Minimally invasive surgery (MIS) technologies continue to be one of the most innovative areas of the global spine device industry, with many factors driving growth.
One of the catalysts of this market movement is the participation of key market players, and their dedication to development, application, and education. While many external drivers and limiters also affect this market, the activities of leading competitors with a strong MIS focus, like NuVasive, are a great example of this drive for development in not only products, but also the industry as a whole.
In terms of the competitive landscape, a mix of companies are present in the minimally invasive market space. Companies with a stronger MIS focus, such as NuVasive and Globus Medical, continue to show strong growth and expand their device portfolios. In addition, many larger established companies, such as Medtronic, Zimmer Biomet, Stryker and DePuy Synthes, have developed strong portfolios in this segment. While the MIS segment shares many of the same drivers as the overall spine industry, increasing awareness and familiarity among physicians and patients are ever more important.
The major procedural drivers for MIS technology are its widely-known clinical benefits. Rather than using a large opening, MIS approaches create small ports of entry for the procedure. This method reduces muscle and tissue damage, decreases complications and extends the intraoperative time limit. As a result, recovery times can be lessened for patients while simultaneously increasing the number of procedures a physician could perform within a given amount of time, compared to the open approach.
Industry Growth is More Than Technology
While these benefits appear obvious, promoting and publicizing clinical research is important for companies. Fortunately, the innovative nature of the MIS market means that studies are often underway or being published. This includes ongoing studies on established segments of the MIS industry. In February 2017, the U.K.-based National Industry for Clinical Excellence (NICE) published a comprehensive literature review on the efficacy of the lateral approach. Reviewing over 200 articles, the study found a weighted average rate of fusion of 94%, as well as a weighted average of 60% for improvement in pain. This is a positive endorsement for MIS technologies, such as the lateral XLIF® procedure through which NuVasive established itself. The company reported that it had submitted a body of internal data for the purposes of the study.
Physician education is one of the most important drivers for increased adoption, and it’s self-reinforcing. As physicians begin to use MIS devices, they will, in turn, make other patients and physicians aware of what is available. In addition to promotional work at physician and research conferences, companies will integrate MIS devices into their broader surgeon education programs. Some of the major limiters to MIS technology in its early stages were the unfamiliarity of physicians and the complexity of the procedure. This has been particularly true for retractor-based techniques, which can be harder to master than traditional open surgical approaches.
By providing long-term and consistent education and support, companies are able to overcome, or at least mitigate, this limiter to MIS adoption. An example of this in practice is NuVasive’s expansion of the Clinical Professional Development (CPD) program at the end of 2017. This expansion came alongside the release of several new devices and is intended to provide support to surgeons throughout their careers. In addition to product portfolios, quality of education will be a major distinguishing market for companies who are trying to expand their presence in the MIS segment.
Market Limiters of MIS Devices
One of the limiters faced by companies is the pricing of minimally invasive devices. Theoretically, lower pricing for MIS alternatives compared to standard technologies would be a strong driver for adoption. However, this has not been the case in the market. Hospital buyer data shows that average sales prices for MIS technologies are often more expensive compared to standard counterparts. This is true for both fixation and interbody devices. This means that it is even more important for MIS companies to capitalize on other drivers of the technology.
Hospital purchase order data further shows a wide variance in selling prices for individual fixation packages. This implies that across different product lines, companies are using low-price strategies to target increased placement, and high-price strategies to support innovative technologies. MIS interbody devices tended to be priced more highly compared to standard counterparts. Companies marketing both categories will be able to make use of the opportunities afforded by each. The incentive for such variance may be one reason why MIS companies are rapidly expanding their portfolios.
Expanding Product Portfolios Driving Growth
Major competitors are seeking to invest heavily in this growing market by widening their offerings, as can be seen by the volume of recent portfolio development. Throughout 2017, NuVasive released and updated various aspects of its portfolio, particularly focusing on interbody devices. The final months of the year saw a focus on new materials as well, such as the 3D-printed porous titanium Modulus® XLIF®, the porous COALESCE™ device for both TLIF and PLIF procedures and expanded clearance for its COHERE® cervical device and TLX™ interbody system for TLIF procedures. In addition, the company also pursued several acquisitions in 2017. In particular, the company cited porous PEEK technology as being a major factor in the acquisition of Vertera Spine.
This expansion of portfolio options will also reinforce company brand recognition and client relationships. With many customers still focusing on standard solutions for spinal fusion, companies offering both services are well placed to expand the use of MIS technologies. From a competitive analysis perspective, companies offering both types of devices can likely expect to see strong growth. In addition to its traditionally strong presence in the MIS interbody device market, according to iData’s latest research, NuVasive has also been able to expand their presence in the MIS fixation market to approximately 20%, showing growth in both standard and MIS segments of its portfolio. Furthermore, established competitors in the standard device segments, such as Medtronic, DePuy Synthes, Stryker and Zimmer Biomet, have been among the most effective at establishing themselves in the MIS industry. It is expected that they will be particularly effective at expanding the MIS segments in markets such as Latin America and Asia-Pacific, where established distributor relationships are important.
Where is the MIS Spine Market Heading?
The result of these various drivers is that strong growth within the MIS markets is expected to continue. In the United States, MIS spine technologies are expected to expand from an estimated $1.7 billion in 2017 to over $2 billion by 2024. MIS interbody devices and MIS pedicle screws will account for the largest segments in this market. Strong growth is also expected in markets outside of the United States. In many geographies, a demographic trend towards growing elderly populations will mean increasing demand for spinal surgical technologies. With many of these patients seeking more personalized solutions, companies have strong incentive to make sure that both institutions and patients are educated about MIS solutions.
Further growth on the part of companies is expected, especially as those with the largest market shares continue to expand globally. Growing markets outside of the U.S. and Europe will likely begin to see more diverse selections of devices. It is no surprise that NuVasive and other companies are employing a strategy of promotion on all fronts, from clinical information to strong expansion of portfolios. With such growth reflected in procedure volumes and market values, competitors and observers will continue to consider MIS to be one of the most dynamic parts of the spine industry.
About the Authors
Ash Milton is a Senior Research Analyst at iData Research and was the lead researcher for the latest US and Europe MIS Spine reports, among many other Spine, Robotics, Navigation, and Orthopedics research projects.
Jeffrey Wong is the Analyst Director at iData Research. Through many years of analysis, he has been the lead on most of iData’s medical, dental, and pharmaceutical market research and now drives research strategy, product development and consulting research.
About iData Research
iData Research is an international market research and consulting firm focused on providing market intelligence for the medical device, dental and pharmaceutical industries. To learn more about their research go to https://idataresearch.com.