Hardware to treat degenerative disc disease, herniated discs, scoliosis and vertebral fractures.
January 2024
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 spine market surpassed $10.4 billion in sales in 2023, accounting for 17.6% 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 acquisitions, enabling technology pull-through and new opportunities like motion preservation to drive growth.
We estimate that the global spine market grew to $10.4 billion in 2023, reflecting accelerated growth of +5.4%. An expanding patient population and adoption of new treatment options will drive the market to $11.7 billion by 2027.
Exhibit 1: Worldwide Spine Sales by Year ($millions)
Get More Orthopedic Market Data. Download the Orthopedic Revenue Matrix for our most complete and granular numbers. It contains worldwide orthopedic sales for 68 public and private companies by segment from 2016 through 2023.
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 short-term market volatility are three of the many factors we considered in creating our forecast for the spine segment.
Demand for spine surgery 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 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. Spine companies seek ways to improve the efficiency and accuracy of their treatment without ballooning the costs of care.
Companies are looking to underserved markets to accelerate growth as the fusion market slows. Disc replacement and vertebral body tethering, for example, 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.
The spine market showed more resilience during the pandemic than some segments, but it did build up a modest backlog that drove sales overperformance in 2023. Those elevated volumes will drive more growth in 2024 but taper to normalized levels in 2025. However, continuing supply chain pressure, volume-based procurement in China and competitive landscape shakeups will offset some of spine’s short-term upside.
Procedure volumes recovered well in the U.S. and regions of EMEA in 2023. VBP remains a significant factor for companies competing in China. The U.S. accounted for 71% or nearly $7.4 billion in spine market sales in 2023, while OUS markets reached $3 billion in sales.
Exhibit 2: Spine Sales by Region ($millions)
Spine | FY23 | FY22 | $ Chg | % Chg |
---|---|---|---|---|
US | $7,355.7 | $6,967.0 | $388.7 | 5.6% |
OUS | $3,048.4 | $2,901.3 | $147.1 | 5.1% |
EMEA | $1,706.3 | $1,598.7 | $107.6 | 6.7% |
APAC | $1,050.8 | $1,026.3 | $24.5 | 2.4% |
ROW | $291.3 | $276.3 | $15.0 | 5.4% |
Total | $10,404.1 | $9,868.2 | $535.9 | 5.4% |
Exhibit 3: Spine Market Share by Region ($millions)
Medtronic owns nearly 22% 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 a 17.5% share on a pro forma basis.
Spine now features three companies – Medtronic, Globus, and Stryker – with more than $1 billion in annual spinal hardware sales, representing 50% of the market.
Please note that enabling technology is not included in our spine sales figures and can be found in a separate market overview.
Exhibit 4: Top 10 Spine Players and All Others ($millions)
Company | FY23E | FY22A | $ Chg | % Chg |
---|---|---|---|---|
Medtronic | $2,234.0 | $2,186.7 | $47.3 | 2.2% |
Globus Medical * | $1,816.1 | $1,438.9 | $377.3 | 26.2% |
Stryker | $1,182.0 | $1,145.8 | $36.2 | 3.2% |
DePuy Synthes | $898.4 | $933.1 | ($34.7) | (3.7%) |
ATEC | $369.7 | $270.9 | $98.8 | 36.5% |
ZimVie | $315.0 | $350.8 | ($35.8) | (10.2%) |
Orthofix * | $255.7 | $223.9 | $31.8 | 14.2% |
Aesculap | $162.5 | $154.8 | $7.7 | 5% |
ulrich medical | $151.0 | $141.5 | $9.5 | 6.7% |
SI-BONE | $136.5 | $106.4 | $30.1 | 28.3% |
All Others | $2,883.1 | $2,915.4 | ($32.3) | (1.1%) |
Segment Total | $10,404.1 | $9,868.2 | $535.9 | 5.4% |
Exhibit 5: Spine Market Share by Company ($millions)
* On a pro forma basis.
ATEC dominated the mid-tier spine market 36.5% growth in 2023. 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.
ZimVie threw in the towel on spine in late 2023, selling off that business to become a pure-play dental company.
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.
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.
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.
Since it bottomed out in 2018, ATEC’s turnaround is one of the best growth stories in orthopedics. With a CAGR over 31% 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 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.
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.
Our overview of the $10 billion spine implant market includes up-to-date information on forecasted growth, the top companies and industry-driving trends.
Hardware to treat degenerative disc disease, herniated discs, scoliosis and vertebral fractures.
January 2024
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 spine market surpassed $10.4 billion in sales in 2023, accounting for 17.6% 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 acquisitions, enabling technology pull-through and new opportunities like motion preservation to drive growth.
We estimate that the global spine market grew to $10.4 billion in 2023, reflecting accelerated growth of +5.4%. An expanding patient population and adoption of new treatment options will drive the market to $11.7 billion by 2027.
Exhibit 1: Worldwide Spine Sales by Year ($millions)
Get More Orthopedic Market Data. Download the Orthopedic Revenue Matrix for our most complete and granular numbers. It contains worldwide orthopedic sales for 68 public and private companies by segment from 2016 through 2023.
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 short-term market volatility are three of the many factors we considered in creating our forecast for the spine segment.
Demand for spine surgery 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 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. Spine companies seek ways to improve the efficiency and accuracy of their treatment without ballooning the costs of care.
Companies are looking to underserved markets to accelerate growth as the fusion market slows. Disc replacement and vertebral body tethering, for example, 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.
The spine market showed more resilience during the pandemic than some segments, but it did build up a modest backlog that drove sales overperformance in 2023. Those elevated volumes will drive more growth in 2024 but taper to normalized levels in 2025. However, continuing supply chain pressure, volume-based procurement in China and competitive landscape shakeups will offset some of spine’s short-term upside.
Procedure volumes recovered well in the U.S. and regions of EMEA in 2023. VBP remains a significant factor for companies competing in China. The U.S. accounted for 71% or nearly $7.4 billion in spine market sales in 2023, while OUS markets reached $3 billion in sales.
Exhibit 2: Spine Sales by Region ($millions)
Spine | FY23 | FY22 | $ Chg | % Chg |
---|---|---|---|---|
US | $7,355.7 | $6,967.0 | $388.7 | 5.6% |
OUS | $3,048.4 | $2,901.3 | $147.1 | 5.1% |
EMEA | $1,706.3 | $1,598.7 | $107.6 | 6.7% |
APAC | $1,050.8 | $1,026.3 | $24.5 | 2.4% |
ROW | $291.3 | $276.3 | $15.0 | 5.4% |
Total | $10,404.1 | $9,868.2 | $535.9 | 5.4% |
Exhibit 3: Spine Market Share by Region ($millions)
Medtronic owns nearly 22% 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 a 17.5% share on a pro forma basis.
Spine now features three companies – Medtronic, Globus, and Stryker – with more than $1 billion in annual spinal hardware sales, representing 50% of the market.
Please note that enabling technology is not included in our spine sales figures and can be found in a separate market overview.
Exhibit 4: Top 10 Spine Players and All Others ($millions)
Company | FY23E | FY22A | $ Chg | % Chg |
---|---|---|---|---|
Medtronic | $2,234.0 | $2,186.7 | $47.3 | 2.2% |
Globus Medical * | $1,816.1 | $1,438.9 | $377.3 | 26.2% |
Stryker | $1,182.0 | $1,145.8 | $36.2 | 3.2% |
DePuy Synthes | $898.4 | $933.1 | ($34.7) | (3.7%) |
ATEC | $369.7 | $270.9 | $98.8 | 36.5% |
ZimVie | $315.0 | $350.8 | ($35.8) | (10.2%) |
Orthofix * | $255.7 | $223.9 | $31.8 | 14.2% |
Aesculap | $162.5 | $154.8 | $7.7 | 5% |
ulrich medical | $151.0 | $141.5 | $9.5 | 6.7% |
SI-BONE | $136.5 | $106.4 | $30.1 | 28.3% |
All Others | $2,883.1 | $2,915.4 | ($32.3) | (1.1%) |
Segment Total | $10,404.1 | $9,868.2 | $535.9 | 5.4% |
Exhibit 5: Spine Market Share by Company ($millions)
* On a pro forma basis.
ATEC dominated the mid-tier spine market 36.5% growth in 2023. 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.
ZimVie threw in the towel on spine in late 2023, selling off that business to become a pure-play dental company.
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.
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.
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.
Since it bottomed out in 2018, ATEC’s turnaround is one of the best growth stories in orthopedics. With a CAGR over 31% 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 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.
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.
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