Large Spine Players Focus Acquisitions on Robotics, Navigation, Additive

In the last month, Medtronic, DePuy Synthes, Stryker and Globus Medical—four of the five largest spine companies ranked by revenue—announced acquisitions that focus on the leading technology conversations taking place in the space today: robotics/navigation and additive manufacturing. Their increasing emphasis on computer-assisted and additively manufactured products indicates that these technologies will drive revenue and shape the market in the years to come.

Here is a brief recap of the transactions, starting with the most recent.

• Medtronic entered into a definitive agreement to acquire Mazor Robotics for $1.64BB in cash; the transaction is slated to close in January 2019. The announcement is not surprising, given their relationship that began in 2016 with a multi-phase commercial agreement for co-promotion, co-development and exclusive global distribution of certain Mazor products, as well as an equity investment in Mazor by Medtronic. The partnership led to >80 installations of the Mazor X Robotic Guidance platform for spine surgery since the system’’s launch in 2016. The acquisition will allow Medtronic to further leverage Mazor’s guidance tools with Medtronic’s implants, navigation and imaging technologies. One example is Mazor X Stealth Edition, which will debut at the NASS Annual Meeting.

• Globus Medical acquired Nemaris and its Surgimap software used to preoperatively plan spine surgery. Globus plans to incorporate Surgimap into its ExcelsiusGPS robotic guidance and navigation system, as well as future products, in order to streamline workflow and enable more robust data analytics. The acquisition complements Globus’ 2Q18 purchase of KB Medical, developer of the AQrate Robotic Assistance system. Surgimap is widely used by Globus’ competitors, including DePuy Synthes, K2M, Medtronic, NuVasive, Orthofix, Stryker and Zimmer Biomet. Per industry analysts, management noted that this acquisition will not impact any existing partnerships.

• Johnson & Johnson Medical GmbH made a definitive agreement to acquire Emerging Implant Technologies (EIT), a manufacturer of 3D-printed titanium interbodies for spinal fusion. EIT’s implants are manufactured from EIT Cellular Titanium® that yields a porosity of 80% and are designed to mimic trabecular bone structure, obviating the need for bone graft. EIT entered the U.S. market in 4Q17. Ex-U.S, EIT’s products have been used in >10,000 procedures in >15 countries, including Australia, France, Germany, Korea and the Netherlands.

• By ORTHOWORLD estimates, Stryker’s definitive agreement to purchase K2M for $1.4BB will rank the company among the top three players in spine, narrowly stepping over NuVasive. The new lineup will be #1 Medtronic, #2 DePuy Synthes and #3 Stryker. K2M was #7 on our list prior to the transaction. The purchase allows Stryker to gain access to K2M’s robust portfolio of complex and minimally invasive products, filling gaps in its own product lines. Additionally, the acquisition combines two forces promoting implants that use proprietary additive manufacturing processes: Stryker with Tritanium and K2M with Lamellar Titanium Technology. (Stryker also made a definitive agreement to purchase Invuity and its portfolio of single-use, lighted instruments that deliver enhanced visualization for multiple applications, including spine.)

Spine companies large and small are making strategic changes. We tracked 31 mergers and acquisitions in the spine space from 2017 through mid-September 2018.

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