The implants used for surgeries of the spine are the segment of highest growth on the orthopedic market. This growth is directly related to the changes that have occurred in the treatment of spinal diseases. Originally, instrumentation was used only in the correction of spinal deformities such as scoliosis. Over the past 10 to 15 years, however, the application of internal fixation has also been used for other conditions such as degenerative, traumatic, tumoral, and infectious diseases. Other devices used in spine surgery such as bone graft substitutes, growth factors technologies, and spinal arthroplasty devices have also contributed to the growth of this market, side by side with the increasing population of elderly patients, favorable changes regarding reimbursement, and the development of minimally invasive surgical techniques. The global spine market was valued at $2.4 billion in 2003, with a 14.9% increase compared to 2002, and by 2008 it is expected to be over $3.7 billion.

The problems related to the application of modern technologies in the health area are complex and are intimately linked to the economic and cultural characteristics of each country or region. The analysis of these problems cannot be generalized but must focus on a region of interest. The Latin American spine market represents a small part of the global spine market and was valued at $56 million in 2003. This figure reflects the influence of the economic situation and of the organization and funding of the health systems on the spinal implant market. For the purpose of analysis of the spinal implant market, Latin America is considered here to consist of Brazil, Mexico, Colombia, Argentina, Venezuela, and Chile.

Despite the low absolute value of the Latin American implant market in relation to the world market, growth is predicted to occur over the next few years, influenced by recovery of the market as a function of the improved economic situation of the countries, reforms to improve the health care system in several countries, increased training of surgeons in the use of orthopedic devices, and an aging population likely to have a greater incidence of degenerative disc disease, arthritis, and osteoporosis. Unemployment and a high level of poverty continue to be limiting factors regarding the growth of the orthopedic implant market in Latin America.

The orthopedic implant market was estimated at $200 million (US dollars) in 2003, with reconstructive implants ($90.0 million) and trauma implants ($69.1 million) accounting for the leading shares of this market, followed by spinal implants ($56.93 million) (Fig. 33.1). The vertebral implant market has been negatively affected by the devaluation of some currencies (real, bolivar, and Argentine peso) in Latin America, by the bankruptcy of the Venezuelan health care system, and by the lack of training of surgeons in the use of new techniques. Driving the market over the forecast period, however, is an increase incidence of degenerative disc disease stemming from an aging population and improvement in various health care systems, notably in Chile and Mexico.

In Latin America, the implant market is directly related to population size (Figs. 33.2,33.3). Thus, Brazil, the country with the largest population (fifth in the world), represents, in general, the largest orthopedic implant market, estimated at $70 million in 2003. The Brazilian market is price sensitive and has the highest number of strong domestic manufacturers of reconstructive, trauma, and spinal implants, with five manufacturers being among the top 20 competitors in the Latin American orthopedic market. Argentina also has various domestic manufacturers, whereas few are available in Mexico and Colombia, which rely primarily on imported products. Similarly, Venezuela and Chile import most of their products and have the smallest number of domestic implant manufacturers.