Spine Implant Market Size and Share
Market Definition
Hardware to treat degenerative disc disease, herniated discs, scoliosis and vertebral fractures.
November 2023
Mike Evers, Senior Market Analyst
Welcome to our spine implant market report, a companion to the spine chapter in THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT®. The competitive landscape has shifted dramatically in recent quarters, and we anticipate more changes. I’ll be back in late November with important segment updates and our year-end projections. See you soon!
The Market at a Glance
The spine market surpassed $9.8 billion in sales in 2022 and accounts for 17.8% of the $55 billion global orthopedic market. Spine has highly favorable patient demographics, but growth in core fusion products has slowed to the low single digits. Companies increasingly rely on acquisitions, enabling technology pull-through and new opportunities like motion preservation to drive growth.
Market Forecast
We project that the global spine market will grow to $10 billion in 2023, as its growth accelerates slightly to +2.2%. An expanding patient population and adoption of new treatment options will drive the market to $10.9 billion by 2026.
Exhibit 1: Worldwide Spine Sales by Year ($millions)
Get More Orthopedic Market Data. Download the Orthopedic Revenue Matrix for our most complete and granular numbers. It contains worldwide orthopedic sales for 67 public and private companies by segment from 2016 through 2022.
Core fusion products make up most of the market and grew in the low single digits. Sales from fusion technologies often help companies fund market expansion of less invasive techniques and motion-preserving implants. Artificial disc replacement is an increasingly competitive space with low double-digit growth.
Patient demographics, new market opportunities and reduced upside in the Chinese market are three of the many factors we considered in creating our forecast for the spine segment.
A Compounding, Global Problem
The global population aged 60 years or older will double by 2050. Back pain affects 1 in 10 people globally and costs $560 billion in the U.S. due to treatment costs and productivity loss. It is the primary cause of disability in the U.S.
The spine market clearly has highly favorable patient demographics, but the patients pose a monumental challenge for the healthcare system and overall society. Spine companies seek ways to improve the efficiency and accuracy of their treatment without ballooning the costs of care.
Fostering New Markets
Companies are looking to underserved markets to accelerate growth as the fusion market slows. ZimVie plans to use its large fusion business to fund the development of markets like disc replacement and vertebral body tethering. Those two markets represent a $1.2 billion opportunity into which companies have made relatively few inroads.
Minimally invasive surgery and motion preservation devices have technical and reimbursement challenges to overcome before surgeons transition fusion patients in meaningful numbers. However, multiple companies, including Premia Spine and Empirical Spine, are pursuing novel motion-preserving products.
Surgeon reimbursement continues to be a challenge in some areas, but the differential between fusion and motion preservation is lessening year-to-year. We think we are approaching a tipping point in the market where total disc replacement will become more of the standard of care.
Steven Murray, Centinel Spine CEO
National Tender in China
While there have been provincial volume-based procurement (VBP) tenders for spine in China, companies are preparing for a national tender like the ones established for joint replacement and trauma. Those tenders led to drastic price reductions and volume shifts to domestic Chinese companies.
Some companies like ZimVie pulled up stakes and left the market altogether. However, companies like Medtronic that have large footprints in China plan to offset the price decreases with reduced selling and marketing costs. We expect VBP will remain a headwind in spine throughout 2023 and into 2024.
Other Segment Reports
Orthopedic Market Overview
October 26, 2023
Joint Replacement Implant Market
October 26, 2023
Trauma Implant Market
October 26, 2023
Sports Medicine Market
October 26, 2023
Orthobiologics Market
October 26, 2023
Enabling Technology Market
October 26, 2023
Sales by Region
Procedure volumes recovered well in the U.S. and regions of EMEA in 2022. However, lingering COVID surges from late 2021 caused significant disruption in markets like Australia, China and Brazil. VBP remains a significant factor for companies competing in China, while a strengthening U.S. dollar created mid-single-digit headwinds for global companies.
The U.S. accounted for 70% or nearly $7 billion in spine market sales in 2022, while OUS markets reached $2.9 billion in sales.
Exhibit 2: Spine Sales by Region ($millions)
| Region | FY22 | FY21 | $ Chg | % Chg |
|---|---|---|---|---|
| US | $6,967.0 | $6,638.0 | $329.0 | 5% |
| OUS | $2,901.3 | $3,038.4 | ($137.1) | (4.5%) |
| EMEA | $1,598.7 | $1,567.6 | $31.1 | 2% |
| APAC | $1,026.3 | $1,170.8 | ($144.5) | (12.3%) |
| ROW | $276.3 | $300.0 | ($23.7) | (7.9%) |
| Total | $9,868.2 | $9,676.3 | $191.9 | 2% |
Exhibit 3: Spine Market Share by Region ($millions)
Top Companies
Medtronic owns nearly 23% of the spine market. Globus Medical completed its acquisition of NuVasive in the second-half of 2023, making it the number two player in the space with 17.4% share.
Spine now features four companies – Medtronic, Globus, DePuy Synthes and Stryker – with more than $1 billion in annual sales that represent 65% of the entire market.
Please note that enabling technology is not included in our spine sales figures and can be found in a separate market overview.
Exhibit 4: Top 10 Spine Players and All Others ($millions)
| Company | FY22 | FY21 | $ Chg | % Chg |
|---|---|---|---|---|
| Medtronic | $2,246.9 | $2,206.7 | $40.2 | 1.8% |
| DePuy Synthes | $1,208.0 | $1,273.8 | ($65.8) | (5.2%) |
| Stryker | $1,191.4 | $1,209.8 | ($18.3) | (1.5%) |
| NuVasive | $859.5 | $807.8 | $51.6 | 6.4% |
| Globus Medical | $857.0 | $818.1 | $38.9 | 4.8% |
| ZimVie | $350.8 | $420.1 | ($69.3) | (16.5%) |
| ATEC | $270.9 | $192.8 | $78.1 | 40.5% |
| Aesculap | $154.8 | $149.7 | $5.1 | 3.4% |
| ulrich medical | $141.5 | $135.0 | $6.5 | 4.8% |
| SeaSpine * | $122.8 | $93.6 | $29.2 | 31.2% |
| All Others | $2,464.7 | $2,369.0 | $95.7 | 4% |
| Total | $9,868.2 | $9,676.3 | $191.9 | 2% |
Exhibit 5: Spine Market Share by Company ($millions)
* As a reminder, the merger between Orthofix and SeaSpine closed in the first few days of 2023. The data shown here represents SeaSpine stand-alone sales.
ATEC dominated the mid-tier spine market with better than 40% growth in 2022. This part of the market also saw consolidation in the merger between Orthofix and SeaSpine. The combined Orthofix organization is still a single-digit market share player in spine, but closed the gap on companies like ATEC and ZimVie.
Over the next five years, ZimVie is likely to take a few steps back as it exits unprofitable geographies and rationalizes its portfolio. The company plans to use its legacy fusion business to fuel growth in areas such as motion preservation and minimally invasive surgery.
The opportunity here is to transition more patients from fusion to new modalities. These are great market development opportunities requiring substantial clinical selling, which we believe we can leverage to our advantage.
Vafa Jamali, ZimVie CEO
Medtronic leveraged improving procedure volumes in the U.S. and implant pull-through from its digital ecosystem to offset VBP and currency headwinds. DePuy Synthes and Stryker fell behind the competition in the enabling technology segment, which hurt their spine performance.
Globus Medical surprised many observers by using its plentiful cash reserves to double down on the spine market with its acquisition of NuVasive. The company will have to buck a trend of failed M&A integrations in the segment by meshing two very different cultures.
Important Developments in the Spine Market
Too Big to Grow?
Globus Medical’s decision to acquire NuVasive made some wonder if the company is approaching the point of diminishing returns in the segment. Medtronic is the only spine company with more than 20% market share. It, too, faced questions about its ability to drive topline growth.
Evercore analyst Vijay Kumar said, “I do feel like one of the better theses is Medtronic is too big to grow.” The new Globus Medical still has some headroom before reaching that threshold. The company believes that it can defy the industry’s recent history of troubled spine company integrations and grow above the market average going forward.
It’s human nature to have some discomfort with change, but we don’t need to beg. Globus pays strongly for its reps, and we’ve been doing that historically without change, unlike other companies. We’re talking about strong compensation with arguably the strongest product offering in the spine market.
Dan Scavilla, Globus Medical CEO
Not a Division of a Division
Since it bottomed out in 2018, ATEC’s turnaround is one of the best growth stories in orthopedics. With a CAGR of nearly 40% since 2018, the company rocketed up the revenue ranks in spine. ATEC expects revenues of $555 million by 2025 and a cashflow breakeven point when a revenue run rate reaches between $500 million and $600 million. ATEC’s eminently confident CEO Pat Miles sees the company as a standard bearer in the market that’s focused solely on spine surgery, rather than a “division of a division” at a conglomerate.
The Move Toward Intelligent Surgery
The gravitational pull of enabling technology is difficult to escape in the spine market. According to former NuVasive CEO Chris Barry, the future of spine surgery does not lie with a new interbody implant or innovative procedure. He believes it will be defined by patient selection, surgical planning, intraoperative technology and postoperative outcomes management for patient and surgeon. Stryker’s growth is marred by an enabling technology gap in spine that must be fixed before it can grow above the segment’s market average.
Further Reading
Thanks for visiting! Need more insight on the spine market? Questions and comments are always welcome. You can reach me by email. I’ll be back soon with updates to this page as we complete our projections for the 2023 finish.
Until then, I’ve selected a few posts that give insight into our thinking on the spine market.
September 7, 2023
,
Mike Evers
February 15, 2023
,
Mike Evers
Welcome to our spine implant market report, a companion to the spine chapter in THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT®. The competitive landscape has shifted dramatically in recent quarters, and we anticipate more changes. The spine market surpassed $9.8 billion in sales in 2022 and accounts for 17.8% of the $55 billion global orthopedic market.
Market Definition
Hardware to treat degenerative disc disease, herniated discs, scoliosis and vertebral fractures.
November 2023
Mike Evers, Senior Market Analyst
Welcome to our spine implant market report, a companion to the spine chapter in THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT®. The competitive landscape has shifted dramatically in recent quarters, and we anticipate more changes. I’ll be back in late November with important segment updates and our year-end projections. See you soon!
The Market at a Glance
The spine market surpassed $9.8 billion in sales in 2022 and accounts for 17.8% of the $55 billion global orthopedic market. Spine has highly favorable patient demographics, but growth in core fusion products has slowed to the low single digits. Companies increasingly rely on acquisitions, enabling technology pull-through and new opportunities like motion preservation to drive growth.
Market Forecast
We project that the global spine market will grow to $10 billion in 2023, as its growth accelerates slightly to +2.2%. An expanding patient population and adoption of new treatment options will drive the market to $10.9 billion by 2026.
Exhibit 1: Worldwide Spine Sales by Year ($millions)
Get More Orthopedic Market Data. Download the Orthopedic Revenue Matrix for our most complete and granular numbers. It contains worldwide orthopedic sales for 67 public and private companies by segment from 2016 through 2022.
Core fusion products make up most of the market and grew in the low single digits. Sales from fusion technologies often help companies fund market expansion of less invasive techniques and motion-preserving implants. Artificial disc replacement is an increasingly competitive space with low double-digit growth.
Patient demographics, new market opportunities and reduced upside in the Chinese market are three of the many factors we considered in creating our forecast for the spine segment.
A Compounding, Global Problem
The global population aged 60 years or older will double by 2050. Back pain affects 1 in 10 people globally and costs $560 billion in the U.S. due to treatment costs and productivity loss. It is the primary cause of disability in the U.S.
The spine market clearly has highly favorable patient demographics, but the patients pose a monumental challenge for the healthcare system and overall society. Spine companies seek ways to improve the efficiency and accuracy of their treatment without ballooning the costs of care.
Fostering New Markets
Companies are looking to underserved markets to accelerate growth as the fusion market slows. ZimVie plans to use its large fusion business to fund the development of markets like disc replacement and vertebral body tethering. Those two markets represent a $1.2 billion opportunity into which companies have made relatively few inroads.
Minimally invasive surgery and motion preservation devices have technical and reimbursement challenges to overcome before surgeons transition fusion patients in meaningful numbers. However, multiple companies, including Premia Spine and Empirical Spine, are pursuing novel motion-preserving products.
Surgeon reimbursement continues to be a challenge in some areas, but the differential between fusion and motion preservation is lessening year-to-year. We think we are approaching a tipping point in the market where total disc replacement will become more of the standard of care.
Steven Murray, Centinel Spine CEO
National Tender in China
While there have been provincial volume-based procurement (VBP) tenders for spine in China, companies are preparing for a national tender like the ones established for joint replacement and trauma. Those tenders led to drastic price reductions and volume shifts to domestic Chinese companies.
Some companies like ZimVie pulled up stakes and left the market altogether. However, companies like Medtronic that have large footprints in China plan to offset the price decreases with reduced selling and marketing costs. We expect VBP will remain a headwind in spine throughout 2023 and into 2024.
Other Segment Reports
Orthopedic Market Overview
October 26, 2023
Joint Replacement Implant Market
October 26, 2023
Trauma Implant Market
October 26, 2023
Sports Medicine Market
October 26, 2023
Orthobiologics Market
October 26, 2023
Enabling Technology Market
October 26, 2023
Sales by Region
Procedure volumes recovered well in the U.S. and regions of EMEA in 2022. However, lingering COVID surges from late 2021 caused significant disruption in markets like Australia, China and Brazil. VBP remains a significant factor for companies competing in China, while a strengthening U.S. dollar created mid-single-digit headwinds for global companies.
The U.S. accounted for 70% or nearly $7 billion in spine market sales in 2022, while OUS markets reached $2.9 billion in sales.
Exhibit 2: Spine Sales by Region ($millions)
| Region | FY22 | FY21 | $ Chg | % Chg |
|---|---|---|---|---|
| US | $6,967.0 | $6,638.0 | $329.0 | 5% |
| OUS | $2,901.3 | $3,038.4 | ($137.1) | (4.5%) |
| EMEA | $1,598.7 | $1,567.6 | $31.1 | 2% |
| APAC | $1,026.3 | $1,170.8 | ($144.5) | (12.3%) |
| ROW | $276.3 | $300.0 | ($23.7) | (7.9%) |
| Total | $9,868.2 | $9,676.3 | $191.9 | 2% |
Exhibit 3: Spine Market Share by Region ($millions)
Top Companies
Medtronic owns nearly 23% of the spine market. Globus Medical completed its acquisition of NuVasive in the second-half of 2023, making it the number two player in the space with 17.4% share.
Spine now features four companies – Medtronic, Globus, DePuy Synthes and Stryker – with more than $1 billion in annual sales that represent 65% of the entire market.
Please note that enabling technology is not included in our spine sales figures and can be found in a separate market overview.
Exhibit 4: Top 10 Spine Players and All Others ($millions)
| Company | FY22 | FY21 | $ Chg | % Chg |
|---|---|---|---|---|
| Medtronic | $2,246.9 | $2,206.7 | $40.2 | 1.8% |
| DePuy Synthes | $1,208.0 | $1,273.8 | ($65.8) | (5.2%) |
| Stryker | $1,191.4 | $1,209.8 | ($18.3) | (1.5%) |
| NuVasive | $859.5 | $807.8 | $51.6 | 6.4% |
| Globus Medical | $857.0 | $818.1 | $38.9 | 4.8% |
| ZimVie | $350.8 | $420.1 | ($69.3) | (16.5%) |
| ATEC | $270.9 | $192.8 | $78.1 | 40.5% |
| Aesculap | $154.8 | $149.7 | $5.1 | 3.4% |
| ulrich medical | $141.5 | $135.0 | $6.5 | 4.8% |
| SeaSpine * | $122.8 | $93.6 | $29.2 | 31.2% |
| All Others | $2,464.7 | $2,369.0 | $95.7 | 4% |
| Total | $9,868.2 | $9,676.3 | $191.9 | 2% |
Exhibit 5: Spine Market Share by Company ($millions)
* As a reminder, the merger between Orthofix and SeaSpine closed in the first few days of 2023. The data shown here represents SeaSpine stand-alone sales.
ATEC dominated the mid-tier spine market with better than 40% growth in 2022. This part of the market also saw consolidation in the merger between Orthofix and SeaSpine. The combined Orthofix organization is still a single-digit market share player in spine, but closed the gap on companies like ATEC and ZimVie.
Over the next five years, ZimVie is likely to take a few steps back as it exits unprofitable geographies and rationalizes its portfolio. The company plans to use its legacy fusion business to fuel growth in areas such as motion preservation and minimally invasive surgery.
The opportunity here is to transition more patients from fusion to new modalities. These are great market development opportunities requiring substantial clinical selling, which we believe we can leverage to our advantage.
Vafa Jamali, ZimVie CEO
Medtronic leveraged improving procedure volumes in the U.S. and implant pull-through from its digital ecosystem to offset VBP and currency headwinds. DePuy Synthes and Stryker fell behind the competition in the enabling technology segment, which hurt their spine performance.
Globus Medical surprised many observers by using its plentiful cash reserves to double down on the spine market with its acquisition of NuVasive. The company will have to buck a trend of failed M&A integrations in the segment by meshing two very different cultures.
Important Developments in the Spine Market
Too Big to Grow?
Globus Medical’s decision to acquire NuVasive made some wonder if the company is approaching the point of diminishing returns in the segment. Medtronic is the only spine company with more than 20% market share. It, too, faced questions about its ability to drive topline growth.
Evercore analyst Vijay Kumar said, “I do feel like one of the better theses is Medtronic is too big to grow.” The new Globus Medical still has some headroom before reaching that threshold. The company believes that it can defy the industry’s recent history of troubled spine company integrations and grow above the market average going forward.
It’s human nature to have some discomfort with change, but we don’t need to beg. Globus pays strongly for its reps, and we’ve been doing that historically without change, unlike other companies. We’re talking about strong compensation with arguably the strongest product offering in the spine market.
Dan Scavilla, Globus Medical CEO
Not a Division of a Division
Since it bottomed out in 2018, ATEC’s turnaround is one of the best growth stories in orthopedics. With a CAGR of nearly 40% since 2018, the company rocketed up the revenue ranks in spine. ATEC expects revenues of $555 million by 2025 and a cashflow breakeven point when a revenue run rate reaches between $500 million and $600 million. ATEC’s eminently confident CEO Pat Miles sees the company as a standard bearer in the market that’s focused solely on spine surgery, rather than a “division of a division” at a conglomerate.
The Move Toward Intelligent Surgery
The gravitational pull of enabling technology is difficult to escape in the spine market. According to former NuVasive CEO Chris Barry, the future of spine surgery does not lie with a new interbody implant or innovative procedure. He believes it will be defined by patient selection, surgical planning, intraoperative technology and postoperative outcomes management for patient and surgeon. Stryker’s growth is marred by an enabling technology gap in spine that must be fixed before it can grow above the segment’s market average.
Further Reading
Thanks for visiting! Need more insight on the spine market? Questions and comments are always welcome. You can reach me by email. I’ll be back soon with updates to this page as we complete our projections for the 2023 finish.
Until then, I’ve selected a few posts that give insight into our thinking on the spine market.
September 7, 2023
,
Mike Evers
February 15, 2023
,
Mike Evers
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