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 30 1. SPINAL SURGERY ROBOTS MARKET DESCRIPTION AND MARKET DYNAMICS 31 1.1 Key Elements Of Spinal Robot System 31 1.2 Industry Overview - Spine 33 1.2.1 Robot Assisted Surgery 35 1.2.2 Spine Robotic Surgical Market Strategy 36 1.2.3 Focus on Key Institutions 37 1.2.4 Focus on Leading Surgeons to Drive Rapid and Broad Adoption 37 1.2.5 Maintain Market Leadership 38 1.3 Spine Surgery 38 2. SPINE SURGICAL ROBOT MARKET SHARES AND FORECASTS 41 2.1 Spine Surgical Robot Mapping 41 2.1.1 Spine Surgery Robotics Market Driving Forces 45 2.2 Spine Surgery Robot Market Shares 47 2.2.1 Mazor 51 2.2.2 Surgical Robots for the Spine: Mazor Robotics 51 2.2.3 Mazor Renaissance® System 55 2.2.4 Mazor Robotics Guidance System Maximizes Precision And Safety 56 2.3 Surgical Robot for Spine Market Forecasts 57 2.3.1 Surgical Robot Systems vs. Disposable Instruments Forecasts 69 2.3.2 Shenzhen Advanced Institute Spinal Surgical Robot 74 2.3.3 U.S. Minimally Invasive Spinal Implant Market To Outpace Growth In Traditional Spine Market 74 2.4 Medical Robotic Surgery Challenges 75 2.5 Key Players In The Global Medical Robots 78 2.5.1 Key Players In The Global Spinal Implant Market 81 2.5.2 Medtronic 84 2.5.3 NuVasive 84 2.5.4 SI-BONE 85 2.5.5 Minimally Invasive Surgical Instruments 85 2.5.6 Spinal Restorative Therapy Target Markets 87 2.6 Spine Surgery Robot Prices 87 2.7 Spine Surgery Robot Regional Market Segments 91 2.7.1 US 93 2.7.2 U.S.-Europe Product Introduction Swap 94 2.7.3 Asia-Pacific 95 2.7.4 China 95 2.7.5 Underdeveloped Regions 96 2.7.6 Brazil 96 2.7.7 Spinal Patients in Taiwan Receive Fast Care with Unique Reimbursement Structure; Market Led by DePuy Synthes, Medtronic 97 3. SURGICAL ROBOTS PRODUCT DESCRIPTION 98 3.1 Mazor Robotics 98 3.1.1 Mazor Renaissance In the Operating Room 101 3.1.2 Mazor Robotics Ease of Use and Reduced Length of Stay 101 3.1.3 Mazor Products: Components of the Renaissance System 102 3.1.4 Mazor Mounting Platforms, Disposables, and Accessories 104 3.1.5 Surgical Workflow Using Mazor Renaissance 104 3.1.6 Mazor Three-Dimensional (3D) Synchronization 106 3.1.7 Mazor Spine Surgical Execution 107 3.1.8 Mazor Spine Robot Surgery Applications: 109 3.1.9 Mazor Spine Robot Surgery Applications: Spinal Fusion 110 3.1.10 Mazor Spine Robot Surgery Applications: Scoliosis Surgery 110 3.1.11 Mazor Renaissance® System For Robotic Guidance 111 3.1.12 Mazor Renaissance® Spine Procedures 113 3.1.13 Mazor Robotics Spine Procedures 117 3.1.14 Mazor Robotics Clinical Study 118 3.1.15 Mazor Robotics Reduced Exposure to Radiation 119 3.2 Medtronic 119 3.2.1 Medtronic Spinal Fusion 121 3.2.2 Medtronic Cervical Artificial Disc Products 122 3.2.3 Medtronic Biologics Products 124 3.2.4 Medtronic Minimally Invasive Spinal Surgery 124 3.2.5 Medtronic Posterior OCT Reconstruction 127 3.3 Stryker Spine Surgery 128 3.3.1 Stryker Spine Navigation Software 128 3.3.2 Stryker's VertaPlex® HV First PMMA to Receive Clearance for Treating Sacral Insufficiency Fractures 129 3.4 Exactech 131 3.5 Zimmer / Biomet Spine 132 3.6 Medacta 133 3.7 DJO 135 3.8 Johnson & Johnson / DePuy 138 3.8.1 Johnson & Johnson / Ethicon 138 3.9 NuVasive 139 3.9.1 Nuvasive Spinal Surgical Solutions 140 4. MEDICAL ROBOT TECHNOLOGY AND DISEASE STATISTICS 142 4.1.1 Healthcare Robotics Enabling Technology 142 4.1.2 Robotic-Assisted Minimally Invasive Surgery Market Driving Forces 143 4.2 Mazor Renaissance Surgical Spine Robot FDA Marketing Clearance 510(k) 146 4.3 Robotic Surgical Clinical Applications 146 4.4 Mesenchymal Stem Cells (MSC) Role In Regenerative Medicine 148 4.5 Types of Spine Surgeries 148 4.6 Minimally Invasive Spine Fusion: 150 4.6.1 Scoliosis Correction Surgery: 151 4.6.2 Vertebroplasty: 152 4.6.3 Spine Biopsies: 153 4.7 Spine Surgery Device Market 154 4.8 Mazor Renaissance® Guidance System Technology 155 4.9 Government Regulation 156 4.9.1 California Regulation 159 4.9.2 International Regulation 159 4.9.3 Third Party Reimbursement 160 5. SPINAL SURGICAL ROBOTS COMPANY DESCRIPTION 163 5.1 Accel Spine 163 5.2 Alliance Spine 163 5.2.1 Alliance Spine has Surgical Advisory Boards 164 5.2.2 Alliance Spine Bone Marrow Concentrate System 165 5.3 Alphatec 168 5.3.1 Alphatec Spine 168 5.4 Apollo Spine 170 5.5 Ascendx Spine 170 5.6 Back 2 Basics Spine 171 5.7 Boston Scientific 172 5.7.1 Boston Scientific Precision™ Plus Spinal Cord Stimulator System 172 5.7.2 Boston Scientific Pain Medicine 173 5.8 Brainlab AG 174 5.8.1 Brainlab AG Revenue 175 5.8.2 Brainlab 177 5.9 Captiva Spine 178 5.10 Centinel Spine 179 5.11 Elekta 180 5.11.1 Elekta Gamma Radio Surgery System 181 5.11.2 Elekta - Interim Report May – October 2015/16 182 5.11.3 Elekta Transformation Program On Track 184 5.12 Globus Medical 186 5.10.1 Globus Purchased Excelsius Surgical 188 5.13 K2M 188 5.14 Life Spine 190 5.15 Mazor Robotics 190 5.15.1 Mazor Robotics Creates Robotic Guidance Systems 192 5.15.2 Mazor Robotics Strategy 192 5.15.3 Research Agreement with Cleveland Clinic Foundation (CCF) 196 5.15.4 Mazor Surgical Workflow Using Renaissance for Spine Procedures 197 5.15.5 Mazor Robotic Pre-Operative Planning 198 5.16 Medacta 201 5.16.1 Medacta Business 202 5.17 Medtronic 202 5.17.1 Medtronic Revenue 203 5.17.2 Medtronic Operating Segments 206 5.17.3 Medtronic Sacroiliac Joint Fusion Device Spinal Implant Market 212 5.17.4 Medtronic Spine 213 5.17.5 Medtronic in the U.S. Spinal Implant Market 214 5.17.6 Medtronic Acquisition of Covidian 215 5.17.7 Medtronic Acquisition of RF Surgical Systems 215 5.17.8 Medtronic Acquisition of Medina Medical 215 5.17.9 Medtronic Pelvic Mesh Litigation 216 5.17.10 Medtronic Restorative Therapies Group 216 5.18 MicroPort Scientific Corporation 218 5.18.1 MicroPort Orthopedic Devices 219 5.18.2 MicroPort Acquires OrthoRecon Business from Wright Medical Technologies 219 5.18.3 Microport Hip Systems 220 5.19 NLT Spine 220 5.20 NuVasive 221 5.20.1 NuVasive Full-Year 2015 Revenue 221 5.21 Precision Spine 223 5.22 Shenzhen Advanced Institute Spinal Surgical Robot 225 5.23 Si-Bone 225 5.23.1 SI-BONE iFuse Implant System 227 5.24 SIGNUS Medical 228 5.25 Spinal Elements 230 5.26 Spineart 230 5.27 SpineGuard 231 5.28 Spine Frontier 231 5.29 Spineology 232 5.30 Spine Smith Partners 232 5.31 Spine Surgical Innovations 233 5.31.1 Spine Surgical Innovations MIMS Approach, Minimum Incision, Maximum Sight 233 5.32 Spine View 234 5.33 Spine Wave 235 5.34 St. Jude Medical 235 5.35 Stryker 236 5.35.1 Stryker / MAKO Surgical 237 5.35.2 Stryker Revenue 237 5.35.3 Stryker Results Of Operations 239 5.35.4 Stryker Segment Orthopaedics 240 5.35.5 Stryker Business Segment Operations 241 5.35.6 Stryker Revenue 242 5.35.7 Stryker Hip Recall: $1.4 Billion Settlement 243 5.35.8 Stryker Regional Revenue Segment 244 5.35.9 Stryker Robots 245 5.35.10 Stryker / MAKO Surgical 252 5.35.11 Stryker / Mako 253 5.35.12 MAKO Surgical RIO Robotic Arm 263 5.35.13 Stryker Endoscopy 264 5.35.14 Mako Surgical Business 265 5.35.15 Mako Products 266 5.35.16 Mako Surgical Strategy 269 5.35.17 Mako Surgical Revenue 272 5.35.18 Mako Surgical Business 274 5.35.19 Mako Products 275 5.35.20 Mako Surgical Strategy 278 5.35.21 Mako Surgical Revenue 281 5.36 Wenzel Spine 281 5.37 Wright Medical Technology 282 5.37.1 Wright Revenue 282 5.37.2 Wright Medical Group NV Revenue 283 5.37.3 Wright Medical Group N.V. Revenue for 2015 Third Quarter 284 5.37.4 Wright / Tornier 289 5.38 X-spine 289 5.39 Zyga Technology 291 5.40 Zimmer Biomet 293 5.40.1 Zimmer Biomet Sales by Product Category 296 5.40.2 Zimmer Biomet 297 5.40.3 Zimmer Metal-on-Metal Hip Recall 299 5.41 Spine Surgical Companies 301 5.41.1 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 2015 29 Figure ES-6 30 Spinal Surgical Robots Market Forecasts, Dollars, Worldwide, 2016-2022 30 Table 1-1 32 Key Elements Of A Spinal Robot System 32 Table 1-2 33 Spine Disorder Market Driving Forces 33 Table 1-3 36 Spine Surgical Robot Focus on Key Procedures 36 Table 1-4 39 Spinal Surgery Scientific Advances 39 Table 1-5 39 Robot-Guided Spinal Surgery Advantages: 39 Table 2-1 43 Robot-Guided Spine Surgery Benefits 43 Table 2-2 43 Spine Surgery Robot-Guidance Features 43 Table 2-3 44 Robot-Guide For Spine Surgery Components 44 Table 2-4 45 Robot Spine Surgery Market Driving Forces 45 Figure 2-5 48 Spine Surgical Robot Market Shares, Shipments, Dollars, Worldwide 2015 48 Table 2-6 49 Spine Surgical Robot Market Shares, Dollars, Worldwide, 2015 49 Table 2-7 50 Principal Competitive Factors in the Robotic Spine Surgery Market 50 Table 2-8 51 Mazor Revenue, 2010-2015 51 Figure 2-9 54 Mazor Leading Spine Surgery Innovation 54 Figure 2-10 57 Spinal Surgical Robots Market Forecasts, Dollars, Worldwide, 2016-2022 57 Table 2-11 58 Spinal Surgical Robot Market Forecasts, Dollars, Worldwide, 2016-2022 58 Table 2-12 59 Spinal Surgical Robot Revenue by Segment, Robots and Disposables, Worldwide, 2016-2022 59 Table 2-13 60 Robot Spine Procedures, Number, Worldwide, 2015 60 Table 2-14 61 Spinal Surgical Robot Units Shipped Forecasts, Surgical Robotic Procedures, and Number Procedures per Installed Unit, Worldwide, 2016-2022 61 Table 2-15 62 Spinal Surgical Robot Installed Base, Percent Spinal Procedure Penetration, and # Spinal Procedures, US and Worldwide, 2016-2022 62 Table 2-16 63 Spinal Surgical Patients with Chronic Back Pain and % Penetration Procedures Worldwide, 2016-2022 63 Table 2-17 64 Robot Spine Surgery Market Factors: 64 Table 2-18 65 Robotics Market Aspects 65 Table 2-19 66 Spinal Surgery Hospital Trends 66 Table 2-20 67 Robotic Cost Savings with Spinal Surgical Units 67 Figure 2-21 69 Surgical Robot Systems vs. Instruments Forecasts, Dollars, Worldwide, 2016-2022 69 Table 2-22 71 Benefits of Robotic Surgery For The Surgeon 71 Table 2-23 72 Benefits of Robotic Surgery For The Patient 7 Table 2-24 73 Benefits of Robotic Surgery For The Hospital 73 Table 2-25 76 Challenges of Open Surgery and Minimally Invasive Surgery 76 Table 2-26 77 Challenges of Developing Medical Robotic Surgery Systems 77 Table 2-27 78 Surgical Robotic Product Development Challenges 78 Table 2-28 79 Key Players In The Global Medical Robots Market 79 Table 2-29 83 Key Players In The Global Spinal Implant Market 83 Table 2-30 86 Advantages of Minimally Invasive Surgeries 86 Table 2-31 86 Challenges of Minimally Invasive Surgeries 86 Figure 2-32 91 Spine Surgical Robot Regional Market Segments, Dollars, Worldwide, 2015 91 Table 2-33 92 Spine Surgical Robot Regional Market Segments, 2015 92 Figure 3-1 99 Mazor 3D Visualization of Surgical Planning 99 Figure 3-2 100 Mazor Planning Software / 3D visualization 100 Table 3-3 102 Mazor Components of the Renaissance System 102 Table 3-4 103 Mazor Renaissance System Component Tasks 103 Table 3-5 105 MAZOR RBT Device Surgical Workflow Using Renaissance for Spine Procedures 105 Figure 3-6 107 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 3-7 108 Mazor RBT Device (with an arm connected to it) on Clamp Mount Ready To Guide The Surgeon 108 Figure 3-8 109 Mazor Spine Robot Surgery Applications: 109 Figure 3-9 112 Mazor Robotics’ Renaissance® System For Guidance 112 Figure 3-10 113 Mazor Renaissance® Spine Procedures 113 Figure 3-11 117 Mazor Robotics Spine Procedures Variety 117 Table 3-12 120 Medtronic Spinal Conditions Treated 120 Table 3-13 123 Medtronic Infuse® Bone Graft/LT-Cage® Lumbar Tapered Fusion Device Risks 123 Table 3-14 126 Medtronic Minimally Invasive Spine Platform Enables A Variety Of Cervical, Thoracic, And Lumbar Procedures126 Figure 3-15 127 Medtronic Posterior OCT Reconstruction 127 Table 3-16 129 Stryker Spine Navigation Software Key Advantages 129 Table 3-17 132 Zimmer / Biomet Spine Surgical Solutions 132 Figure 3-18 133 Biomet Sequoia® Thoracolumbar Pedicle Screws with TM Ardis™ Interbody System 133 Figure 3-19 135 DJO Cement Solutions 135 Table 3-20 135 DJO Spine Devices 135 Table 3-21 140 Nuvasive Surgical Solutions Procedures 140 Table 3-22 141 Nuvasive Surgical Solutions NVM5® Nerve Monitoring System 141 Table 4-1 142 Healthcare Robotics Enabling Technologies 142 Table 4-2 143 Robotic-Assisted Minimally Invasive Surgery Market Driving Forces 143 Table 4-2 (Continued) 144 Robotic-Assisted Minimally Invasive Surgery Market Driving Forces 144 Table 4-3 145 Types Of Procedures Performed Using Robotic Surgical Systems 145 Table 4-4 148 Types of Spinal Pathology and Disorders 148 Table 4-5 149 Types of Spinal Deformities 149 Table 4-6 150 Types of Spinal Disorder Treatments 150 Figure 5-1 166 Alliance Spine Nakoma SL Anterior Cervical Plating System 166 Figure 5-2 167 Alliance Spine Alamo C 167 Figure 5-3 173 Boston Scientific SCS System: 32 Contacts and 32 Dedicated Power Sources 173 Figure 5-4 174 Brainlab Collaborative Workspace 174 Figure 5-5 175 Brainlab AG Worldwide Presence, Headquarters in Germany 175 Figure 5-6 179 Captiva Spine Pedicle Screw System 179 Figure 5-7 181 Elekta Gamma Radio Surgery System 181 Figure 5-8 187 Globus Medical Spine Surgery Products 187 Table 5-9 191 Mazor Revenue, 2010-2015 191 Table 5-10 193 Mazor Robotics Strategy Key Elements 193 Table 5-11 193 Mazor Robotics Commercialization of Renaissance System Strategy Key Elements 193 Table 5-12 194 Mazor Robotics Utilization Of Installed Base Strategy Key Elements 194 Table 5-13 195 Mazor Robotics Clinical And Financial Value Strategy Key Elements 195 Table 5-14 196 Mazor Robotics Research And Development Strategy Key Elements 196 Table 5-15 197 Basic Steps for Surgical Workflow Using Mazor Renaissance Robot 197 Figure 5-16 199 Mazor Surgical Planning Software Provides A Slice-By-Slice Image Display 199 Figure 5-17 200 Mazor Surgical Robot: 3D Marker; C-arm in 2 positions taking registration images for 3D Synchronization process200 Figure 5-18 201 Mazor RBT Device (with an arm connected to it) on Clamp Mount ready to guide the surgeon 201 Figure 5-19 205 Medtronic / Covidian Integration 205 Table 5-20 213 Medtronic Principal Products Offered by Spine Division: 213 Table 5-21 217 Medtronic Spine Division Principal Products 217 Table 5-22 218 MicroPort® Advanced Technology Product Segments Addressed 218 Table 5-23 220 Microport Hip Systems 220 Figure 5-24 224 Precision Spine Cervical Spine Devices 224 Figure 5-25 229 SIGNUS Medical Sacroiliac Joint Medical Device 229 Figure 5-26 246 Stryker Joint Implants 246 Figure 5-27 248 Stryker Patient Specific Pre-Operative Planning 248 Figure 5-28 249 Stryker Patient Specific Pre-Operative Planning 249 Table 5-29 250 Stryker Better Fit Orthopedics 250 Table 5-30 251 Stryker Osteoarthritis Affects Compartments Of The Knee 251 Figure 5-31 252 Stryker / MAKO Surgical RIO Robotic Arm Interactive System 252 Figure 5-32 260 MAKO Surgical Restoris 260 Figure 5-33 262 Mako Robotic Arm Technology Assists in Total Hip Replacement 262 Figure 5-34 263 MAKO Surgical 263 Figure 5-35 264 MAKO Surgical Implants 264 Table 5-36 269 MAKO Robotic Surgery Benefits 269 Figure 5-37 273 Mako Robotic Arm Technology Assists in Total Hip Replacement 273 Table 5-38 278 MAKO Robotic Surgery Benefits 278 Figure 5-39 292 Zyga Technology SImmetry System 292 Table 5-40 298 Zimmer Biomet Musculoskeletal Healthcare Offerings 298 Table 5-41 300 Zimmer Metal On Metal Hip Replacement Difficulties and Side Effects. 300