Spine Implant Market Size and Share
Market Definition
Hardware to treat degenerative disc disease, herniated discs, scoliosis and vertebral fractures.
October 2024 (update coming January 2025)
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.
The Market at a Glance
The spine market surpassed $10.4 billion in sales in 2023, accounting for 18% of the $59 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 a few factors to drive growth: acquisitions of competitors, implant pull-through spurred by enabling technology and new opportunities like motion preservation.
Market Forecast
As the market settles after a period of major consolidation, we expect 2024 spine sales of $10.8 billion. We estimate the market will grow to $11.8 billion by 2027. Favorable demographics and expanding treatment options beyond fusion will impact the mid-term growth rate.
Exhibit 1: Worldwide Spine Sales by Year ($millions)
Get More Orthopedic Market Data. Download the Orthopedic Companies Sales Matrix for our most complete and granular numbers. It contains worldwide orthopedic sales for 75 public and private companies by segment from 2016 through 2024.
Here are some of the spine market dynamics we considered in our forecasts:
Accelerating Demand for Care
Spine’s surgical volumes will increase as the global population grows and ages. The number of people aged 60 or older will double between 2020 and 2050, from 1 billion to 2.1 billion. Back pain affects 1 in 10 people globally and is the primary cause of disability in the U.S., costing the government $560 billion annually due to treatment expenses and productivity loss. Spine companies seek ways to improve the efficiency and accuracy of treatment without ballooning the costs of care.
Emerging Opportunities
Companies are looking to underserved markets to accelerate growth as the fusion market slows. For example, disc replacement and vertebral body tethering 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, Empirical Spine and 3Spine, are pursuing novel motion-preserving products.
The outcomes of current artificial disc replacement are extremely positive, but facet issues, stenosis and instability will continue to limit ADR indications. Our big advantage comes from treating all pain generators and correcting segmental alignment issues.
Scott Hodges, D.O., 3Spine Co-founder and Medical Director
Mixed Short-term Environment
The spine market showed more resilience during the pandemic than some other segments, but it did build up a modest backlog that drove overperformance of sales in 2023. Those elevated volumes will drive more growth in 2024 but taper to normalized levels in 2025. However, continuing supply chain pressure, VBP in China and competitive landscape shakeups will offset some of spine’s short-term upside.
Sales by Region
VBP caused the Chinese spine market to contract during 2022 and 2023. However, the largest global spine companies remain committed to the market after its reset. By reducing sales and marketing costs in China, companies like Medtronic can remain profitable in what will be the world’s largest healthcare market.
According to the International Monetary Fund, China’s over-65 cohort will reach 400 million by 2049. The over-85 cohort will triple to 150 million, surpassing their peers in the United States and Europe combined.
Spine players reported strength in the European markets but must contend with the forthcoming Medical Device Regulation (MDR). Orthofix said its 2023 MDR expenses were $9.5 million, with an expected annual run rate of $3 million. Before its merger with Orthofix, SeaSpine decided to pull its spinal implants from the European market rather than incur the costs.
Exhibit 2: Spine Sales by Region ($millions)
| Region | FY23 | FY22 | $ Chg | % Chg |
|---|---|---|---|---|
| US | $7,361.7 | $6,967.0 | $394.7 | 5.7% |
| OUS | $3,050.9 | $2,901.3 | $149.6 | 5.2% |
| EMEA | $1,707.7 | $1,598.7 | $109.0 | 6.8% |
| APAC | $1,051.7 | $1,026.3 | $25.4 | 2.5% |
| ROW | $291.6 | $276.3 | $15.2 | 5.5% |
| Total | $10,412.6 | $9,868.2 | $544.4 | 5.5% |
Exhibit 3: Spine Market Share by Region ($millions)
Top Companies
Medtronic accounts for 21% of global spine sales, while Globus Medical became the clear number two player in the market with just under 18% share after its merger with NuVasive. Medtronic, Globus Medical and Stryker are the only companies with over $1 billion in annual spinal hardware sales. Combined, they account for 50% of the total market.
Exhibit 4: Top 10 Spine Players and All Others ($millions)
| Company | FY23 | FY22 | $ Chg | % Chg |
|---|---|---|---|---|
| Medtronic | $2,234.0 | $2,186.7 | $47.3 | 2.2% |
| Globus Medical | $1,863.3 | $1,711.6 | $151.7 | 8.9% |
| Stryker | $1,188.9 | $1,145.8 | $43.0 | 3.8% |
| DePuy Synthes | $944.0 | $940.0 | $4.0 | 0.4% |
| ATEC | $377.7 | $270.9 | $106.8 | 39.4% |
| ZimVie | $316.1 | $351.4 | ($35.3) | (10%) |
| Orthofix | $266.3 | $223.9 | $42.4 | 18.9% |
| Aesculap | $164.0 | $156.2 | $7.8 | 5% |
| ulrich medical | $152.4 | $142.8 | $9.6 | 6.7% |
| SI-BONE | $138.9 | $106.4 | $32.5 | 30.5% |
| All Others | $2,766.9 | $2,632.4 | $134.5 | 5.1% |
| Segment Total | $10,412.6 | $9,868.2 | $544.4 | 5.5% |
Exhibit 5: Spine Market Share by Company ($millions)
* On a pro forma basis.
Medtronic found itself with credible competition after the Globus Medical/NuVasive merger. However, Medtronic’s years as the market leader helped it build a robot install base that exceeds 10,000 systems, which the company said is four times more than its nearest competitor.
Globus Medical is facing a multi-year integration in a market segment with few such success stories. While rep overlap appears to be minimal, Globus is projecting low-single-digit growth for 2024 on a pro forma basis as it works through dissynergies. Eventually, its newfound scale will help it go head-to-head with Medtronic while fending off fresh challenges from Stryker’s and DePuy Synthes’ spine robots.
By the time our acquisition of NuVasive was unblinded, our rep overlap was about 3% in the U.S. We didn’t have to do a major amount of untangling, just reorganizing for efficiency. We have a lot of reps, we need all our reps.
Keith Pfeil, Globus Medical COO and CFO
Disruption from consolidation also hit mid-tier companies, as Orthofix looked to realign its priorities after merging with SeaSpine. ZimVie couldn’t find a tenable way forward with its spine business and opted to sell those assets in early 2024.
ATEC remains the primary beneficiary of the spine market’s disruption and distraction. The company has made small acquisitions around enabling technology, but it probably needs to make a major move to drive scale before it cracks the upper echelon of companies.
Important Developments in the Spine Market
Longtail Disruption
While overall M&A has slowed significantly, spine still provided some of the most consequential deals in the orthopedic industry’s recent history. Globus Medical and Orthofix shook up the market with their respective mergers, while privately-held Highridge Medical emerged out of ZimVie’s spine assets. Impacts from those moves will play out over several years. But, judging from executive commentary, the disruption isn’t a one-way street. Several companies sounded bullish on competitive recruiting within the upended spine market.
Technology Shifting Competitive Dynamics
Scale alone is no longer enough to compete at the top levels of spine. Enabling technology’s role is expanding across orthopedics, but it has become a strategic necessity for the market’s biggest players. Mid-tier companies like Orthofix and ATEC recognize the value of technology in spine surgery, while Augmedics’ AR-based navigation technology continues to draw investor dollars despite the tough funding environment.
Accounts are making investments in a company now. The Medtronic ecosystem versus some other ecosystem, and there’s not many out there. It’s also changing the industry structure because it takes a lot of expertise and capital to build these ecosystems. You don’t have this long tail of tiny spine companies that are preying on docs. Those are going away.
Geoffrey Martha, Medtronic CEO
Smaller Players Developing Breakthrough Devices
Nearly 29% of all orthopedic investments made since 2016 went to spine companies. The next highest category is enabling technology, a segment with significant spine overlap, at 19%. Despite a challenging funding environment, spine is on pace for its second-highest funding volume in nearly a decade. Companies like Bioretec, Canary Medical, MiRus, ORTHOSON and Renovos received FDA breakthrough device designations in 2024, joining Carlsmed and Premia Spine as recent designees.
Further Reading
Thanks for visiting! Need more insight on the spine market? Questions and comments are always welcome. You can reach me by email. Until then, I’ve selected a few posts that give insight into our thinking on the spine market.
September 13, 2024
,
Julie A. Vetalice
September 6, 2024
,
Carolyn LaWell
Our overview of the $10 billion spine implant market includes up-to-date information on forecasted growth, the top companies and industry-driving trends.
Market Definition
Hardware to treat degenerative disc disease, herniated discs, scoliosis and vertebral fractures.
October 2024 (update coming January 2025)
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.
The Market at a Glance
The spine market surpassed $10.4 billion in sales in 2023, accounting for 18% of the $59 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 a few factors to drive growth: acquisitions of competitors, implant pull-through spurred by enabling technology and new opportunities like motion preservation.
Market Forecast
As the market settles after a period of major consolidation, we expect 2024 spine sales of $10.8 billion. We estimate the market will grow to $11.8 billion by 2027. Favorable demographics and expanding treatment options beyond fusion will impact the mid-term growth rate.
Exhibit 1: Worldwide Spine Sales by Year ($millions)
Get More Orthopedic Market Data. Download the Orthopedic Companies Sales Matrix for our most complete and granular numbers. It contains worldwide orthopedic sales for 75 public and private companies by segment from 2016 through 2024.
Here are some of the spine market dynamics we considered in our forecasts:
Accelerating Demand for Care
Spine’s surgical volumes will increase as the global population grows and ages. The number of people aged 60 or older will double between 2020 and 2050, from 1 billion to 2.1 billion. Back pain affects 1 in 10 people globally and is the primary cause of disability in the U.S., costing the government $560 billion annually due to treatment expenses and productivity loss. Spine companies seek ways to improve the efficiency and accuracy of treatment without ballooning the costs of care.
Emerging Opportunities
Companies are looking to underserved markets to accelerate growth as the fusion market slows. For example, disc replacement and vertebral body tethering 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, Empirical Spine and 3Spine, are pursuing novel motion-preserving products.
The outcomes of current artificial disc replacement are extremely positive, but facet issues, stenosis and instability will continue to limit ADR indications. Our big advantage comes from treating all pain generators and correcting segmental alignment issues.
Scott Hodges, D.O., 3Spine Co-founder and Medical Director
Mixed Short-term Environment
The spine market showed more resilience during the pandemic than some other segments, but it did build up a modest backlog that drove overperformance of sales in 2023. Those elevated volumes will drive more growth in 2024 but taper to normalized levels in 2025. However, continuing supply chain pressure, VBP in China and competitive landscape shakeups will offset some of spine’s short-term upside.
Sales by Region
VBP caused the Chinese spine market to contract during 2022 and 2023. However, the largest global spine companies remain committed to the market after its reset. By reducing sales and marketing costs in China, companies like Medtronic can remain profitable in what will be the world’s largest healthcare market.
According to the International Monetary Fund, China’s over-65 cohort will reach 400 million by 2049. The over-85 cohort will triple to 150 million, surpassing their peers in the United States and Europe combined.
Spine players reported strength in the European markets but must contend with the forthcoming Medical Device Regulation (MDR). Orthofix said its 2023 MDR expenses were $9.5 million, with an expected annual run rate of $3 million. Before its merger with Orthofix, SeaSpine decided to pull its spinal implants from the European market rather than incur the costs.
Exhibit 2: Spine Sales by Region ($millions)
| Region | FY23 | FY22 | $ Chg | % Chg |
|---|---|---|---|---|
| US | $7,361.7 | $6,967.0 | $394.7 | 5.7% |
| OUS | $3,050.9 | $2,901.3 | $149.6 | 5.2% |
| EMEA | $1,707.7 | $1,598.7 | $109.0 | 6.8% |
| APAC | $1,051.7 | $1,026.3 | $25.4 | 2.5% |
| ROW | $291.6 | $276.3 | $15.2 | 5.5% |
| Total | $10,412.6 | $9,868.2 | $544.4 | 5.5% |
Exhibit 3: Spine Market Share by Region ($millions)
Top Companies
Medtronic accounts for 21% of global spine sales, while Globus Medical became the clear number two player in the market with just under 18% share after its merger with NuVasive. Medtronic, Globus Medical and Stryker are the only companies with over $1 billion in annual spinal hardware sales. Combined, they account for 50% of the total market.
Exhibit 4: Top 10 Spine Players and All Others ($millions)
| Company | FY23 | FY22 | $ Chg | % Chg |
|---|---|---|---|---|
| Medtronic | $2,234.0 | $2,186.7 | $47.3 | 2.2% |
| Globus Medical | $1,863.3 | $1,711.6 | $151.7 | 8.9% |
| Stryker | $1,188.9 | $1,145.8 | $43.0 | 3.8% |
| DePuy Synthes | $944.0 | $940.0 | $4.0 | 0.4% |
| ATEC | $377.7 | $270.9 | $106.8 | 39.4% |
| ZimVie | $316.1 | $351.4 | ($35.3) | (10%) |
| Orthofix | $266.3 | $223.9 | $42.4 | 18.9% |
| Aesculap | $164.0 | $156.2 | $7.8 | 5% |
| ulrich medical | $152.4 | $142.8 | $9.6 | 6.7% |
| SI-BONE | $138.9 | $106.4 | $32.5 | 30.5% |
| All Others | $2,766.9 | $2,632.4 | $134.5 | 5.1% |
| Segment Total | $10,412.6 | $9,868.2 | $544.4 | 5.5% |
Exhibit 5: Spine Market Share by Company ($millions)
* On a pro forma basis.
Medtronic found itself with credible competition after the Globus Medical/NuVasive merger. However, Medtronic’s years as the market leader helped it build a robot install base that exceeds 10,000 systems, which the company said is four times more than its nearest competitor.
Globus Medical is facing a multi-year integration in a market segment with few such success stories. While rep overlap appears to be minimal, Globus is projecting low-single-digit growth for 2024 on a pro forma basis as it works through dissynergies. Eventually, its newfound scale will help it go head-to-head with Medtronic while fending off fresh challenges from Stryker’s and DePuy Synthes’ spine robots.
By the time our acquisition of NuVasive was unblinded, our rep overlap was about 3% in the U.S. We didn’t have to do a major amount of untangling, just reorganizing for efficiency. We have a lot of reps, we need all our reps.
Keith Pfeil, Globus Medical COO and CFO
Disruption from consolidation also hit mid-tier companies, as Orthofix looked to realign its priorities after merging with SeaSpine. ZimVie couldn’t find a tenable way forward with its spine business and opted to sell those assets in early 2024.
ATEC remains the primary beneficiary of the spine market’s disruption and distraction. The company has made small acquisitions around enabling technology, but it probably needs to make a major move to drive scale before it cracks the upper echelon of companies.
Important Developments in the Spine Market
Longtail Disruption
While overall M&A has slowed significantly, spine still provided some of the most consequential deals in the orthopedic industry’s recent history. Globus Medical and Orthofix shook up the market with their respective mergers, while privately-held Highridge Medical emerged out of ZimVie’s spine assets. Impacts from those moves will play out over several years. But, judging from executive commentary, the disruption isn’t a one-way street. Several companies sounded bullish on competitive recruiting within the upended spine market.
Technology Shifting Competitive Dynamics
Scale alone is no longer enough to compete at the top levels of spine. Enabling technology’s role is expanding across orthopedics, but it has become a strategic necessity for the market’s biggest players. Mid-tier companies like Orthofix and ATEC recognize the value of technology in spine surgery, while Augmedics’ AR-based navigation technology continues to draw investor dollars despite the tough funding environment.
Accounts are making investments in a company now. The Medtronic ecosystem versus some other ecosystem, and there’s not many out there. It’s also changing the industry structure because it takes a lot of expertise and capital to build these ecosystems. You don’t have this long tail of tiny spine companies that are preying on docs. Those are going away.
Geoffrey Martha, Medtronic CEO
Smaller Players Developing Breakthrough Devices
Nearly 29% of all orthopedic investments made since 2016 went to spine companies. The next highest category is enabling technology, a segment with significant spine overlap, at 19%. Despite a challenging funding environment, spine is on pace for its second-highest funding volume in nearly a decade. Companies like Bioretec, Canary Medical, MiRus, ORTHOSON and Renovos received FDA breakthrough device designations in 2024, joining Carlsmed and Premia Spine as recent designees.
Further Reading
Thanks for visiting! Need more insight on the spine market? Questions and comments are always welcome. You can reach me by email. Until then, I’ve selected a few posts that give insight into our thinking on the spine market.
September 13, 2024
,
Julie A. Vetalice
September 6, 2024
,
Carolyn LaWell
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