Tracking the surge of Spine M&A activity during COVID-19.

The med device market downturn related to COVID-19 has led to a notable uptick in M&A activity across the board, with a number of acquisitions that will impact the Spine market.

Recent Deals
Perhaps the most notable deal has been Medtronic's* (MDT) agreement to acquire Medicrea, a manufacturer of custom spine implants, for about €7.00 per share, a premium of 22% over the closing price of shares on July 14. The acquisition is expected to close by the end of 2020.

The latest intel suggests the spine market is rebounding more quickly than expected, but certain new market dynamics will persist.

While much remains up in the air, early data suggests the spine market is rebounding more quickly than expected. Surgeons are beginning to perform cases that were postponed through March and April due to COVID-19. In conversations with WFS analysts,  NuVasive* (NUVA) management reported a mix of both deferred cases and new volume in May. NUVA’s spine business reportedly tracked ~50% below pre-COVID levels in May versus ~70% below in April. The Company’s current trajectory and consensus expectations for the quarter implies a recovery in procedure volumes to 35% below pre-COVID levels in June according to  WFS NUVA: Takeaways From The 2020 “Virtual” Bus Tour Report. Similarly, Canaccord Genuity estimates  Alphatec’s* FY20 US revenue will be down –9.7% YoY with an estimated -45.6% drop in Q220 sales. This assumes the impact from COVID-19 started in mid-March, April revenues were down ~60-70%, and notable improvement began in early May as more states resume procedures.

Spine’s solid start to Q120 was derailed in March by COVID-19, leading to a -10.6% YoY decline globally.

Q120 reporting gives us the first glimpse into the effect of COVID-19 on the spinal hardware market, with the impact in the US felt starting in mid-March. A multi-dimensional survey of 902 spine surgeons around the globe revealed that 67.1% of respondents saw the cancellation of greater than 75% of their surgical cases per week in late March/early April. Global Spine J.

The WW Spine Hardware market experienced a -10.6% downturn in the quarter, with the US down -11.2%. Several companies noted they were tracking for strong Q1 growth prior to the pandemic. At the end of February, SeaSpine* reported that it was looking at another quarter of double-digit US growth, but ended up with a slight overall decline in Q1 US revenue due to March procedures being down an estimated -18% vs March 2019. 

Among the many topics covered in the comprehensive Q120 Spine Market Recap* are:

Companies like startup TrackX Technology are taking navigation technology to the next level to provide real-time instrument tracking while minimizing radiation exposure during minimally invasive spine procedures.

Enabling technologies, including robotics and navigation systems in spine surgery, are here to stay and were on display at the Spine Summit 2020 meeting held in Las Vegas, Nevada from March 5-8. While navigation has been around for decades, companies like startup TrackX Technology are taking the technology to the next level to provide real-time instrument tracking while minimizing radiation exposure during minimally invasive spine procedures.

Improvements in procedure volumes drove strong growth across the spine hardware market.

Improvements in procedure volumes drove positive growth across the spine hardware market, with the WW spine hardware market up for Q419 and FY2019, respectively, according to the SmartTRAK Financial Dashboard. Similarly, Cantor Fitzgerald analysts estimate 2019 global spine market (inclusive of biologics) growth at +2.2%, the highest growth the market has seen in 5 years, with +2.1% US growth and +2.2% growth OUS.

Among the many topics covered in the comprehensive  Q419 Spine Market Recap*  are:

Shifting spine procedures to an ASC setting and participating in a free market healthcare environment.

Richard A. Kube II, MD discusses the advantages and challenges of moving spine procedures to an Ambulatory Surgery Center (ASC) setting in an interview with SmartTRAK. Spine surgeon Dr. Kube founded the  Prairie Surgicare Spine Surgical Facility in Peoria, Illinois as well as the Illinois chapter of  Free Market Medical Association. He shares with us why many are choosing an ASC setting as well as the importance of transparency in healthcare. To find out more, click on the following video. A transcript of the interview is also provided below.

The WW Spine Hardware market saw a return to growth in Q319 with +3.6% growth, the highest growth rate this market has seen in at least 2 years. An uptick in procedure volumes across the board drove robust US market growth of +5.7%. WFS analysts estimate the Q319 Spine market (excluding Infuse) accelerated 90bps sequentially on a stacked two-year basis with Medtronic, Globus and NuVasive taking share from DePuy Synthes, Stryker and Zimmer Biomet.

SmartTRAK identifies trends to watch in Spine

By most accounts, the Spine market has stabilized with modest low single-digit growth expected this year. Medtronic CEO Omar Ishrak agrees that the Spine market seems to have stabilized and is starting to inch back up. However, he suggests that it is still slower than a year or two ago as price declines are now offsetting procedure growth, resulting in flat to low single-digit to growth. For 2019, Needham analysts are modeling 2% spine market growth with overall orthopedic market growth of 3.4%.

Med device giants are scooping up innovative technologies

The Spine market is bustling with activity so far this spring, with two notable acquisitions hot off the press.

Medtronic announced its acquisition of Titan Spine,  strengthening Medtronic's interbody position with Titan Spine's portfolio, which consists of a full line of titanium, surface-enhanced interbody fusion devices featuring Titan’s nanoLock surface technology. The acquisition is expected to close during Medtronic's first fiscal quarter ending July 26, 2019, although terms of the deal were not disclosed. Titan Spine currently markets its line of Endoskeleton interbody devices in the US, Europe and Australia. This acquisition further validates the shift in the interbody market from PEEK to porous titanium. Medtronic already offers interbodies manufactured from Ti-coated PEEK (Pure Titanium Coating or PTC) and just last year launched a titanium 3D printed platform – TiONIC Technology - that enables more complex designs and integrated surface technologies for spine surgery implants.

Q418 US Spine market remains fairly flat, rounding out a stable but unremarkable FY18.

SmartTRAK’s Financial Dashboard indicates a fairly flat Q418 US Spine market, with a decline of -0.4%. Similarly, for the full year, the US Spine Market was stable, with +0.9% growth. WW revenues increased modestly with a +1% uptick for FY2018. Spine market growth as a whole slowed sequentially to +1% in Q418 from +2% in Q3 according to estimates. Growth continues to be restricted in the US Spine market by a few key factors. Payer pushback is the norm, and while most surgical practices have learned to deal with it, the environment is ever-changing with new obstacles and hurdles.

Among the many topics covered in SmartTRAK's Q418/FY18 Spine Market Recap are: