion devices, share by supplier, 2019………………………………… 2-24
Exhibit 2-12: Selected thoracolumbar fixation/pedicle screw systems …………………………………….. 2-26
Exhibit 2-13: ATEC Spine’s Arsenal spinal fixation system ………………………………………………………. 2-29
Exhibit 2-14: Selected posterior cervicothoracic fixation and pedicle screw systems…………………. 2-30
Exhibit 2-15: Pedicle screw/posterior fixation systems, market forecast ($m), by region, 2019–24 ……………………………………………………………………………………………………….. 2-32
Exhibit 2-16: Pedicle screw/posterior fixation systems, share by supplier, 2019……………………….. 2-33
Exhibit 2-17: Medtronic net sales ($m), by product category and geography, FY2018–20………….. 2-35
Exhibit 2-18: Johnson & Johnson net sales ($m), by product category and geography, 2017–19…. 2-37
Exhibit 2-19: Stryker net sales ($m), by product category and geography, 2017–19 ………………….. 2-39
Exhibit 2-20: Zimmer Biomet net sales ($m), by product category and geography, 2017–19………. 2-40
Exhibit 2-21: NuVasive net sales ($m), by product category and geography, 2017–19……………….. 2-41
Exhibit 2-22: Globus Medical net sales ($m), by product category and geography, 2017–19………. 2-42

APPENDIX: COMPANY LISTING …………………………………………………………………………………… A-1