Surgical Robot for the Spine Market Shares, Strategies, and Forecasts, Worldwide, 2016 to 2022

Transcription

1 3 Surgical Robot for the Spine Market Shares, Strategies, and Forecasts, Worldwide, 2016 to 2022 Mountains of Opportunity Picture by Susan Eustis WinterGreen Research, Inc. Lexington, Massachusetts

2 CHECK OUT THESE KEY TOPICS Spine Surgical Robots Support Spinal Repair and Pain Relief Spine Surgical Robot Smart Instruments Medical Devices Healthcare Implant Enabling Technology Robotically-Assisted Minimally Invasive Surgery Mounting Platforms, Disposables, and Accessories Surgical Workflow Using Mazor Renaissance Robot Three-Dimensional (3D) Synchronization Spine Surgical Execution Spine Robot Surgery Spinal Fusion Scoliosis Surgery Renaissance System For Robotic Guidance Renaissance Spine Procedures Robotics Spine Procedures Robotics Clinical Study Spine Surgical Robott Growth Strategy: Robotics Reduced Exposure to Radiation Spinal Surgical System Minimally-Invasive Spinal Surgery, Next Generation Spine RobotSurgery Flexible Surgical Platform Minimally Invasive Surgery MIS Spinal Surgical Robots: Market Shares, Strategies, and Forecasts, Worldwide, LEXINGTON, Massachusetts (February 2, 2016) WinterGreen Research announces that it has published a new study Surgical Robots for the Spine: Market Shares, Strategy, and Forecasts, Worldwide, 2016 to The 2016 study has 313 pages, 111 tables and figures. Worldwide spinal surgical robot markets are poised to achieve significant growth with the adaptation of robotic technology to the second most widely performed surgical procedure, spinal surgery. Aging of the population and hospital cost reductions through decreased length of stay are key market driving forces. Spinal surgical robots increase spine surgery repeatability and accuracy. Back conditions can result in instability and compression of the spinal nerves, causing back pain and/or radiating pain in the legs. Robotic procedures offer significant cost savings in terms of pre- and postoperation care costs and length of stay at hospitals. Technological advances and breakthroughs leverage new materials and new sensor configurations. Sophisticated software is further evolving product implementation.

3 In the United States, there are 1.34 million spinal operations performed annually, worldwide there are 4.83 million annually. Patients have problems with degenerative conditions and injury. 11 million people in the U.S. and 78 million people worldwide suffer from chronic back pain in 2015, indicating the potential for more surgery if the accuracy and pain relief can be alleviated with better surgery from robots. Sacroiliac (SI) joint dysfunction is responsible for up to 30 to 35 percent of lower back pain. Surgery is performed to relieve the pain when other means do not work. Robots improve the accuracy of procedures and reduce the complication rates in spinal surgeries. The Mazor robots are flexible. Mazor Renaissance disposable kits are designed to easily adapt the RBT Device to a multitude of surgical applications and for the different mounting platforms utilized by the surgeon. Renaissance spine accessories are offered. Mazor Renaissance accessories include trays of reusable surgical tools. Pre-operative planning of the procedure is used for intra-operative control of the system. The surgery is performed according to the pre-operative plan. Renaissance provides increased safety and precision in corrective surgery. It allows surgeons to plan ahead before entering the operating room. Mazor Robotics advanced 3D planning software is used before surgery to create the procedure with modification and customization for each patient s condition. During the operation, the physician does the actual work; Renaissance guides the surgeon s tools according to the predetermined blueprint to place the implants safely and with the highest level of accuracy in the exact planned locations. Robot-guidance increases the accuracy and safety of surgical procedures. It allows these procedures to be performed with less intra-operative radiation exposure to patients and health care providers. Robotguided spine surgery allows surgeons to perform less invasive surgical procedures with smaller incisions, less bleeding, faster recovery and shorter hospital stays. Minimally invasive surgeries to increase repeatability and accuracy through the use of robots. Surgical robots improve the accuracy of procedures and thus reduce the complication rates in surgeries. Robotic procedures offer significant cost savings in terms of pre- and post-operation care costs and length of stay at hospitals. Technological advances and breakthroughs leverage new materials and new sensor configurations. Sophisticated software is further evolving product implementation. Clinically efficient solutions Clinically less complex surgery Shorter length of stay Minimally invasive surgery Financially lower cost Operationally more simple Old people have trouble making their joints last as long as they do. The patient stability and the relief from pain provided by the robot surgery is compelling. The major suppliers are looking at providing spinal robots that are based on the Mazor state of the art devices.

4 Spinal surgery has evolved dramatically over the years as advances in technology have made it possible to improve surgical techniques. Mazor is the market leader by far in the spinal surgical robot market, the only company with measurable market share. Spinal surgery involves the modification of the affected area of the back bones and nerves. The implantation of one or more screws or components is a very delicate surgery. The robot can achieve better precision than can a skilled surgeon. The robot is more consistent. Reconstructive spinal surgery depends on precision instruments. Robots are expected to grow significantly in surgery. Once, the penetration of spinal robots achieves the level of 35% of penetration in a country, all spinal surgeons will demand that hospitals offer spinal surgical robot capability because the outcomes are more predictable and better. The surgeons can give better pain relief to their patients, so naturally, given a choice of hospitals, they will pick the one that has the robot that gives superior outcomes. Spinal surgical markets have been impacted by the reduction in insurance payments. Payment reductions have forced hospitals to act as businesses. The cost of delivering care has become as much a factor as providing quality care when making decisions about patient improvement in condition. Costcutting has been made in the supply chain. Suppliers are examined closely for quality and cost. The number of suppliers is sure to increase. As Mazor grows its penetration of the market, the larger market participants in spinal surgery equipment will surely follow. Mazor is positioned to continue to dominate the market. As the first providers it builds a strong base of surgeons who are trained in using the equipment these surgeons will continue to purchase updated robots as they are offered to the market. The new are pressured to improve prices and efficiencies. Hospitals, physicians, and care providers have been financially incentivized to create accountable care organizations (ACOs). Coordinated patient care plans and value-based purchasing were rewarded. The med device buyer shifted from physicians to the ACOs and smart buying groups. According to Susan Eustis, lead author of the study, Use of the robotic spinal surgery represents a key milestone in reconstructive surgery. Robots provide an opportunity to transform orthopedics. New materials and new designs are bringing that transformation forward. By furthering the growth of innovation with spinal surgery robots, patients can get better treatment. By enhancing the surgeon and patient experience is is likely that the entire market will grow rapidly. The worldwide market for spinal surgical robots is $26 million anticipated to reach $2.77 billon by The complete report provides a comprehensive analysis including procedure numbers, units sold, market value, forecasts, as well as a detailed competitive market shares and analysis of major players success, challenges, and strategies in each segment and sub-segment. The reports cover markets for surgery medical specialties and sub-specialties.

5 WinterGreen Research is an independent research organization funded by the sale of market research studies all over the world and by the implementation of ROI models that are used to calculate the total cost of ownership of equipment, services, and software. The company has 35 distributors worldwide, including Global Information Info Shop, Market Research.com, Research and Markets, Bloomberg, and Thompson Financial. It conducts its business with integrity. WinterGreen Research is an independent research organization funded by the sale of market research studies all over the world and by the implementation of ROI models that are used to calculate the total cost of ownership of equipment, services, and software. The company has 35 distributors worldwide, including Global Information Info Shop, Market Research.com, Research and Markets, and Thompson Financial. WinterGreen Research is positioned to help customers facing challenges that define the modern enterprises. The increasingly global nature of science, technology and engineering is a reflection of the implementation of the globally integrated enterprise. Customers trust wintergreen research to work alongside them to ensure the success of the participation in a particular market segment. WinterGreen Research supports various market segment programs; provides trusted technical services to the marketing departments. It carries out accurate market share and forecast analysis services for a range of commercial and government customers globally. These are all vital market research support solutions requiring trust and integrity. Key Words: Spine Surgical Robot, Smart Instruments, Medical Devices, Healthcare Implant, Enabling Technology, Robotically- Assisted Minimally Invasive Surgery, Mounting Platforms, Disposables, and Accessories, Surgical Workflow Using Mazor Renaissance, Robot Three-Dimensional (3D) Synchronization, Spine Surgical Execution, Spine Robot Surgery, Spinal Fusion, Scoliosis Surgery, Renaissance System For Robotic Guidance, Renaissance Spine Procedures, Robotics Spine Procedures, Robotics Clinical Study, Robotics Reduced Exposure to Radiation, Spinal Surgical System, Minimally-Invasive Spinal Surgery,, Next Generation Spine RobotSurgery, Flexible Surgical Platform, Minimally Invasive Surgery, MIS., Companies Profiled Market Leaders Mazor Market Participants Accel Spine Alliance Spine Alphatec Spine Apollo Spine Ascendx Spine Back 2 Basics Spine

6 Boston Scientific Brainlab AG Captiva Spine Centinel Spine Elekta Globus Medical K2M Life Spine Mazor Robotics Medacta Medtronic MicroPort Scientific Corporation NLT Spine NuVasive Precision Spine Shenzhen Advanced Institute Spinal Surgical Robot Si-Bone SIGNUS Medical Spinal Elements Spineart SpineGuard Spine Frontier Spineology Spine Smith Partners Spine Surgical Innovations Spine View Spine Wave St. Jude Medical Stryker / Mako Wright / Tornier X-spine Zyga Technology Zimmer Biomet Spine Surgical Robots: Market Shares, Strategies, and Forecasts, Worldwide, 2016 to 2022 Report Methodology This is the 659th report in a series of primary market research reports that provide forecasts in communications, telecommunications, the Internet, computer, software, telephone equipment, health equipment, and energy. Automated process and significant growth potential are a priority in topic selection. The project leaders take direct responsibility for writing and preparing each report. They have significant experience preparing industry studies. They are supported by a team, each person with specific research tasks and proprietary automated process database analytics. Forecasts are based on primary research and proprietary data bases. The primary research is conducted by talking to customers, distributors and companies. The survey data is not enough to make accurate assessment of market size, so WinterGreen Research looks at the value of shipments and the average price to achieve market assessments. Our track record in achieving accuracy is unsurpassed in the industry. We are known for being able to develop accurate market shares and projections. This is our specialty.

7 The analyst process is concentrated on getting good market numbers. This process involves looking at the markets from several different perspectives, including vendor shipments. The interview process is an essential aspect as well. We do have a lot of granular analysis of the different shipments by vendor in the study and addenda prepared after the study was published if that is appropriate. Forecasts reflect analysis of the market trends in the segment and related segments. Unit and dollar shipments are analyzed through consideration of dollar volume of each market participant in the segment. Installed base analysis and unit analysis is based on interviews and an information search. Market share analysis includes conversations with key customers of products, industry segment leaders, marketing directors, distributors, leading market participants, opinion leaders, and companies seeking to develop measurable market share. Over 200 in depth interviews are conducted for each report with a broad range of key participants and industry leaders in the market segment. We establish accurate market forecasts based on economic and market conditions as a base. Use input/output ratios, flow charts, and other economic methods to quantify data. Use in-house analysts who meet stringent quality standards. Interviewing key industry participants, experts and end-users is a central part of the study. Our research includes access to large proprietary databases. Literature search includes analysis of trade publications, government reports, and corporate literature. Findings and conclusions of this report are based on information gathered from industry sources, including manufacturers, distributors, partners, opinion leaders, and users. Interview data was combined with information gathered through an extensive review of internet and printed sources such as trade publications, trade associations, company literature, and online databases. The projections contained in this report are checked from top down and bottom up analysis to be sure there is congruence from that perspective. The base year for analysis and projection is With 2011 and several years prior to that as a baseline, market projections were developed for 2012 through These projections are based on a combination of a consensus among the opinion leader contacts interviewed combined with understanding of the key market drivers and their impact from a historical and analytical perspective. The analytical methodologies used to generate the market estimates are based on penetration analyses, similar market analyses, and delta calculations to supplement independent and dependent variable analysis. All analyses are displaying selected descriptions of products and services.

8 This research includes referencde to an ROI model that is part of a series that provides IT systems financial planners access to information that supports analysis of all the numbers that impact management of a product launch or large and complex data center. The methodology used in the models relates to having a sophisticated analytical technique for understanding the impact of workload on processor consumption and cost. WinterGreen Research has looked at the metrics and independent research to develop assumptions that reflect the actual anticipated usage and cost of systems. Comparative analyses reflect the input of these values into models. The variables and assumptions provided in the market research study and the ROI models are based on extensive experience in providing research to large enterprise organizations and data centers. The ROI models have lists of servers from different manufacturers, Systems z models from IBM, and labor costs by category around the world. This information has been developed from WinterGreen research proprietary data bases constructed as a result of preparing market research studies that address the software, energy, healthcare, telecommunicatons, and hardware businesses. YOU MUST HAVE THIS STUDY Spine Surgical Robot Market Shares, Strategy, and Forecasts, 2016 to 2022 Spine Surgical Robots: Executive Summary Table of Contents The study is designed to give a comprehensive overview of the spine surgical robot equipment market segment. Research represents a selection from the mountains of data available of the most relevant and cogent market materials, with selections made by the most senior analysts. Commentary on every aspect of the market from independent analysts creates an independent perspective in the evaluation of the market. In this manner the study presents a comprehensive overview of what is going on in this market, assisting managers with designing market strategies likely to succeed.

9 Table of Contents SPINE SURGICAL ROBOT EXECUTIVE SUMMARY 23 Spine Surgical Robot Mapping 23 Spine Surgery Robotics Market Driving Forces 27 Spine Surgery Robot Market Shares 28 Surgical Robot for Spine Market Forecasts SPINAL SURGERY ROBOTS MARKET DESCRIPTION AND MARKET DYNAMICS Key Elements Of Spinal Robot System Industry Overview - Spine Robot Assisted Surgery Spine Robotic Surgical Market Strategy Focus on Key Institutions Focus on Leading Surgeons to Drive Rapid and Broad Adoption Maintain Market Leadership Spine Surgery SPINE SURGICAL ROBOT MARKET SHARES AND FORECASTS Spine Surgical Robot Mapping Spine Surgery Robotics Market Driving Forces Spine Surgery Robot Market Shares Mazor Surgical Robots for the Spine: Mazor Robotics Mazor Renaissance System Mazor Robotics Guidance System Maximizes Precision And Safety Surgical Robot for Spine Market Forecasts Surgical Robot Systems vs. Disposable Instruments Forecasts Shenzhen Advanced Institute Spinal Surgical Robot U.S. Minimally Invasive Spinal Implant Market To Outpace Growth In Traditional Spine Market Medical Robotic Surgery Challenges Key Players In The Global Medical Robots Key Players In The Global Spinal Implant Market Medtronic NuVasive SI-BONE Minimally Invasive Surgical Instruments Spinal Restorative Therapy Target Markets Spine Surgery Robot Prices Spine Surgery Robot Regional Market Segments US U.S.-Europe Product Introduction Swap Asia-Pacific China Underdeveloped Regions Brazil Spinal Patients in Taiwan Receive Fast Care with Unique Reimbursement Structure; Market Led by DePuy Synthes, Medtronic SURGICAL ROBOTS PRODUCT DESCRIPTION Mazor Robotics Mazor Renaissance In the Operating Room Mazor Robotics Ease of Use and Reduced Length of Stay Mazor Products: Components of the Renaissance System Mazor Mounting Platforms, Disposables, and Accessories Surgical Workflow Using Mazor Renaissance Mazor Three-Dimensional (3D) Synchronization 106

10 3.1.7 Mazor Spine Surgical Execution Mazor Spine Robot Surgery Applications: Mazor Spine Robot Surgery Applications: Spinal Fusion Mazor Spine Robot Surgery Applications: Scoliosis Surgery Mazor Renaissance System For Robotic Guidance Mazor Renaissance Spine Procedures Mazor Robotics Spine Procedures Mazor Robotics Clinical Study Mazor Robotics Reduced Exposure to Radiation Medtronic Medtronic Spinal Fusion Medtronic Cervical Artificial Disc Products Medtronic Biologics Products Medtronic Minimally Invasive Spinal Surgery Medtronic Posterior OCT Reconstruction Stryker Spine Surgery Stryker Spine Navigation Software Stryker's VertaPlex HV First PMMA to Receive Clearance for Treating Sacral Insufficiency Fractures Exactech Zimmer / Biomet Spine Medacta DJO Johnson & Johnson / DePuy Johnson & Johnson / Ethicon NuVasive Nuvasive Spinal Surgical Solutions MEDICAL ROBOT TECHNOLOGY AND DISEASE STATISTICS Healthcare Robotics Enabling Technology Robotic-Assisted Minimally Invasive Surgery Market Driving Forces Mazor Renaissance Surgical Spine Robot FDA Marketing Clearance 510(k) Robotic Surgical Clinical Applications Mesenchymal Stem Cells (MSC) Role In Regenerative Medicine Types of Spine Surgeries Minimally Invasive Spine Fusion: Scoliosis Correction Surgery: Vertebroplasty: Spine Biopsies: Spine Surgery Device Market Mazor Renaissance Guidance System Technology Government Regulation California Regulation International Regulation Third Party Reimbursement SPINAL SURGICAL ROBOTS COMPANY DESCRIPTION Accel Spine Alliance Spine Alliance Spine has Surgical Advisory Boards Alliance Spine Bone Marrow Concentrate System Alphatec Alphatec Spine Apollo Spine Ascendx Spine Back 2 Basics Spine Boston Scientific Boston Scientific Precision Plus Spinal Cord Stimulator System 172

11 5.7.2 Boston Scientific Pain Medicine Brainlab AG Brainlab AG Revenue Brainlab Captiva Spine Centinel Spine Elekta Elekta Gamma Radio Surgery System Elekta - Interim Report May October 2015/ Elekta Transformation Program On Track Globus Medical Globus Purchased Excelsius Surgical K2M Life Spine Mazor Robotics Mazor Robotics Creates Robotic Guidance Systems Mazor Robotics Strategy Research Agreement with Cleveland Clinic Foundation (CCF) Mazor Surgical Workflow Using Renaissance for Spine Procedures Mazor Robotic Pre-Operative Planning Medacta Medacta Business Medtronic Medtronic Revenue Medtronic Operating Segments Medtronic Sacroiliac Joint Fusion Device Spinal Implant Market Medtronic Spine Medtronic in the U.S. Spinal Implant Market Medtronic Acquisition of Covidian Medtronic Acquisition of RF Surgical Systems Medtronic Acquisition of Medina Medical Medtronic Pelvic Mesh Litigation Medtronic Restorative Therapies Group MicroPort Scientific Corporation MicroPort Orthopedic Devices MicroPort Acquires OrthoRecon Business from Wright Medical Technologies Microport Hip Systems NLT Spine NuVasive NuVasive Full-Year 2015 Revenue Precision Spine Shenzhen Advanced Institute Spinal Surgical Robot Si-Bone SI-BONE ifuse Implant System SIGNUS Medical Spinal Elements Spineart SpineGuard Spine Frontier Spineology Spine Smith Partners Spine Surgical Innovations Spine Surgical Innovations MIMS Approach, Minimum Incision, Maximum Sight Spine View Spine Wave St. Jude Medical 235

12 5.35 Stryker Stryker / MAKO Surgical Stryker Revenue Stryker Results Of Operations Stryker Segment Orthopaedics Stryker Business Segment Operations Stryker Revenue Stryker Hip Recall: $1.4 Billion Settlement Stryker Regional Revenue Segment Stryker Robots Stryker / MAKO Surgical Stryker / Mako MAKO Surgical RIO Robotic Arm Stryker Endoscopy Mako Surgical Business Mako Products Mako Surgical Strategy Mako Surgical Revenue Mako Surgical Business Mako Products Mako Surgical Strategy Mako Surgical Revenue Wenzel Spine Wright Medical Technology Wright Revenue Wright Medical Group NV Revenue Wright Medical Group N.V. Revenue for 2015 Third Quarter Wright / Tornier X-spine Zyga Technology Zimmer Biomet Zimmer Biomet Sales by Product Category Zimmer Biomet Zimmer Metal-on-Metal Hip Recall Spine Surgical Companies Spine Surgical Imaging 307 List of Tables and Figures Table ES-1 25 Robot-Guided Spine Surgery Benefits 25 Table ES-2 25 Spine Surgery Robot-Guidance Features 25 Table ES-3 26 Robot-Guide For Spine Surgery Components 26 Table ES-4 27 Robot Spine Surgery Market Driving Forces 27 Figure ES-5 29 Spine Surgical Robot Market Shares, Shipments, Dollars, Worldwide

13 Figure ES-6 30 Spinal Surgical Robots Market Forecasts, Dollars, Worldwide, Table Key Elements Of A Spinal Robot System 32 Table Spine Disorder Market Driving Forces 33 Table Spine Surgical Robot Focus on Key Procedures 36 Table Spinal Surgery Scientific Advances 39 Table Robot-Guided Spinal Surgery Advantages: 39 Table Robot-Guided Spine Surgery Benefits 43 Table Spine Surgery Robot-Guidance Features 43 Table Robot-Guide For Spine Surgery Components 44 Table Robot Spine Surgery Market Driving Forces 45 Figure Spine Surgical Robot Market Shares, Shipments, Dollars, Worldwide Table Spine Surgical Robot Market Shares, Dollars, Worldwide, Table Principal Competitive Factors in the Robotic Spine Surgery Market 50 Table Mazor Revenue, Figure Mazor Leading Spine Surgery Innovation 54

14 Figure Spinal Surgical Robots Market Forecasts, Dollars, Worldwide, Table Spinal Surgical Robot Market Forecasts, Dollars, Worldwide, Table Spinal Surgical Robot Revenue by Segment, Robots and Disposables, Worldwide, Table Robot Spine Procedures, Number, Worldwide, Table Spinal Surgical Robot Units Shipped Forecasts, Surgical Robotic Procedures, and Number Procedures per Installed Unit, Worldwide, Table Spinal Surgical Robot Installed Base, Percent Spinal Procedure Penetration, and # Spinal Procedures, US and Worldwide, Table Spinal Surgical Patients with Chronic Back Pain and % Penetration Procedures Worldwide, Table Robot Spine Surgery Market Factors: 64 Table Robotics Market Aspects 65 Table Spinal Surgery Hospital Trends 66 Table Robotic Cost Savings with Spinal Surgical Units 67 Figure Surgical Robot Systems vs. Instruments Forecasts, Dollars, Worldwide, Table Benefits of Robotic Surgery For The Surgeon 71 Table Benefits of Robotic Surgery For The Patient 72

15 Table Benefits of Robotic Surgery For The Hospital 73 Table Challenges of Open Surgery and Minimally Invasive Surgery 76 Table Challenges of Developing Medical Robotic Surgery Systems 77 Table Surgical Robotic Product Development Challenges 78 Table Key Players In The Global Medical Robots Market 79 Table Key Players In The Global Spinal Implant Market 83 Table Advantages of Minimally Invasive Surgeries 86 Table Challenges of Minimally Invasive Surgeries 86 Figure Spine Surgical Robot Regional Market Segments, Dollars, Worldwide, Table Spine Surgical Robot Regional Market Segments, Figure Mazor 3D Visualization of Surgical Planning 99 Figure Mazor Planning Software / 3D visualization 100 Table Mazor Components of the Renaissance System 102 Table Mazor Renaissance System Component Tasks 103 Table MAZOR RBT Device Surgical Workflow Using Renaissance for Spine Procedures 105

16 Figure Mazor Renaissance RBT Device Accuracy of the 3D Synchronization 3D Marker; C-arm in 2 Positions Taking Registration Images for 3D Synchronization Process 107 Figure Mazor RBT Device (with an arm connected to it) on Clamp Mount Ready To Guide The Surgeon 108 Figure Mazor Spine Robot Surgery Applications: 109 Figure Mazor Robotics Renaissance System For Guidance 112 Figure Mazor Renaissance Spine Procedures 113 Figure Mazor Robotics Spine Procedures Variety 117 Table Medtronic Spinal Conditions Treated 120 Table Medtronic Infuse Bone Graft/LT-Cage Lumbar Tapered Fusion Device Risks 123 Table Medtronic Minimally Invasive Spine Platform Enables A Variety Of Cervical, Thoracic, And Lumbar Procedures126 Figure Medtronic Posterior OCT Reconstruction 127 Table Stryker Spine Navigation Software Key Advantages 129 Table Zimmer / Biomet Spine Surgical Solutions 132 Figure Biomet Sequoia Thoracolumbar Pedicle Screws with TM Ardis Interbody System 133 Figure DJO Cement Solutions 135 Table

17 DJO Spine Devices 135 Table Nuvasive Surgical Solutions Procedures 140 Table Nuvasive Surgical Solutions NVM5 Nerve Monitoring System 141 Table Healthcare Robotics Enabling Technologies 142 Table Robotic-Assisted Minimally Invasive Surgery Market Driving Forces 143 Table 4-2 (Continued) 144 Robotic-Assisted Minimally Invasive Surgery Market Driving Forces 144 Table Types Of Procedures Performed Using Robotic Surgical Systems 145 Table Types of Spinal Pathology and Disorders 148 Table Types of Spinal Deformities 149 Table Types of Spinal Disorder Treatments 150 Figure Alliance Spine Nakoma SL Anterior Cervical Plating System 166 Figure Alliance Spine Alamo C 167 Figure Boston Scientific SCS System: 32 Contacts and 32 Dedicated Power Sources 173 Figure Brainlab Collaborative Workspace 174 Figure Brainlab AG Worldwide Presence, Headquarters in Germany 175 Figure

18 Captiva Spine Pedicle Screw System 179 Figure Elekta Gamma Radio Surgery System 181 Figure Globus Medical Spine Surgery Products 187 Table Mazor Revenue, Table Mazor Robotics Strategy Key Elements 193 Table Mazor Robotics Commercialization of Renaissance System Strategy Key Elements 193 Table Mazor Robotics Utilization Of Installed Base Strategy Key Elements 194 Table Mazor Robotics Clinical And Financial Value Strategy Key Elements 195 Table Mazor Robotics Research And Development Strategy Key Elements 196 Table Basic Steps for Surgical Workflow Using Mazor Renaissance Robot 197 Figure Mazor Surgical Planning Software Provides A Slice-By-Slice Image Display 199 Figure Mazor Surgical Robot: 3D Marker; C-arm in 2 positions taking registration images for 3D Synchronization process200 Figure Mazor RBT Device (with an arm connected to it) on Clamp Mount ready to guide the surgeon 201 Figure Medtronic / Covidian Integration 205 Table Medtronic Principal Products Offered by Spine Division: 213 Table

19 Medtronic Spine Division Principal Products 217 Table MicroPort Advanced Technology Product Segments Addressed 218 Table Microport Hip Systems 220 Figure Precision Spine Cervical Spine Devices 224 Figure SIGNUS Medical Sacroiliac Joint Medical Device 229 Figure Stryker Joint Implants 246 Figure Stryker Patient Specific Pre-Operative Planning 248 Figure Stryker Patient Specific Pre-Operative Planning 249 Table Stryker Better Fit Orthopedics 250 Table Stryker Osteoarthritis Affects Compartments Of The Knee 251 Figure Stryker / MAKO Surgical RIO Robotic Arm Interactive System 252 Figure MAKO Surgical Restoris 260 Figure Mako Robotic Arm Technology Assists in Total Hip Replacement 262 Figure MAKO Surgical 263 Figure MAKO Surgical Implants 264 Table

20 MAKO Robotic Surgery Benefits 269 Figure Mako Robotic Arm Technology Assists in Total Hip Replacement 273 Table MAKO Robotic Surgery Benefits 278 Figure Zyga Technology SImmetry System 292 Table Zimmer Biomet Musculoskeletal Healthcare Offerings 298 Table Zimmer Metal On Metal Hip Replacement Difficulties and Side Effects. 300

21 ABOUT THE COMPANY WinterGreen Research, research strategy relates to identifying market trends through reading and interviewing opinion leaders. By using analysis of published materials, interview material, private research, detailed research, social network materials, blogs, and electronic analytics, the market size, shares, and trends are identified. Analysis of the published materials and interviews permits WinterGreen Research senior analysts to learn a lot more about markets. Discovering, tracking, and thinking about market trends is a high priority at WinterGreen Research. As with all research, the value proposition for competitive analysis comes from intellectual input. WinterGreen Research, founded in 1985, provides strategic market assessments in telecommunications, communications equipment, health care, Software, Internet, Energy Generation, Energy Storage, Renewable energy, and advanced computer technology. Industry reports focus on opportunities that expand existing markets or develop major new markets. The reports access new product and service positioning strategies, new and evolving technologies, and technological impact on products, services, and markets. Innovation that drives markets is explored. Market shares are provided. Leading market participants are profiled, and their marketing strategies, acquisitions, and strategic alliances are discussed. The principals of WinterGreen Research have been involved in analysis and forecasting of international business opportunities in telecommunications and advanced computer technology markets for over 30 years. The studies provide primary analytical insight about the market participants. By publishing material relevant to the positioning of each company, readers can look at the basis for analysis. By providing descriptions of each major participant in the market, the reader is not dependent on analyst assumptions, the information backing the assumptions is provided, permitting readers to examine the basis for the conclusions. WinterGreen Research is positioned to help customers facing challenges that define the modern enterprises. The increasingly global nature of science, technology and engineering is a reflection of the implementation of the globally integrated enterprise. Customers trust wintergreen research to work alongside them to ensure the success of the participation in a particular market segment. WinterGreen Research supports various market segment programs; provides trusted technical services to the marketing departments. It carries out accurate market share and forecast analysis services for a range of commercial and government customers globally. These are all vital market research support solutions requiring trust and integrity. ABOUT THE PRINCIPAL AUTHORS Ellen T. Curtiss, Technical Director, co-founder of WinterGreen Research, conducts strategic and market assessments in technology-based industries. Previously she was a member of the staff of Arthur D. Little, Inc., for 23 years, most recently as Vice President of Arthur D. Little Decision Resources, specializing in strategic planning and market development services. She is a graduate of Boston University and the Program for Management Development at Harvard Graduate School of Business Administration. She is the author of recent studies on worldwide telecommunications markets, the top ten internet equipment companies, the top ten contract manufacturing companies, and the Top Ten Telecommunications market analysis and forecasts.

22 Susan Eustis, President, co-founder of WinterGreen Research is a senior analyst. She has done research in communications and computer markets and applications. She holds several patents in microcomputing and parallel processing. She has the original patents in electronic voting machines. She has new patent applications in format varying, mulitprocessing, and electronic voting. She is the author of recent studies of the Solar REnewable Energy, Wind Energy, Thin Film Batteries, Business Process Management marketing strategies, Internet equipment, biometrics, a study of Internet Equipment, Worldwide Telecommunications Equipment, Top Ten Telecommunications, Digital Loop Carrier, Web Hosting, Web Services, and Application Integration markets. Ms. Eustis is a graduate of Barnard College. Worldwide Who s Who named her Top Female CEO of 2012.