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One of the key benefits of the current underutilization is that the European spine market will be able to support simultaneous growth of fusion, flexible stabilization and prosthetic disc technologies--the former for severe degenerative disease and the latter two for less advanced cases. Thus, the dominant traditional fusion instrumentation segment is set to increase 13% annually, although the most dramatic growth will occur in prosthetic discs, flexible stabilization systems, minimally invasive fusion products and bone morphogenetic proteins. Spine surgery will also benefit from the trend to less invasive approaches and the enhanced clinical outcomes that will favor treatment over rehabilitative and palliative care. Additional important trends will include expanded use of vertebral fracture management technologies to manage trauma and corpectomy secondary to bone metastases, gradually expanded use of vertebroplasty and kyphoplasty to treat osteoporotic vertebral fractures, and investigation of new approaches, such as facet replacement, annulus repair and interventional technologies, for selected patients. These are among the findings of Health Research International's comprehensive new report entitled "Opportunities in European Spinal Product Markets", distributed exclusively by Life Science Intelligence. Technologies covered include: traditional instrumentation, metal and allograft implants, minimally invasive fusion and discectomy products, bone graft substitutes, prosthetic discs, bone growth stimulators, flexible stabilization, interventional products, vertebroplasty and kyphoplasty, among others. Supplier shares are provided for each major product type, and the market forecasts incorporate intensive econometric analysis of leading indicators, penetration rates and product usage per procedure, as well as the important clinical and cost considerations driving usage. This report incorporates 168 exhibits detailing products, technologies, market forecasts and supplier shares. EXECUTIVE SUMMARY Procedure Trends Fusion Instrumentation Prosthetic Discs Bone Graft Substitutes and Growth Factors Vertebral Fracture Management Other Spinal Technologies Suppliers Country Profiles 1.0 OVERVIEW OF SPINAL DISORDERS 1.1 Anatomy of the Human Spine 1.1.1 Bone Physiology and Remodeling 1.1.2 Vertebrae 1.1.3 Intervertebral Discs 1.1.4 Spinal Cord 1.2 Spinal Conditions 1.2.1 Degenerative Disorders 1.2.1.1 Degenerative Disc Disease 1.2.1.2 Herniated Disc 1.2.1.3 Spinal Stenosis 1.2.1.4 Spondylosis 1.2.1.5 Spondylolisthesis 1.2.1.6 Osteoporosis 1.2.1.7 Osteoarthritis 1.2.1.8 Rheumatoid Arthritis 1.2.2 Spinal Trauma 1.2.2.1 Structural Spinal Trauma 1.2.2.2 Spinal Cord Trauma 1.2.3 Deformity Disorders 1.2.3.1 Scoliosis 1.2.3.2 Kyphosis 1.2.3.3 Lordosis 1.2.4 Spinal Tumors 1.2.4.1 Malignant Spinal Tumors 1.2.4.2 Spinal Hemangiomas 2.0 TREND IN EUROPEAN SPINAL FUSIONS 2.1 Clinical Goals and Outcomes 2.1.1 Failure of Fusion 2.1.2 Failure of Pain Relief 2.1.3 Long-Term Outcomes 2.2 Classification of Spinal Fusions 2.2.1 Spine Segments Fused 2.2.2 Levels Fused 2.2.3 Use of Instrumentation and Cages 2.2.4 Surgical Approaches 2.3 Specialists Performing Spine Surgery 2.4 Spinal Fusions by Segment and Instrumentation 2.4.1 Cervical Spine 2.4.2 Thoracolumbar Spine 2.4.2.1 Approaches 2.4.2.2 Instrumentation Preferences 2.4.2.3 Procedure Forecast 3.0 FUSION INSTRUMENTATION 3.1 Traditional Instrumentation Systems 3.1.1 Configurations 3.1.1.1 Hook/Screw and Rod Systems 3.1.1.2 Plate Systems 3.1.1.3 Wires and Clamps 3.1.2 Products and Suppliers by Segment 3.1.2.1 Thoracolumbar Instrumentation 3.1.2.2 Cervical Instrumentation 3.1.3 Procedure Forecast 3.1.4 Market Analysis 3.1.4.1 Cervical Instrumentation Systems 3.1.4.2 Thoracolumbar Instrumentation Systems 3.1.4.3 Supplier Shares 3.2 Minimally Invasive Spine Surgery 3.2.1 Laparoscopic Anterior Spinal Fusion 3.2.1.1 Procedure 3.2.1.2 Advantages and Limitations 3.2.1.3 Products 3.2.1.4 Clinical Experience 3.2.2 Percutaneous Spinal Fusion 3.2.2.1 Procedure 3.2.2.2 Advantages and Limitations 3.2.2.3 Products (5 Profiles) 3.2.3 Port-Access Spinal Fusion 3.2.3.1 Procedure 3.2.3.2 Advantages and Limitations 3.2.3.3 Products 3.2.3.4 Clinical Experience 3.2.4 Procedure Forecast 3.2.5 Market Analysis 3.3 Bioabsorbable Spinal Implants 3.3.1 Clinical Rationale 3.3.2 Clinical Applications and Products 3.3.3 Market Assessment 4.0 INTERBODY FUSION DEVICES 4.1 Performance Criteria and Goals 4.2 Materials 4.2.1 Metal 4.2.2 Carbon Fiber 4.2.3 PEEK 4.2.4 Bioabsorbable Polymers 4.3 Cage Designs 4.3.1 Cylindrical Cages 4.3.2 Rectangular Cages 4.4 Implantation Technique 4.4.1 Anterior Lumbar Interbody Fusion 4.4.2 Posterior Lumbar Interbody Fusion 4.4.3 Transforaminal Lumbar Interbody Fusion 4.5 Failure of Interbody Fusion Devices 4.6 Products and Suppliers 4.7 Allograft Implants 4.7.1 Benefits and Limitations 4.7.2 Materials Supply 4.7.3 Clinical Experience 4.7.4 Implantation 4.7.5 Products and Suppliers 4.8 Market Analysis 4.8.1 Cages 4.8.2 Structural Allografts 5.0 BONE GRAFT SUBSTITUTES AND GROWTH FACTORS 5.1 Performance Properties 5.2 Bone Graft Substitutes 5.2.1 Types of Bone Graft Materials 5.2.1.1 Autograft 5.2.1.2 Base Allograft 5.2.1.3 Demineralized Bone Matrix 5.2.1.4 Ceramic and Synthetic Bone Graft Substitutes 5.2.1.5 Xenograft 5.2.2 Applications 5.2.3 Regulatory Issues 5.2.3.1 General EC Directives 5.2.3.2 Allograft Products 5.2.3.3 Xenograft Products 5.2.3.4 Bone Graft Substitutes 5.2.3.5 Demineralized Bone Matrix 5.2.4 Products and Suppliers 5.2.5 Procedure Forecasts 5.2.6 Market Analysis 5.2.6.1 Allograft 5.2.6.2 Demineralized Bone Matrix 5.2.6.3 Synthetic Substitutes 5.2.6.4 Xenograft 5.3 Bone Growth Factors 5.3.1 Background 5.3.2 Product Components 5.3.3 Autologous-Derived Growth Factors 5.3.4 Bone Morphogenetic Proteins (BMPs) (3 Profiles) 5.3.5 Local Gene Therapy for Spinal Fusion (5 Profiles) 5.3.6 Procedure and Market Forecast 6.0 PROSTHETIC DISCS 6.1 Approaches 6.1.1 Total Disc Replacement 6.1.1.1 Technology 6.1.1.2 Indications 6.1.2 Nucleus Replacement 6.1.2.1 Technology 6.1.2.2 Indications 6.2 Implantation Techniques 6.2.1 Total Disc Implantation 6.2.2 Nucleus Implantation 6.3 Total Prosthetic Disc Products (8 Profiles and Comprehensive Chart) 6.4 Nucleus Replacement Products (2 Profiles and Comprehensive Chart) 6.5 Disc Regeneration 6.6 Market Analysis 6.6.1 Procedure Forecasts 6.6.2 Market Forecasts 6.6.3 Competitive Analysis 7.0 MANAGEMENT OF VERTEBRAL FRACTURES AND TUMORS 7.1 Indications 7.1.1 Osteoporotic Compression Fractures 7.1.2 Vertebral Trauma Fractures 7.1.3 Malignant Spinal Tumors 7.1.4 Spinal Hemangiomas 7.2 Clinical Goals of Therapy 7.3 Techniques 7.3.1 Vertebroplasty 7.3.1.1 Technique 7.3.1.2 Setting and Specialties 7.3.1.3 Clinical Experience 7.3.1.4 Contraindications 7.3.1.5 Reimbursement 7.3.1.6 Regulatory Issues 7.3.1.7 Products 7.3.1.7.1 Bone Cements 7.3.1.7.2 Delivery Systems 7.3.2 Kyphoplasty 7.3.2.1 Technique 7.3.2.2 Setting and Specialties 7.3.2.3 Applications 7.3.2.4 Advantages and Limitations 7.3.2.5 Clinical Experience 7.3.2.6 Product Requirements (2 Profiles) 7.3.2.7 Reimbursement 7.3.3 Vertebral Body Replacement 7.3.3.1 Technique 7.3.3.2 Indications 7.3.3.3 Contraindications 7.3.3.4 Complications 7.3.3.5 Product Requirements 7.3.3.6 Clinical Experience 7.3.3.7 Vertebral Body Replacement Devices 7.4 Procedure Forecasts 7.5 Market Analysis 7.6 Supplier Shares 8.0 OTHER SPINAL TECHNOLOGIES 8.1 Surgical Technologies 8.1.1 Flexible Stabilization 8.1.1.1 Products (5 Profiles and Comprehensive Chart) 8.1.1.2 Procedure Trend 8.1.1.3 Market Analysis 8.1.2 Minimally Invasive Discectomy 8.1.2.1 Microdiscectomy Techniques 8.1.2.2 Indications 8.1.2.3 Site of Herniation 8.1.2.4 Risks 8.1.2.5 Technologies 8.1.2.5.1 Chemonucleolysis 8.1.2.5.2 Manual and Automated Removal 8.1.2.5.3 Laser-Assisted Discectomy 8.1.2.5.4 Electrothermal 8.1.2.5.5 High Intensity Focused Ultrasound 8.1.2.6 Products 8.1.2.7 Procedure Trend 8.1.2.8 Market Analysis 8.1.3 Emerging Surgical Approaches 8.1.3.1 Annulus Repair 8.1.3.2 Facet Joint Arthroplasty 8.1.3.3 Extra-Ligamentous Repair 8.2 Interventional Technologies 8.2.1 Intradiscal Heating (Thermal Therapy) (2 Profiles) 8.2.1.1 Procedure and Market Forecasts 8.2.2 Ozone Therapy 8.2.3 Percutaneous Neuromodulation Therapy 8.2.4 Intradiscal Hypothermia Therapy 8.3 Spinal Bone Growth Stimulators 8.3.1 Product Technology 8.3.1.1 Electrical Bone Growth Stimulators 8.3.1.1.1 Direct Current 8.3.1.1.2 Capacitive Coupling 8.3.1.1.3 Pulsed Electromagnetic Field 8.3.1.1.4 Combined Magnetic Field 8.3.1.2 Ultrasound Bone Growth Stimulators 8.3.2 Spinal Applications 8.3.3 Impact of Graft Substitutes and Growth Factors 8.3.4 Products 8.3.5 Product Trends 8.3.6 Clinical Experience 8.3.7 Patient Forecast 9.0 COUNTRY PROFILES 9.1 Overview of European Healthcare 9.1.1 Healthcare Spending and Reform 9.1.2 Healthcare Facilities and Manpower 9.1.3 Reimbursement 9.1.4 Impact of the European Community 9.1.4.1 EC Directives 9.1.4.2 Pricing 9.2 National Profiles 9.2.1 Germany 9.2.1.1 Health Care Statistical Overview 9.2.1.2 Emerging Legislation 9.2.1.3 Spinal Products Market 9.2.2 France 9.2.2.1 Health Care Statistical Overview 9.2.2.2 Medical Products Regulation 9.2.2.3 Spinal Products Market 9.2.3 Italy 9.2.3.1 Emerging Private Sector 9.2.3.2 Product Issues 9.2.3.3 Spinal Products Market 9.2.4 Spain 9.2.4.1 Structure of Health Care Funding and Delivery 9.2.4.2 Overview of Health Statistics 9.2.4.3 Ambulatory Care Reforms 9.2.4.4 Product Issues 9.2.4.5 Spinal Products Market 9.2.5 United Kingdom 9.2.5.1 National Health System 9.2.5.2 Medical Products Regulation 9.2.5.3 Prevalence of Back Pain 9.2.5.4 Health Statistics Overview 9.2.5.5 Spinal Products Market 9.2.6 Benelux Nations 9.2.6.1 Health Care Systems 9.2.6.1.1 Belgium 9.2.6.1.2 Luxembourg 9.2.6.1.3 Netherlands 9.2.6.2 Spinal Products Market 10.0 COMPANY PROFILES 10.1 B. Braun Melsungen AG (Aesculap) 10.2 Biomet, Inc. (EBI, IQL) 10.3 Biorthex, Inc. 10.4 Centerpulse AG (Spine-Tech) 10.5 Corin Group PLC 10.6 Endius, Inc. 10.7 Interpore Cross International, Inc. 10.8 IsoTis SA/GenSci Regeneration Sciences, Inc. 10.9 Johnson & Johnson (DePuy AcroMed) 10.10 Kyphon, Inc. 10.11 Link Spine Group, Inc. 10.12 Medtronic, Inc. (Sofamor Danek) 10.13 Orquest, Inc. 10.14 Orthofix International NV 10.15 Orthovita, Inc. 10.16 Osteotech, Inc. 10.17 Raymedica, Inc. 10.18 Scient'sx SA 10.19 Smith & Nephew, plc 10.20 Spinal Concepts, Inc. 10.21 Spine Network (Eurosurgical) 10.22 Spine Solutions, Inc. 10.23 Stryker Corporation (Howmedica Osteonics, Surgical Dynamics) 10.24 Surgicraft Limited 10.25 Synthes-Stratec, Inc. 10.26 Wright Medical Group, Inc. APPENDIX: COMPANY LIST LIST OF EXHIBITS Summary Exhibit 1: European Spinal Products Market by Major Product Summary Exhibit 2: Major Spine Procedures, Forecast by Type, 2001-2008 Summary Exhibit 3: Fusion Instrumentation, Market Forecast by Major Type, 2001-2008 Summary Exhibit 4: Prosthetic Discs, Patient and Market Forecasts by Type, 2001-2008 Summary Exhibit 5: Bone Graft Substitutes, Market Forecast by Type,2001-2008 Summary Exhibit 6: Vertebral Fracture Management, Procedure and Market Forecasts, 2001-2008 Summary Exhibit 7: Other Spinal Technologies, Procedure and Market Forecasts, 2001-2008 Summary Exhibit 8: Estimated Supplier Shares, 2002 Summary Exhibit 9: European Spine Market, Forecasts by Country, 2001-2008 Exhibit 1-1: Structure of the Vertebrae Exhibit 1-2: The Spine Exhibit 1-3: Prolapsed Intervertebral Disc Exhibit 1-4: Overview of Spine Conditions Exhibit 1-5: Types of Spondylolisthesis Exhibit 1-6: Overview of Osteoporosis Exhibit 1-7: Comparison of Osteoarthritis and Rheumatoid Arthritis Exhibit 1-8: Spinal Trauma Exhibit 1-9: Comparison of Spinal Deformity Disorders Exhibit 1-10: Cancers With Probable Bone Metastases, Deaths, 1996 and 1998 Exhibit 2-1: Methods of Categorizing Spinal Fusion Procedures Exhibit 2-2: Major Surgical Approaches for Spinal Fusion Exhibit 2-3: Spinal Fusions by Segment, Procedure Forecast, 2001-2008 Exhibit 2-4: Spinal Fusions by Country, Procedure Forecast, 2001-2008 Exhibit 2-5: Fusion Procedures by Surgical Approach, 2002 & 2008 Exhibit 2-6: Instrumented Fusions by Segment, 2001-2008 Exhibit 2-7: Instrumented Cervical Fusions by Modality, Procedure Forecast, 2001-2008 Exhibit 2-8: Total and Instrumented Cervical Fusions by Country, 2001-2008 Exhibit 2-9: Instrumented Thoracolumbar Fusions by Modality, Procedure Forecast, 2001-2008 Exhibit 2-10: Total and Instrumented Thoracolumbar Fusions by Country, 2001-2008 Exhibit 3-1: Traditional Instrumentation Product Configurations Exhibit 3-2: Selected Thoracolumbar Spine Systems, 2003 Exhibit 3-3: Selected Cervical Spine Systems, 2003 Exhibit 3-4: Spinal Fusions Using Traditional Instrumentation, Procedure Forecast, 2001-2008 Exhibit 3-5: Cervical Fusions Using Traditional Instrumentation, Procedure Forecast by Country, 2001-2008 Exhibit 3-6: Thoracolumbar Fusions Using Traditional Instrumentation, Procedure Forecast by Country, 2001-2008 Exhibit 3-7: Traditional Spinal Instrumentation, Market Forecast, 2001-2008 Exhibit 3-8: Traditional Instrumentation, Market Forecast by Country, 2001-2008 Exhibit 3-9: Traditional Cervical Instrumentation, Market Forecast by Country, 2001-2008 Exhibit 3-10: Traditional Thoracolumbar Instrumentation, Market Forecast by Country, 2001-2008 Exhibit 3-11: Traditional Spinal Instrumentation, Supplier Shares, 2002 Exhibit 3-12: Minimally Invasive Approaches for Spinal Fusion Surgery Exhibit 3-13: Selected Percutaneous Implantation Systems and Instrumentation, 2003 Exhibit 3-14: Selected Percutaneous Fusion Technologies Exhibit 3-15: Selected Port Access Spinal Fusion Products, 2003 Exhibit 3-16: Images of Selected Port-Access Spinal Fusion Products, 2003 Exhibit 3-17: Minimally Invasive Spinal Fusion, Procedure and Market Forecast, 2001-2008 Exhibit 3-18: Design Criteria for Medical Biodegradable Polymers Exhibit 3-19: Emerging Spinal Applications for Bioabsorbable Implants Exhibit 4-1: Comparison of Materials Used for Interbody Fusion Devices Exhibit 4-2: Interbody Fusion Device Designs Exhibit 4-3: Approaches and Techniques Used for Lumbar Interbody Fusion Devices Exhibit 4-4: Reasons for Failure of Interbody Fusion Device Procedures Exhibit 4-5: Selected Interbody Fusion Devices, 2003 Exhibit 4-6: Selected Structural Allograft Implants, Products and Suppliers, 2003 Exhibit 4-7: Spinal Fusions Using Cages, Procedure Forecast, 2001-2008 Exhibit 4-8: Cervical Cage Procedures by Country, 2001-2008 Exhibit 4-9: Thoracolumbar Cage Procedures by Country, 2001-2008 Exhibit 4-10: Cervical Cages, Market Forecast by Country, 2001-2008 Exhibit 4-11: Thoracolumbar Cages, Market Forecast by Country, 2001-2008 Exhibit 4-12: Interbody Fusion Cages, Supplier Shares, 2002 Exhibit 4-13: Structural Allografts, Procedure and Market Forecast, 2001-2008 Exhibit 4-14: Structural Allografts, Estimated Supplier Shares, 2002 Exhibit 5-1: Design Criteria for 'sIdeal's Bone Graft Product Exhibit 5-2: Types and Features of Bone Graft Materials Exhibit 5-3: European Community Directives Relating to Importation and Use of Animal Tissue Exhibit 5-4: Selected Base Allograft Products, 2003 Exhibit 5-5: Selected Xenograft Products, 2003 Exhibit 5-6: Selected Synthetic Bone Graft Substitutes, 2003 Exhibit 5-7: Selected Demineralized Bone Matrix Products, 2003 Exhibit 5-8: Bone Graft Substitutes, Procedure Forecast, 2001-2008 Exhibit 5-9: Traditional Bone Graft Substitutes, Market Forecast, 2001-2008 Exhibit 5-10: Traditional Bone Graft Substitutes, Market Forecast by Country, 2001-2008 Exhibit 5-11: Approaches for Incorporating Growth Factors into Bone Graft Products Exhibit 5-12: Selected Bone Growth Factor Programs, 2003 Exhibit 5-13: Comparison of Selected Platelet-Derived Growth Factor Technologies Exhibit 5-14: Advantages and Limitations of BMPs Exhibit 5-15: Bone Growth Factors, Procedure and Market Forecast, 2001-2008 Exhibit 5-16: Bone Morphogenetic Proteins, Market Forecast by Country, 2001-2008 Exhibit 6-1: Total Disc Replacement versus Nucleus Replacement Exhibit 6-2: Overview of Indication Criteria for Total Disc Replacement Exhibit 6-3: Selected Total Disc Replacement Products, 2003 Exhibit 6-4: Product Presentation Exhibit 6-5: Product Presentation Exhibit 6-6: Product Presentation Exhibit 6-7: Product Presentation Exhibit 6-8: Product Presentation Exhibit 6-9: Selected Nucleus Replacement Products and Programs, 2003 Exhibit 6-10: Product Presentation Exhibit 6-11: Product Presentation Exhibit 6-12: Product Presentation Exhibit 6-13: Selected Disc Regeneration Programs, 2003 Exhibit 6-14: Market Drivers and Concerns of Prosthetic Disc Products Exhibit 6-15: Recent Acquisitions of Prosthetic Disc Companies Exhibit 6-16: Prosthetic Disc Products, Procedure Forecast, 2001-2008 Exhibit 6-17: Prosthetic Disc Products, Market Forecast, 2001-2008 Exhibit 6-18: Total Disc Replacements, Procedure and Market Forecast by Country, 2001-2008 Exhibit 6-19: European Market for Total Disc Replacements, Supplier Shares by Segment, 2002 Exhibit 7-1: Major Indications for Vertebral Intervention Exhibit 7-2: Techniques for Managing Vertebral Fractures and Tumors Exhibit 7-3: Relative Contraindications to Vertebroplasty Exhibit 7-4: Performance Requirements for Vertebroplasty Bone Cement Exhibit 7-5: Selected Vertebroplasty Bone Cements, 2003 Exhibit 7-6: Current and Emerging Vertebroplasty Cement Delivery Systems, 2003 Exhibit 7-7: Advantages and Limitations of Kyphoplasty Exhibit 7-8: Selected Clinical Experience with Kyphoplasty Exhibit 7-9: Indications for Vertebral Body Replacement Exhibit 7-10: Cancers With Probable Bone Metastases, Deaths, 1996 and 1998 Exhibit 7-11: Contraindications for Vertebral Body Replacement Exhibit 7-12: Potential Complications Associated with Vertebral Body Replacement Exhibit 7-13: Selected Vertebral Body Replacement Devices, 2003 Exhibit 7-14: Images of Selected Vertebral Body Replacement Devices, 2003 Exhibit 7-15: Vertebral Fracture and Tumor Management, Procedure Forecast, 2001-2008 Exhibit 7-16: Vertebroplasty, Procedure Forecast by Country, 2001-2008 Exhibit 7-17: Kyphoplasty, Procedure Forecast by Country, 2001-2008 Exhibit 7-18: Vertebral Body Replacements, Procedure Forecast by Country, 2001-2008 Exhibit 7-19: Vertebral Fracture Management Products, Market Forecast, 2001-2008 Exhibit 7-20: Bone Cements, Market Forecast, 2001-2008 Exhibit 7-21: Kyphoplasty Disposables, Market Forecast by Country, 2001-2008 Exhibit 7-22: Vertebral Body Replacement Devices, Market Forecast by Country, 2001-2008 Exhibit 7-23: Vertebral Body Replacement Devices, Supplier Shares, 2002 Exhibit 8-1: Selected Flexible Stabilization Technologies, 2003 Exhibit 8-2: Product Presentation Exhibit 8-3: Product Presentation Exhibit 8-4: Product Presentation Exhibit 8-5: Product Presentation Exhibit 8-6: Product Presentation Exhibit 8-7: Product Presentation Exhibit 8-8: Flexible Stabilization, Procedure and Market Forecast, 2001-2008 Exhibit 8-9: Flexible Stabilization Systems, Supplier Shares, 2002 Exhibit 8-10: Intervertebral Discs Exhibit 8-11: Comparison of Minimally Invasive Discectomy Techniques Exhibit 8-12: Advantages and Limitations of Min. Invasive Discectomy Techniques Exhibit 8-13: Indications for Minimally Invasive Discectomy Exhibit 8-14: Risks Associated with Minimally Invasive Discectomy Exhibit 8-15: Comparison of Current and Emerging Disc Removal Techniques Exhibit 8-16: Selected Minimally Invasive Discectomy Technologies, 2003 Exhibit 8-17: Images of Selected Minimally Invasive Discectomy Technologies, 2003 Exhibit 8-18: Minimally Invasive Discectomy, Procedure and Market Forecast, 2001-2008 Exhibit 8-19: Overview of Emerging Surgical Approaches to the Spine Exhibit 8-20: Selected Early Stage Annulus Repair Technologies Exhibit 8-21: Selected Early Stage Facet Joint Replacement Programs, 2003 Exhibit 8-22: Emerging Approaches to Interventional Spine Care Exhibit 8-23: Product Presentation Exhibit 8-24: Product Presentation Exhibit 8-25: Product Presentation Exhibit 8-26: Product Presentation Exhibit 8-27: Intradiscal Heating, Procedure and Market Forecast, 2001-2008 Exhibit 8-28: Product Presentation Exhibit 8-29: Types of Bone Growth Stimulation Devices Exhibit 8-30: Selected Spinal Bone Growth Stimulators Marketed in Europe, 2003 Exhibit 8-31: Selected Spinal Bone Growth Stimulators, 2003 Exhibit 8-32: Spinal Bone Growth Stimulation, Patient and Market Forecast, 2001-2008 Exhibit 8-33: Spinal Bone Growth Stimulators, Supplier Shares, 2002 Exhibit 9-1: Health Care Expenditures by Country Exhibit 9-2: Practicing Physicians by Country Exhibit 9-3: Acute Care Hospital Beds and Utilization Exhibit 9-4: Germany, Health Care Profile Exhibit 9-5: Spinal Products Market in Germany, 2001-2008 Exhibit 9-6: France, Health Care Profile Exhibit 9-7: Spinal Products Market in France, 2001-2008 Exhibit 9-8: Italy, Health Care Profile Exhibit 9-9: Spinal Products Market in Italy, 2001-2008 Exhibit 9-10: Spain, Health Care Profile Exhibit 9-11: Spinal Products Market in Spain, 2001-2008 Exhibit 9-12: United Kingdom, Health Care Profile Exhibit 9-13: Spinal Products Market in the United Kingdom, 2001-2008 Exhibit 9-14: Benelux Nations, Health Care Profiles Exhibit 9-15: Spinal Products Market in Benelux Nations, 2001-2008
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Although Europe has a large, aging population subject to degenerative spine disease, the European spine market has failed to match the dramatic growth seen in the U.S. Inadequate surgeon training, unreliable fusion outcomes, expensive products, reimbursement challenges and the fact that back pain is not a life-threatening condition have contributed to this situation, which has been compounded by suppliers' focus on the fast-growing U.S. market. As a result, Europe remains an underserved spine market, with total product sales to the major nations estimated at less than $300 million in 2002. Now, as the maturing U.S. fusion market shifts gradually towards disc replacement, suppliers of instrumentation are seeking new outlets for their products. Simultaneously, European spine surgeons have both grown in number and are delivering more consistent, quality fusion outcomes, which is removing clinical barriers to spine surgery in Europe. This convergence of supply and demand is projected to drive a 21% annual increase in the European spinal products market to $883 million in 2008.
Company listing available upon request.
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This report is listed in the following markets:
Orthopedics and Spine