Is neuromodulation entering its next growth cycle? Lessons from Medtronic, Axonics, and Boston Scientific

Why is neuromodulation moving from niche therapy to mainstream adoption in 2025?

The medical device industry is witnessing a shift that could redefine chronic care: neuromodulation, once viewed as a niche therapy reserved for highly specific conditions, is now entering a new growth phase. Medtronic plc (NYSE: MDT), Boston Scientific Corporation (NYSE: BSX), and Axonics, Inc. (NASDAQ: AXNX) have become central players in this transition, pushing technologies beyond spinal cord stimulation into urology, pain management, and even mood disorders.

The timing of Medtronic’s FDA approval for its Altaviva implantable tibial neuromodulation device underscores the scale of this shift. Once limited to invasive procedures requiring sedation and imaging, neuromodulation is evolving toward minimally invasive therapies designed for real-world use. At the same time, Boston Scientific has doubled down on its acquisition strategy, most recently with the high-profile purchase of Axonics, a company that built its reputation by disrupting sacral neuromodulation. Together, these moves raise a question that investors, clinicians, and patients are asking alike: is neuromodulation finally moving into its next growth cycle?

How large is the neuromodulation market today and where is it headed over the next decade?

The neuromodulation market is no longer a speculative corner of medtech. Industry analysts valued the global neuromodulation devices segment at more than 9 billion dollars in 2024, with forecasts suggesting it could more than double to exceed 22 billion dollars by 2033. This represents a compound annual growth rate of nearly 10 percent — well above many other device categories.

Sacral neuromodulation, the sub-sector most directly relevant to bladder and bowel control, already accounts for hundreds of millions in annual sales. Projections place this market at more than 700 million dollars by the mid-2030s, reflecting a steady 6 to 7 percent growth rate. Growth is being driven not only by device innovation but also by increasing awareness, patient willingness to seek treatment, and healthcare system recognition of the costs of untreated conditions like incontinence or chronic pain.

This trajectory suggests neuromodulation is set to expand beyond its original base in spinal cord and deep brain stimulation, moving into conditions such as urinary incontinence, hypertension, and even obesity.

What role does Medtronic play in driving the neuromodulation growth story?

Medtronic has long been the market leader in neuromodulation, with decades of experience in spinal cord and deep brain stimulation. Its latest approval, the Altaviva implantable tibial neuromodulation device, represents an important step in expanding adoption. The device is placed just beneath the skin near the ankle and delivers electrical impulses to the tibial nerve, helping re-establish communication between the brain and bladder.

Unlike older therapies, Altaviva does not require sedation or imaging, reducing the barriers for both patients and clinicians. With a battery life of up to 15 years, simplified 30-minute recharging, and MRI compatibility, it is designed to fit seamlessly into patient lifestyles. This combination of usability and clinical efficacy is expected to accelerate adoption among the 16 million Americans who suffer from urge urinary incontinence.

Financially, the therapy may not yet move the needle on Medtronic’s 32 billion dollars in annual revenue. But strategically, it positions the company to capture growth in a high-need, under-served segment. For investors, the device signals Medtronic’s commitment to pipeline innovation even as its broader stock performance remains defensive, with dividend stability attracting long-term institutional holders.

Why has Boston Scientific made neuromodulation a cornerstone of its strategy?

Boston Scientific has chosen acquisition as its lever for expansion. The 2024 purchase of Axonics sent a clear message: the company sees neuromodulation not as an optional diversification but as a core growth engine. By integrating Axonics’ sacral neuromodulation systems into its broader urology and neuroscience businesses, Boston Scientific strengthens its portfolio in a space where Medtronic has historically dominated.

Beyond acquisitions, Boston Scientific continues to innovate in spinal cord stimulation, with new lead configurations designed for more flexible therapy delivery. The company is positioning itself as not only a competitor to Medtronic but also as an innovator capable of reshaping the patient experience. For investors, Boston Scientific’s broader balance sheet and history of scaling acquisitions suggest it may be able to accelerate commercialization faster than standalone players.

How has Axonics disrupted the bladder control therapy market before joining Boston Scientific?

Axonics entered the market as a challenger brand, differentiating itself with smaller, rechargeable devices that offered long-lasting therapy for bladder and bowel dysfunction. Clinical trials, particularly the ARTISAN-SNM study, demonstrated high efficacy and durable results, helping the company capture market share against Medtronic’s earlier systems.

Although Axonics operated at a net loss in its early years, revenue growth of more than 30 percent annually signaled strong demand. By 2023, Axonics generated more than 350 million dollars in sales, supported by expanding approvals across multiple geographies. This growth trajectory made it a natural acquisition target for Boston Scientific, which valued both its technology and its clinical credibility.

The combination of Axonics’ disruptive culture with Boston Scientific’s scale creates a powerful competitor in neuromodulation’s next phase.

What innovations are driving adoption of neuromodulation therapies in 2025?

The technological improvements shaping this growth cycle are significant. Device size has decreased, procedures have become less invasive, and long-life or rechargeable batteries have reduced the need for frequent replacements. Compatibility with MRI scans has removed a major barrier for patients requiring imaging for unrelated conditions.

Equally important, therapy delivery has become simpler. Devices like Medtronic’s Altaviva are designed to be “set-and-forget,” eliminating the need for daily patient adjustments. This reduces cognitive burden and makes adoption more attractive for patients who might otherwise avoid surgical therapies.

Clinical evidence is also catching up. Multi-year trial results now demonstrate not just short-term efficacy but long-term durability, addressing one of the biggest historical concerns with neuromodulation. Together, these innovations create a patient-centric value proposition that is increasingly difficult for healthcare providers to ignore.

What challenges could slow the neuromodulation growth cycle?

Despite strong tailwinds, several barriers remain. Reimbursement pathways vary widely between countries and even within regions, creating uncertainty for both patients and providers. Awareness remains limited, with stigma continuing to discourage many people from seeking treatment for conditions like urinary incontinence.

Cost is another hurdle. Devices and procedures remain expensive relative to conservative therapies, which can slow adoption in healthcare systems under budget constraints. Training requirements for physicians also limit the speed of adoption, particularly in markets with fewer specialists.

Finally, competitive intensity is rising. While Medtronic, Boston Scientific, and Axonics dominate headlines, smaller players and startups are experimenting with wearable and non-implantable alternatives, potentially creating new pressure on pricing and positioning.

What key takeaways do neuromodulation’s latest innovations offer for investors, doctors, and patients in the medical device sector?

For investors, neuromodulation represents a medium-term growth opportunity in a medtech sector otherwise dominated by slower-growth categories. Companies with diversified portfolios and proven commercialization capability are likely to outperform. Medtronic’s breadth, Boston Scientific’s acquisition strategy, and Axonics’ innovation pipeline each represent different strategic paths toward capturing growth.

For clinicians, the lesson is that neuromodulation is no longer experimental — it is entering mainstream practice. With devices becoming simpler to implant and manage, more physicians are likely to integrate these therapies into their treatment options.

For patients, the shift means greater access to therapies that can improve quality of life without the compromises associated with older devices. Reduced invasiveness and improved durability address many of the historical concerns that kept adoption low.

What future developments could define the neuromodulation industry as it expands beyond bladder control into broader chronic disease therapies?

The next five years will likely determine how far neuromodulation can expand beyond its traditional niches. New indications such as hypertension, obesity, and gastrointestinal disorders are being actively researched, and devices capable of adaptive, closed-loop stimulation could become standard.

As reimbursement frameworks evolve and awareness increases, adoption is expected to accelerate. At the same time, consolidation through mergers and acquisitions will likely continue, as companies seek to build scale and technology depth.

For now, the message is clear: neuromodulation has entered a new growth cycle. Whether through Medtronic’s steady innovation, Boston Scientific’s acquisition strategy, or Axonics’ disruptive clinical approach, the industry is poised for expansion. Investors, clinicians, and patients alike will be watching closely to see how this growth story unfolds.