Document:

EX-4.4

 Exhibit 4.4 

SECOND AMENDED AND RESTATED 

PUT-CALL AGREEMENT 
 By
and Among 
 LDR HOLDING CORPORATION, 

LDR Médical S.A.S., 

and 
 The Médical
Shareholders and Warrant Holders 
 Listed on Schedule A hereto 

and 
 The Médical
Noteholders 
 Listed on Schedule B hereto. 

Dated as of August 6, 2013 

 TABLE OF CONTENTS 

 

					
	 	  	Page	 
		
	ARTICLE I	  			
	DEFINITIONS AND INTERPRETATION	  			
		
	 Section 1.01. Definitions
	  	 	1	  
	 Section 1.02. Interpretation
	  	 	2	  
		
	ARTICLE II	  			
	PUT-CALL OPTIONS	  			
		
	 Section 2.01. Condition to Put Option and Call Option
	  	 	3	  
	 Section 2.02. Put Option
	  	 	3	  
	 Section 2.03. Call Option
	  	 	4	  
	 Section 2.04. Option Exercise
	  	 	4	  
	 Section 2.05.
	  	 	4	  
		
	ARTICLE III	  			
	REPRESENTATIONS AND WARRANTIES OF MÉDICAL SHAREHOLDERS AND WARRANT HOLDERS	  			
		
	 Section 3.01. Ownership and Title
	  	 	7	  
	 Section 3.02. Investment Purpose
	  	 	8	  
		
	ARTICLE IV	  			
	ESCROW	  			
		
	 Section 4.01. Deposit of Shares into Escrow
	  	 	8	  
	 Section 4.02. Distribution of Escrowed Certificates
	  	 	9	  
		
	ARTICLE V	  			
	MISCELLANEOUS	  			
		
	 Section 5.01. Assignment; Binding Effect
	  	 	9	  
	 Section 5.02. Survival of Representations and Warranties
	  	 	9	  
	 Section 5.03. Cooperation
	  	 	9	  
	 Section 5.04. Amendment; Waiver
	  	 	9	  
	 Section 5.05. Termination
	  	 	10	  
	 Section 5.06. Notices
	  	 	10	  
	 Section 5.07. Counterparts
	  	 	11	  
	 Section 5.08. Governing Law
	  	 	11	  
	 Section 5.09. Arbitration
	  	 	11	  
	 Section 5.10. Severability
	  	 	12	  
	 Section 5.11. Entire Agreement; No Third Party Beneficiaries
	  	 	12	  

					
	 Section 5.12. Specific Performance
	  	 	12	  
	 Section 5.13. No Right of Offset
	  	 	12	  
	 Section 5.14. Effective Date
	  	 	12	  

  

			
	 Schedule A
	 	Schedule of Médical Shareholders and Warrant Holders
		
	 Schedule B
	 	Schedule of Médical Noteholders
		
	 Exhibit I
	 	Form of Voting Arrangement

  
 ii 

 SECOND AMENDED AND RESTATED 

PUT-CALL AGREEMENT 
 This
SECOND AMENDED AND RESTATED PUT-CALL AGREEMENT (this “Agreement”), dated as of August 6, 2013, is by and among (i) LDR Holding Corporation, a Delaware corporation (“Holding Corp.”), (ii) LDR
Médical S.A.S., a French corporation (“Médical”), (iii) certain shareholders of Médical set forth on Schedule A hereto (the “Shareholders”), (iv) certain holders of
Médical’s Subordinated Secured Promissory Notes issued pursuant to that certain Note Purchase Agreement dated April 25, 2012 set forth on Schedule B hereto (the “Noteholders,” and together with the
Shareholders, the “Médical Shareholders”), and (v) the holders of certain warrants (the “Médical Warrants”) to purchase shares of the capital stock of Médical (the “Warrant
Holders”) set forth on Schedule A hereto. 
 WHEREAS, Holding Corp. owns 616,209 shares of the outstanding 1,152,338
shares of Médical capital stock, or 53.47% of the outstanding voting capital stock of Médical; 
 WHEREAS, the
Shareholders hold all of the remaining shares of the capital stock of Médical; 
 WHEREAS, Holding Corp., Médical,
certain shareholders of Médical and certain noteholders of Médical are parties to that certain Amended and Restated Put-Call Agreement dated as of September 11, 2007, as amended by that certain Amendment No. 1 to Put-Call
Agreement dated as of April 25, 2012 (the “Prior Agreement”); 
 WHEREAS, Holding Corp. and Médical
desire to amend and restate the Prior Agreement as set forth herein to provide that, in the event of a firm commitment underwritten public offering of the Common Stock of Holding Corp., par value $0.001 per share (the “Holding Common
Stock”), Holding Corp. shall have a call option to exchange, or cause the exchange of Holding Common Stock for the capital stock of Médical then held by the Médical Shareholders; 

WHEREAS, pursuant to Section 5.04 of the Prior Agreement, the Prior Agreement may be amended only by an instrument in writing
signed by (i) Holding Corp., (ii) Médical and (iii) the holders of a majority of the Shareholder Médical Stock (as defined in the Prior Agreement) (the “Required Consenting Parties”); and 

WHEREAS, the undersigned represents the Required Consenting Parties. 

 NOW, THEREFORE, in consideration of the foregoing and the mutual covenants contained
herein, the parties hereto agree as follows: 
 ARTICLE I  

DEFINITIONS AND INTERPRETATION 

Section 1.01. Definitions. Wherever used in this Agreement, unless the context shall otherwise require or except as otherwise
expressly provided, the following terms shall have the following respective meanings: 
 “Business Day” shall mean a day
other than Saturday, Sunday or any day on which the principal commercial banks located in the State of New York are authorized or obligated to close under the laws of such state. 

“Governmental Entity” shall mean a court, arbitral tribunal, administrative agency or commission or any federal, state, local
or foreign governmental or regulatory authority or agency. 
 “HSR Act” shall mean the Hart-Scott-Rodino Antitrust Improvements Act of 1976, as amended. 
 “IPO” shall
mean a firm commitment underwritten public offering of Holding Common Stock. 
 “Liquidation Event” shall be defined as any
liquidation, dissolution or winding up of Holding Corp., either voluntary or involuntary, and shall be deemed to be occasioned by, or to include, (A) the acquisition of Holding Corp. by means of any transaction or series of related transactions
(including, without limitation, any stock acquisition, reorganization, merger or consolidation) unless Holding Corp.’s stockholders of record as constituted immediately prior to such acquisition or sale will, immediately after such acquisition
or sale (by virtue of securities issued as consideration for the Holding Corp.’s acquisition or sale or otherwise) hold at least a majority of the voting power of the surviving or acquiring entity (except that the sale by Holding Corp. of
shares of its capital stock to investors in bona fide equity financing transactions, or in an IPO, shall not be deemed a Liquidation Event for this purpose) or (B) a sale, exclusive license, pledge, conveyance or other disposition of all or
substantially all of the assets of the Holding Corp., including a sale, exclusive license, pledge, conveyance or other disposition of all or substantially all of the assets of Holding Corp.’s subsidiaries, if such assets constitute
substantially all of the assets of Holding Corp. and such subsidiaries taken as a whole. Notwithstanding the foregoing, a Liquidation Event shall not include the issuance of shares of capital stock of the Holding Corp., upon the contribution of
shares of capital stock of Médical to Holding Corp. pursuant to the terms of this Agreement. 
 “Notes” shall mean those
Subordinated Secured Promissory Notes issued by Médical pursuant to that certain Note Purchase Agreement dated April 25, 2012, as set forth on Schedule B attached hereto. 

“Shareholder Médical Stock” shall mean (i) the capital stock of Médical, less those shares of
Médical’s capital stock held by Holding Corp., and (ii) those shares of Médical’s capital stock issuable upon conversion of the Notes, in accordance with the terms of the Notes, held by the Noteholders as set forth on
Schedule B attached hereto. 
 “Spine” shall mean LDR Spine USA, Inc., a Delaware corporation. 

Section 1.02. Interpretation. Unless the context otherwise requires: 

(a) The headings contained in this Agreement are for reference purposes only and shall not affect in any way the meaning or interpretation of
this Agreement. 

  
 2 

 (b) Whenever the words “include,” “includes” or “including” are
used in this Agreement they shall be deemed to be followed by the words “without limitation.” 
 (c) The words “hereof,”
“herein” and “herewith” and words of similar import shall, unless otherwise stated, be construed to refer to this Agreement as a whole and not to any particular provision of this Agreement, and article, section, paragraph,
exhibit and schedule references are to the articles, sections, paragraphs, exhibits and schedules of this Agreement unless otherwise specified. 

(d) The meaning assigned to each term defined herein shall be equally applicable to both the singular and the plural forms of such term, and
words denoting any gender shall include all genders. Where a word or phrase is defined herein, each of its other grammatical forms shall have a corresponding meaning. 

(e) A reference to any party to this Agreement or any other agreement or document shall include such party’s successors and permitted
assigns. 
 ARTICLE II 

PUT-CALL OPTIONS 

Section 2.01. Condition to Put Option and Call Option. Each of Médical, each Médical Shareholder, each Warrant
Holder and Holding Corp. hereby acknowledge that the intent of entering into this Agreement is to enable LDR Spine USA, Inc., a Delaware corporation and majority owned subsidiary of Holding Corp., and Médical to operate as a single
coordinated business. Furthermore, the parties hereto acknowledge the need for Holding Corp. to direct the operations of Médical as a condition precedent to Holding Corp. granting the Put Option (as defined below) and each of the
Médical Shareholders and Warrant Holders granting the Call Option (as defined below). To provide Holding Corp. with the requisite authority to control Médical following the execution of this Agreement, Holding and certain of the
Médical Shareholders have entered into the voting arrangement in the form attached hereto as Exhibit I (the “Voting Agreement”). 

In furtherance thereof each of the parties to this Agreement acknowledges and agrees that the officers and directors of each of Holding Corp.,
Médical and Spine will execute and perform their obligations in such a way as to promote the best interests of the combined companies as a single coordinated business under the direction of Holding Corp. To such end, each of the parties
acknowledges and agrees that the fiduciary duties and obligations of the officers and directors of each of Holding Corp., Médical and Spine shall extend and run solely to Holding Corp. and its stockholders (including for these purposes the
Médical Shareholders as if such persons and entities were stockholders of Holding Corp. and not as shareholders of Médical). 

Section 2.02. Put Option. Holding Corp. hereby grants (i) to each Médical Shareholder an irrevocable right and option,
exercisable in each such Médical Shareholder’s sole and absolute discretion, at any time following the date hereof, to exchange, or to cause the exchange of, all and not less than all of the Shareholder Médical Stock held directly
or indirectly by such Médical Shareholder at the time of such exchange, for validly issued, fully paid, non-assessable shares of 

  
 3 

 
capital stock of Holding Corp. (the “Holding Corp. Shares”) and (ii) to each Warrant Holder an irrevocable right and option (together with the option set forth in clause
(i), the “Put Option”) in each such Warrant Holder’s sole and absolute discretion, at any time following the date hereof, to exchange, or to cause the exchange of, such Warrant Holder’s warrant to purchase shares of
Médical’s Class A Stock for shares of Holding Corp. Common Stock in each case as follows: 
 (a) each share of Class A
Stock of Médical held by each Médical Shareholder exercising the Put Option shall be exchanged for 39.15588 shares of Holding Common Stock (as adjusted to reflect any stock dividend, stock split, combination, recapitalization and other
similar event with respect to each such share occurring after the date of this Agreement, the “Common Ratio”); and 
 (b)
each warrant to purchase shares of Médical’s Class A Stock shall first be exercised for the number of shares of Médical Class A Stock issuable upon exercise of such Médical Warrant, and then such Warrant Holder
shall immediately tender such shares of Class A Stock in exchange for shares of Holding Common Stock pursuant to subsection (a) above. 

Section 2.03. Call Option. 

(a) Each Médical Shareholder hereby grants to Holding Corp. the irrevocable right and option, exercisable in Holding Corp.’s sole
and absolute discretion, at any time following the delivery of a Notice of Liquidation Event (as defined in below) or a Notice of IPO (as defined below) by Holding Corp. to the Médical Shareholders, to exchange, or to cause the exchange of,
Holding Common Stock in amounts and types calculated using the Common Ratio for all and not less than all of the Shareholder Médical Stock held directly or indirectly by such Médical Shareholder at the time of such exchange; 

(b) Each Warrant Holder grants to Holding Corp. the irrevocable right and option, exercisable in Holding Corp.’s sole and absolute
discretion, at any time following the delivery of a Notice of Liquidation Event by Holding Corp. to the Warrant Holders, to cause such Warrant Holder to exercise his or her Médical Warrant for all and not less than all of the number of shares
of Médical’s Class A Stock issuable pursuant to the terms of such Médical Warrant, and to immediately thereafter exchange all and not less than all of such Class A Stock issued upon exercise of the Médical Warrant
for shares of Holding Common Stock in amounts and types calculated using the Common Ratio; and 
 (c) Each Warrant Holder grants to Holding
Corp. the irrevocable right and option (together with the option in subsection (a) and (b) above, the “Call Option”), exercisable in Holding Corp.’s sole and absolute discretion, at any time following such Warrant
Holder’s exercise of his or her Médical Warrant following an IPO, to cause the exchange of, Holding Common Stock in amounts and types calculated using the Common Ratio for all and not less than all of the Médical Class A
Stock issued in connection with such exercise. 
 Section 2.04. Option Exercise. 

(a) Put Option. In order to exercise the Put Option, each exercising Médical Shareholder or Warrant Holder shall give written
notice (the “Put Notice”) to Holding Corp. Such Put Notice shall specify the date upon which the Put Option will be exercised (the “Put 

  
 4 

 
Closing Date”) and include a representation that such Médical Shareholder or Warrant Holder owns all right, title or interest in and to the Shareholder Médical Stock or
Médical Warrants, as applicable, to be exchanged, free and clear of all mortgages, liens, loans, claims, security interests and other encumbrances, and a covenant by such Médical Shareholder or Warrant Holder to indemnify Holding Corp.
for any breach of such representation. Upon receipt of the Put Notice, Holding shall, to the extent it may lawfully do so, exchange such Médical Shareholder’s Shareholder Médical Stock or such Warrant Holder’s Médical
Warrants, as applicable, for securities of Holding Corp. in such types and amounts as calculated pursuant to Section 2.02. 
 The
shares of Holding Corp. acquired pursuant to the exercise of the Call Option or Put Option hereunder shall not be transferred by the Médical Shareholders or Warrant Holders acquiring such shares except in accordance with the restrictions on
transfers of shares held by the Stockholders (as defined in the Amended and Restated First Refusal and Co-Sale Agreement, dated as of September 11, 2007 by and among Holding Corp. and the entities listed on Schedules A and B thereto, as
amended from time to time (the “First Refusal and Co-Sale Agreement”)), contained in Section 1 of the First Refusal and Co-Sale Agreement. Any purported sale, assignment, pledge, encumbrance or other transfer in violation of
the First Refusal and Co-Sale Agreement shall be void and ineffectual and shall not operate to transfer any interest or title to the purported transferee of such shares. 

In the event that holders of at least sixty percent of the shares of the capital stock of Médical listed on Schedule A hereto
elect to exercise the Put Option hereunder, each Médical Shareholder and Warrant Holder agrees to exercise the Put Option with respect to the shares of Shareholder Médical Stock and Médical Warrants held by such Médical
Shareholder or Warrant Holder, and hereby appoints Christophe Lavigne their respective attorney-in-fact to exercise such Put Option. 
 (b)
Call Option. 
 (i) In the event that a transaction constituting a Liquidation Event with respect to Holding Corp. is approved
pursuant to the Voting Agreement, Holding Corp. shall deliver to each of the Médical Shareholders and Warrant Holders a written notice describing the basic terms of the proposed transaction (a “Notice of Liquidation Event”).
Holding Corp. shall deliver the Notice of Liquidation Event to each Médical Shareholder and Warrant Holder not less than 15 days prior to the proposed closing of Liquidation Event. 

(ii) In the event of an IPO, Holding Corp. shall deliver to each of the Médical Shareholders and Warrant Holders a written notice
describing the basic terms of the proposed transaction (a “Notice of IPO”). Holding Corp. shall deliver the Notice of IPO to each Médical Shareholder and Warrant Holder not less than five (5) days prior to the expected
closing date of the IPO. 
 (iii) In the event that a Warrant Holder exercises his or her Médical Warrant at any time following an
IPO, Holding Corp. shall deliver to such Warrant Holder a written notice notifying the Warrant Holder of Holding Corp.’s intention to exercise its Call Option as set forth in Section 2.03(c) (the “Post-IPO Notice”). 

  
 5 

 (iv) In order to exercise the Call Option, Holding Corp. shall give written notice (the
“Call Notice”) to such Médical Shareholder(s) and Warrant Holders as Holding Corp. deems appropriate. In the case of a Liquidation Event, Holding Corp. shall deliver the Call Notice within ten (10) days following the
delivery of a Notice of Liquidation Event to the Médical Shareholders and Warrant Holders. In the case of an IPO, the Notice of IPO shall constitute the Call Notice. In the case of a Warrant Holder exercising his or her Médical Warrant
following an IPO, the Post-IPO Notice shall constitute the Call Notice. Such Call Notice shall specify the date upon which the Call Option will be exercised (the “Call Closing Date”). Upon receipt of the Call Notice in connection
with a Liquidation Event or IPO, each Médical Shareholder shall exchange such Médical Shareholder’s Shareholder Médical Stock for capital stock of Holding Corp. in such types and amounts as calculated pursuant to
Section 2.02. Upon receipt of the Call Notice in connection with a Liquidation Event, each Warrant Holder shall exercise his or her Médical Warrant for shares of Médical’s Class A Stock, and immediately thereafter
exchange all but not less than all of such Class A Stock for capital stock of Holding Corp. in such types and amounts as calculated pursuant to Section 2.02. Upon receipt of the Call Notice in connection with a Warrant Holder’s
exercise of his or her Médical Warrant following an IPO, such Warrant Holder shall exchange all but not less than all of the Class A Stock of Médical issued upon such exercise of the Médical Warrant for capital stock of
Holding Corp. in such types and amounts as calculated pursuant to Section 2.02. Each Médical Shareholder or Warrant Holder, as applicable, shall deliver to Holding Corp. a certificate, executed by such Médical Shareholder or
Warrant Holder, certifying that such Médical Shareholder or Warrant Holder owns all right, title or interest in and to the Shareholder Médical Stock or the Class A Stock issued upon exercise of a Médical Warrant, as
applicable, to be exchanged, free and clear of all mortgages, liens, loans, claims, security interests and other encumbrances and a covenant by such Médical Shareholder or Warrant Holder to indemnify Holding Corp. for any breach of such
representation. 
 (c) If, prior to the exercise of the Put Option or the Call Option, as applicable, there shall occur any stock dividend,
stock split, stock combination, merger, recapitalization or other similar change to the capital structure of Holding Corp., the number of Holding Corp. Shares exchangeable upon the exercise of the Put Option or Call Option immediately prior thereto
shall be adjusted so that each exchanging Médical Shareholder or Warrant Holder shall be entitled to receive the kind and number of Holding Corp. Shares or other securities of Holding Corp. which it would have owned or have been entitled to
receive has such Put Option been exercised in advance thereof. 
 (d) If, prior to the exercise of the Put Option or the Call Option, as
applicable, there shall occur any stock dividend, stock split, stock combination, merger, recapitalization or other similar change to the capital structure of Médical, then the number of shares of Shareholder Médical Stock or
Médical Warrants exchangeable upon the exercise of the Put Option or Call Option, as applicable, immediately prior thereto shall be adjusted so that Holding Corp. shall be entitled to receive the same percentage of Shareholder Médical
Stock, Médical Warrants or other securities of Médical which it would have owned or have been entitled to receive had such Call Option been exercised in advance thereof. 

(e) The obligations of the parties to consummate the Put Option and the Call Option pursuant to this Agreement shall be subject to the
satisfaction or waiver (in whole or in 

  
 6 

 
part, in writing, by the party in whose favor the condition must be satisfied for purposes of consummating such transactions; provided, however, that the fulfillment of such
conditions may be waived by the holders of a majority of the Shareholder Médical Stock and such waiver shall bind all holders of Shareholder Médical Stock and Médical Warrants regardless of whether a particular holder of
Shareholder Médical Stock consented to such waiver) of each of the following conditions: 
 (i) all (A) applicable
waiting periods (and any extensions thereof) that may be required with respect to the transactions contemplated by this Agreement under the HSR Act shall have expired or otherwise been terminated without the Federal Trade Commission or the Antitrust
Division of the United States Department of Justice, as applicable, having taken any action which has not been terminated or resolved, and (B) approvals or consents required by any Governmental Entities to the transactions contemplated hereby
shall have been obtained; 
 (ii) no law or order shall have been enacted by any Governmental Entity to enjoin, restrain or prohibit in
respect of this Agreement or the transaction contemplated hereby, if such law or order would make it unlawful to consummate such transactions; 

(iii) all representations and warranties of such Médical Shareholder or Warrant Holder set forth in Article III of this Agreement
shall be true and correct in all material respects as of the date of the consummation of the Put Option or the Call Option, as applicable, as though such representations and warranties were then made (unless compliance with any such representations
or warranties were waived in writing by Holding Corp.), and such Médical Shareholder and Warrant Holder shall have delivered to Holding Corp. and Médical a certificate (executed by an officer if such party is an entity) to the effect
that such condition is satisfied in all respects; and 
 (iv) Each Médical Shareholder or Warrant Holder shall have delivered, or
caused to be delivered, to Holding Corp. or Médical such other documents as such party shall reasonably request. 
 ARTICLE III

 REPRESENTATIONS AND WARRANTIES OF MÉDICAL SHAREHOLDERS AND 

WARRANT HOLDERS 

Section 3.01. Ownership and Title. Each Médical Shareholder and Warrant Holder represents and warrants to Holding Corp.
that such Médical Shareholder or Warrant Holder (a) as of the date of this Agreement, is the owner, directly or indirectly, of all right, title and interest (legal, record and beneficial) in and to the number of shares of Shareholder
Médical Stock or Médical Warrants set forth next to such Médical Shareholder’s or Warrant Holder’s name on Schedule A attached hereto. The delivery to Holding Corp. of such shares of Shareholder Médical
Stock or Médical Warrants as are tendered upon exercise of the Put Option or the Call Option and in accordance with the terms hereof will transfer to Holding Corp. good and marketable title to such shares of Shareholder Médical Stock
or Médical Warrants, free and clear of all mortgages, liens, loans, claims, security interests and other encumbrances. 

  
 7 

 Section 3.02. Investment Purpose. The Holding Corp. Shares to be issued to each
Médical Shareholder or Warrant Holder upon exercise of the Put Option or the Call Option will be acquired for investment for such Médical Shareholder’s or Warrant Holder’s own account, not as a nominee or agent, and not with
a view to the resale or distribution of any part thereof, in each case, in violation of applicable securities laws, and no Médical Shareholder or Warrant Holder will have the present intention of selling, granting any participation in, or
otherwise distributing the same except in compliance with applicable securities laws. Each Médical Shareholder and Warrant Holder understands that the issuance and sale by Holding Corp. of the Holding Corp. Shares to be issued to such
Médical Shareholder or Warrant Holder upon exercise of the Put Option or the Call Option will not be registered under the Securities Act of 1933 and the sale provided for in this Agreement and Holding Corp.’s issuance of securities
hereunder will be made in reliance upon an exemption from registration under the Securities Act pursuant to Section 4(a)(2) thereof, and that Holding Corp.’s reliance on such exemption will be based on each Médical
Shareholder’s and Warrant Holder’s representations set forth herein. Each Médical Shareholder or Warrant Holder is, and at the time of the consummation of the Put Option or Call Option will be an “accredited investor” as
defined in Rule 501 of Regulation D promulgated under the Securities Act and was not organized for the purpose of acquiring any of the Holding Corp. Shares. Each Médical Shareholder or Warrant Holder understands that, unless registered
pursuant to a registration statement under Rule 415 of the Securities Act of 1933, as amended, Holding Corp. Shares issued to it upon exercise of the Put Option or the Call Option will be restricted stock, will contain a legend to such effect, and
may not be sold, transferred or otherwise disposed of without registration under the Securities Act or an exemption therefrom. Each Médical Shareholder’s or Warrant Holder’s financial condition is and at the time of the consummation
of the Put Option or the Call Option will be such that it is able to bear the risk of holding the Holding Corp. Shares for an indefinite period of time and the risk of loss of its entire investment. Each Médical Shareholder or Warrant Holder
has sufficient knowledge and experience in investing in companies similar to Holding Corp. so as to be able to evaluate the risks and merits of its investment in Holding Corp. 

ARTICLE IV 
 ESCROW

 Section 4.01. Deposit of Shares into Escrow. Concurrently with the execution of this Agreement or an Adoption Agreement
(as defined below) agreeing to become a party hereto, 
 (a) each Médical Shareholder and Warrant Holder shall deliver a transfer
order with respect to his/her Shareholder Médical Stock (including all shares of Class A Stock of Médical) or Médical Warrants (collectively, the “Escrowed Médical Shares”) to PRAXES Avocats (in such
capacity, the “Escrow Agent”) to be held in escrow by the Escrow Agent pursuant to the terms of this Article IV. 
 (b)
Holding Corp. shall deliver the stock certificates, as applicable, representing the Holding Corp. Shares (the “Escrowed Holding Certificates”) into which the Escrowed Médical Shares of each Médical Shareholder and
Warrant Holder are exchangeable pursuant to Article II of this Agreement to the Escrow Agent to be held in escrow by the Escrow Agent pursuant to the terms of this Article IV. 

  
 8 

 Escrow Agent shall hold the Escrowed Holding Certificates in escrow pending exercise of the Put Option or Call
Option as further described in Section 4.02. 
 Section 4.02. Distribution of Escrowed Certificates. Upon delivery of a
Call Notice to the Médical Shareholders and Warrant Holders or the receipt of a Put Notice from the Médical Shareholders and Warrant Holders, the Escrow Agent shall direct that (i) the Escrowed Médical Shares be transferred
on the books of Médical to Holding Corp. and (ii) the Escrowed Holding Certificates be distributed to the applicable Médical Shareholder or Warrant Holder, effective as of the Call Closing Date or the Put Closing Date, as
applicable. 
 ARTICLE V 

MISCELLANEOUS 

Section 5.01. Assignment; Binding Effect. This Agreement and any rights, benefits, obligations or remedies herein shall not be
transferable or assignable by any party hereto without the prior written consent of the other party. Subject to the preceding sentence, this Agreement shall be binding upon, inure to the benefit of, and be enforceable by, the parties and their
respective successors and assigns. Médical hereby agrees that prior to, and as a condition precedent to, the effectiveness of any grant of any new Médical Warrants, it shall require the recipient of any new Médical Warrants to
execute and deliver to Médical and Holding Corp. an Adoption Agreement substantially in the form attached hereto as Annex A. Upon the execution and delivery of an Adoption Agreement by any holder of new Médical Warrants, such
holder shall be deemed to be a party hereto as if such holder’s signature appeared on the signature pages hereto. 
 Section 5.02.
Survival of Representations and Warranties. The warranties, representations, covenants and agreements of Holding Corp., Médical and each Médical Shareholder and Warrant Holder contained in or made pursuant to this Agreement
shall survive the execution and delivery of this Agreement and shall in no way be affected by any investigation of the subject matter thereof made by any party hereto. 

Section 5.03. Cooperation. Each of Médical, each Médical Shareholder, each Warrant Holder and Holding Corp. shall
use all reasonable efforts to take, or cause to be taken, all actions, and to do, or cause to be done and cooperate with each other in order to do, all things necessary, proper or advisable (subject to any applicable laws) to consummate the
transactions contemplated by this Agreement in a timely manner, including the preparation and filing of all forms, registrations and notices required to be filed to consummate such transactions and the taking of such actions as are necessary to
obtain any requisite approvals, authorizations, consents, orders, licenses, permits, qualifications, exemptions or waivers by any third party or Governmental Entity. In addition, none of Médical, each Médical Shareholder, each Warrant
Holder or Holding Corp. shall take any action after the date hereof that could reasonably be expected to materially delay the obtaining of, or result in not obtaining, any permission, approval or consent from any Governmental Entity or other person
required to be obtained prior to the consummation of the transactions contemplated by this Agreement. 
 Section 5.04. Amendment;
Waiver. This Agreement may be amended or any performance, term or condition waived in whole or in part only by an instrument in writing 

  
 9 

 
signed by (i) Holding Corp., (ii) Médical and (iii) the holders of a majority of the Shareholder Médical Stock; provided, however, Schedule A may
be amended from time to time by Médical with no further action by the parties hereto to add additional Médical Shareholders or Warrant Holders or to reflect the exercise of any Médical Warrants. Any amendment or waiver approved
pursuant to this Section 5.04 shall be binding on each party to this Agreement, regardless of whether such party consented to such amendment or waiver. No failure or delay by any party to take any action with respect to a breach by the other
party to this Agreement or a default by the other party hereunder shall constitute a waiver of the right of such party to enforce any provision of this Agreement or to take action with respect to such breach or default or any subsequent breach or
default. Waiver by any party of any breach or failure to comply with any provision of this Agreement by such party hereto shall not be construed as, or constitute, a continuing waiver of such provisions, or a waiver of any other breach of or failure
to comply with any other provisions of this Agreement. 
 Section 5.05. Termination. This Agreement shall terminate at such time
as the Médical Shareholders and the Warrant Holders shall no longer be the owners of any of Shareholder Médical Stock or Médical Warrants, as applicable. 

Section 5.06. Notices. All notices and other communications hereunder shall be in writing and shall be deemed given if delivered
personally, by commercial delivery service, mailed by registered or certified mail (return receipt requested), sent via facsimile (with confirmation of receipt) or electronic mail to the parties at the address for such party set forth herein (or at
such other address for a party as such party may designate pursuant to this Section 5.06). 
 if to Holding Corp., to: 

LDR Holding Corporation 
 13785
Research Boulevard, Suite 200 
 Austin, Texas, 78750 

Attention: President 

Telephone: (512) 344-3333 

Fax: (512) 344-3350 
 with
a copy (which shall not constitute notice) to: 
 Andrews Kurth LLP 

111 Congress, Suite 2300 

Austin, TX 78704 
 Attention:
Carmelo Gordian 
 Telephone: (512) 320-9290 

Fax: (512) 320-9292 
 if to
Médical, to: 
 LDR Médical S.A.S. 

Hotel de Bureaux 
 4, rue
Gustave Eiffel 

  
 10 

 10430 Rosieres pres Troyes 

France 
 Fax: 33
(0) 325495634 
 Attention: President 

with a copy (which shall not constitute notice) to: 

PRAXES Avocats 
 9, rue Boissy
d’Anglas 
 75008 Paris, France 

Fax: (33)144 90 00 60 

Attention: Jean-Louis Médus 

if to a Shareholder or Warrant Holder , to such Shareholder’s or Warrant Holder’s address as listed on Schedule A hereto, and

 if to a Noteholder, to such Noteholder’s address as listed on Schedule B hereto. 

Notice given by personal delivery, courier service or mail shall be effective upon actual receipt. Notice given by facsimile shall be
effective upon actual receipt if received during the recipient’s normal business hours, or at the beginning of the recipient’s next business day after receipt if not received during the recipient’s normal business hours. All notices
by facsimile shall be confirmed in writing by the sender promptly after transmission via certified mail or personal delivery. Any party may change any address to which notice is to be given to it by giving notice as provided above of such change of
address. 
 An electronic communication (“Electronic Notice”) shall be deemed written notice for purposes of this
Section 5.06 if sent with return receipt requested to the electronic mail address specified by the receiving party in a signed writing in a nonelectronic form. Electronic Notice shall be deemed received at the time the party sending
Electronic Notice receives verification of receipt by the receiving party. Any party receiving Electronic Notice may request and shall be entitled to receive the notice on paper, in a nonelectronic form (“Nonelectronic
Notice”) which shall be sent to the requesting party within ten (10) days of receipt of the written request for Nonelectronic Notice. 

Section 5.07. Counterparts. This Agreement may be executed in two or more counterparts, each of which shall be deemed an original,
but all of which together shall constitute one and the same instrument. 
 Section 5.08. Governing Law. This Agreement shall be
governed by, and construed in accordance with, the laws of the State of Delaware without giving effect to applicable principles of conflicts of laws to the extent that the application of the laws of another jurisdiction would be required thereby.

 Section 5.09. Arbitration. Any controversy or claim arising out of or relating to this Agreement, or the breach thereof,
shall be settled by arbitration in New York, New York, in accordance with the rules, then obtaining, of the American Arbitration Association. Judgment upon the award rendered may be entered in any court having jurisdiction thereof. 

  
 11 

 Section 5.10. Severability. If, at any time, any provision hereof is or becomes
illegal, invalid or unenforceable in any respect under the law of any jurisdiction, neither the legality, validity or enforceability of the remaining provisions hereof nor the legality, validity or enforceability of such provision under the law of
any other jurisdiction shall in any way be affected or impaired thereby; provided, however, that if the removal of such offending provision materially alters the burdens or benefits of any party hereunder, the parties agree to negotiate in good
faith such modifications to this Agreement as are appropriate to ensure the burdens and benefits of each party under such modified Agreement are reasonably comparable to the burdens and benefits originally contemplated and expected. 

Section 5.11. Entire Agreement; No Third Party Beneficiaries. This Agreement (a) constitutes the entire agreement and
supersedes all prior agreements and understandings, both written and oral, among the parties with respect to the subject matter hereof, and (b) except as expressly provided herein, is not intended to confer upon any person other than the
parties hereto any rights or remedies hereunder. 
 Section 5.12. Specific Performance. Each of Médical, each
Médical Shareholder, each Warrant Holder and Holding Corp. acknowledges that the other parties hereto may have no adequate remedy at law if any party fails to perform its respective obligations under this Agreement. In such event, each
Médical Shareholder, each Warrant Holder and Holding Corp. shall have the right, in addition to any other rights each party may have, to seek specific performance of the obligation of the other party. Each Médical Shareholder, each
Warrant Holder and Holding Corp. agrees that it will not take any action to impede the other party’s efforts to enforce such right of specific performance. 

Section 5.13. No Right of Offset. Neither Holding Corp. nor any Médical Shareholder shall have any right to offset or set
off any payment due pursuant to this Agreement against any other payment, obligation or liability arising under this Agreement or otherwise. 

Section 5.14. Effective Date. This Agreement shall be effective as of the date first above written. 

[Signature Pages Follow] 

  
 12 

 IN WITNESS WHEREOF, the parties hereto, acting through their duly authorized representatives,
have caused this Agreement to be signed in their respective names as of the date first above written. 
  

	
	LDR HOLDING CORPORATION
	
	 /s/ Christophe Lavigne

	 Christophe Lavigne

	 President and Chief Executive Officer

	
	LDR MÉDICAL S.A.S.
	
	 /s/ Christophe Lavigne

	 Christophe Lavigne

	 President

 IN WITNESS WHEREOF, the parties hereto, acting through their duly authorized representatives,
have caused this Agreement to be signed in their respective names as of the date first above written. 
  

	
	MÉDICAL SHAREHOLDERS:
	
	 /s/ Christophe Lavigne

	CHRISTOPHE LAVIGNE
	
	 /s/ Herve Dinville

	HERVÉ DINVILLE
	
	 /s/ Patrick Richard

	PATRICK RICHARD

 SCHEDULE A 

Schedule of Médical 

Shareholders and Warrant Holders 
  

													
	 Shareholder
	  	Class A
Shares	 	  	Warrants for
Class A
Shares	 	  	Total	 
	 Christophe Lavigne
	  	 	200,200	  	  	 	—  	  	  	 	200,200	  
	 Hervé Dinville
	  	 	200,200	  	  	 	24,678	  	  	 	224,878	  
	 Patrick Richard
	  	 	100,100	  	  	 	24,678	  	  	 	124,778	  
	 Jean-Louis Médus
	  	 	5,800	  	  	 	—  	  	  	 	5,800	  
	 Xavier Bellot
	  	 	1,950	  	  	 	2,406	  	  	 	4,356	  
	 Jean Huppert
	  	 	7,264	  	  	 	—  	  	  	 	7,264	  
	 Pierre Bernard
	  	 	3,632	  	  	 	—  	  	  	 	3,632	  
	 Marc Ameil
	  	 	14,545	  	  	 	—  	  	  	 	14,545	  
	 Julien Clause
	  	 	527	  	  	 	—  	  	  	 	527	  
	 Jean-Jacques Coll
	  	 	300	  	  	 	—  	  	  	 	300	  
	 Estelle Arbrun
	  	 	60	  	  	 	—  	  	  	 	60	  
	 Alain Roussel
	  	 	878	  	  	 	—  	  	  	 	878	  
	 Christophe Besnard
	  	 	256	  	  	 	255	  	  	 	511	  
	 Stéphane Ménard
	  	 	225	  	  	 	—  	  	  	 	225	  
	 Rupert Griffiths
	  	 	—  	  	  	 	2,000	  	  	 	2,000	  
	 Frederic Dugrillon
	  	 	—  	  	  	 	450	  	  	 	450	  
	 Michael Labrum
	  	 	—  	  	  	 	705	  	  	 	705	  
	 Dominique Ferrari
	  	 	—  	  	  	 	2,355	  	  	 	2,355	  
	 Emmanuelle Arnon
	  	 	—  	  	  	 	706	  	  	 	706	  
	 Jose Thevenin
	  	 	—  	  	  	 	300	  	  	 	300	  
	 Camille Marguier
	  	 	—  	  	  	 	756	  	  	 	756	  
	 Christophe Garnier
	  	 	—  	  	  	 	756	  	  	 	756	  
	 Sophie Stefanutti
	  	 	—  	  	  	 	90	  	  	 	90	  
	 Cedric Demonsand
	  	 	—  	  	  	 	60	  	  	 	60	  
	 Catherine Rodriguez-Chevreau
	  	 	—  	  	  	 	60	  	  	 	60	  
	 Veronique Cesar
	  	 	—  	  	  	 	60	  	  	 	60	  
	 Annabelle Debauchez
	  	 	—  	  	  	 	60	  	  	 	60	  
	 Agnes Koch
	  	 	—  	  	  	 	60	  	  	 	60	  
	 Julien Jordy
	  	 	—  	  	  	 	60	  	  	 	60	  
	 Alexis Mercier
	  	 	—  	  	  	 	757	  	  	 	757	  
	 Eric Vigneron
	  	 	—  	  	  	 	4,936	  	  	 	4,936	  
	 Samuel Lequette
	  	 	—  	  	  	 	511	  	  	 	511	  
	 Matthieu Vidal
	  	 	192	  	  	 	64	  	  	 	256	  

 Schedule A 

													
	 Shareholder
	  	Class A
Shares	 	  	Warrants for
Class A
Shares	 	  	Total	 
	 Lucie Aubourg
	  	 	—  	  	  	 	256	  	  	 	256	  
	 Céline Fauchot
	  	 	—  	  	  	 	383	  	  	 	383	  
	 Maxence Rebut
	  	 	—  	  	  	 	217	  	  	 	217	  
	 Tilman Schlick
	  	 	—  	  	  	 	511	  	  	 	511	  
		  	  
	  
	 	  	  
	  
	 	  	  
	  
	 
	 TOTAL
	  	 	536,129	  	  	 	68,130	  	  	 	604,004	  
		  	  
	  
	 	  	  
	  
	 	  	  
	  
	 

 Schedule A 

 SCHEDULE B 

Schedule of Médical Noteholders 
  

					
	 Noteholder
	  	Principal
Amount of
Médical Note
Purchased	 
	 PO Capinvest 1 SAS

23 bis, avenue de Messine

75008 Paris, France

Fax: 00 33 1 45 63 85 28

Attn: Michele Mezzarobba
	  	$	948,950.08	  
		
	 FCPR R Capital III

42 rue d’Anjou,

75008

Paris, France

Fax: 00 33 1 4074 8820

Attn: Pierre Remy
	  	$	3,420,164.28	  
		
	 DALHIA A SICAR SCA

50 av JF Kennedy, L-295l

Luxemburg

Fax: +33 1 53 01 38 16

Attn: Armando Geday
	  	$	858,019.34	  
		  	  
	  
	 
	 TOTAL:
	  	$	5,227,133.70	  
		  	  
	  
	 

 Schedule B 

 EXHIBIT I 

FORM OF STOCKHOLDER VOTING AGREEMENT 

Exhibit I 

 ANNEX A 

ADOPTION AGREEMENT 
 This
Adoption Agreement (“Adoption Agreement”) is executed by the undersigned (the “Warrant Holder”) pursuant to the terms of that certain Second Amended and Restated Put-Call Agreement dated as of August 6, 2013
(the “Agreement”) by and among (i) LDR Holding Corporation, a Delaware corporation (“Holding Corp.”), (ii) LDR Médical S.A.S., a French corporation (“Médical”),
(iii) certain shareholders of Médical, (iv) certain holders of Médical’s Subordinated Secured Promissory Notes issued pursuant to that certain Note Purchase Agreement dated April 25, 2012, and (v) the holders
of certain warrants (the “Médical Warrants”) to purchase shares of the capital stock of Médical. Capitalized terms used but not defined herein shall have the respective meanings ascribed to such terms in the Agreement.
By the execution of this Adoption Agreement, the Warrant Holder agrees as follows: 
  

	1.	Acknowledgement. The Warrant Holder acknowledges that he or she is acquiring certain Médical Warrants, subject to the terms and conditions of the Agreement. 

 

	2.	Agreement. As partial consideration for such Médical Warrants, the Warrant Holder (i) agrees that he or she shall be bound by and subject to the terms of the Agreement, (ii) hereby makes the
representations and warranties to Holding Corp. contained in Article III of the Agreement and (iii) hereby adopts the Agreement with the same force and effect as if the Warrant Holder were originally a party thereto. 

 

	3.	Notice. Any notice required or permitted by the Agreement shall be given to the Warrant Holder at the address listed beside the Warrant Holder’s signature below. 

EXECUTED AND DATED this      day of             ,
            . 
  

					
	 WARRANT HOLDER

		
	 By:
	 	  

		 	Name:	 	
		 	Title:	 	
		 	Address:	 	
		 		 	
		 	Fax:	 	

  

													
	ACKNOWLEDGED AND ACCEPTED:	 	
			
	LDR HOLDING CORPORATION	 		 	LDR MÉDICAL, S.A.S.
					
	By:	 	  
	 		 	By:	 	  

		 	Name:	 		 		 		 	Name:	 	
		 	Title:	 		 		 		 	Title:EX-4.7.1

 Exhibit 4.7.1 

FIRST AMENDMENT TO 

WARRANT TO PURCHASE STOCK 

This First Amendment to Warrant to Purchase Stock (this “Amendment”) is made as of the 12 day of September, 2013 by and
between LDR HOLDING CORPORATION, a Delaware corporation (the “Company”), and Comerica Ventures Incorporated, a California Corporation, the holder of the Warrant (as hereinafter defined) (the “Holder”). 

A. The Holder is the holder of that certain Warrant to Purchase Stock dated November 23, 2009 (the “Warrant”) by
assignment from its affiliate, Comerica Bank, a Texas banking association; 
 B. Pursuant to and upon the terms and conditions set
forth in the Warrant, the Holder was initially entitled to purchase 154,506 shares of the Series C Preferred Stock of the Company; 
 C. The
Holder and the Company wish to amend the Warrant in order to, among other things, modify the method in which the Warrant may be exercised by the Holder; and 

D. Capitalized terms not otherwise defined herein shall have the respective meanings ascribed thereto in the Warrant. 

NOW, THEREFORE, in consideration of the mutual covenants set forth herein and other good
and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties mutually agree as follows: 
 1.
Amendments. 
 (a) Section 1.1 of the Warrant is hereby amended and restated to read in its entirety as follows: 

“Method of Exercise. Holder may exercise this Warrant by a duly executed Notice of Exercise in substantially the form attached as
Appendix I to the principal office of the Company (or such other appropriate location as Holder is so instructed by the Company). Payment of the aggregate Warrant Price for the Shares being purchased shall be made, at the option of the Holder, by
the following methods: (i) by delivering to the Company a check, wire transfer (to an account designated by the Company) or other form of payment acceptable to the Company; (ii) by instructing the Company to withhold a number of Shares
then issuable upon exercise of this Warrant with an aggregate Fair Market Value (as of the last business day immediately prior to the date of delivery of the Notice of Exercise) equal to the aggregate Warrant Price; or (iii) any combination of
the foregoing. In the event of any withholding of Shares pursuant to clause (ii) or (iii) above where the number of Shares whose value is equal to the aggregate Exercise Price for the Shares being purchased is not a whole number, the
number of Shares 

 
withheld by or surrendered to the Company shall be rounded up to the nearest whole Share and the Company shall make a cash payment to the Holder (by delivery of a check, wire transfer of
immediately available funds or other form of payment acceptable to the Bank) based on the incremental fraction of a Share being so withheld by or surrendered to the Company in an amount equal to the product of (x) such incremental fraction of a
Share being so withheld or surrendered multiplied by (y) the Fair Market Value per Share as of the date immediately prior to the delivery of the Notice of Exercise. Notwithstanding any other provision hereof, if an exercise of any portion of
this Warrant is to be made in connection with a public offering or an Acquisition (as defined below), such exercise may at the election of the Holder be conditioned upon the consummation of such transaction, in which case such exercise shall not be
deemed to be effective until immediately prior to the closing of such transaction. 
 For the purpose of this Warrant, “Fair Market
Value” means, as of any particular date: (a) the volume weighted average of the sales prices of the Shares for such day on all domestic securities exchanges on which the Shares may at the time be listed; (b) if there have been no
sales of the Shares on any such exchange on any such day, the average of the highest bid and lowest asked prices for the Shares on all such exchanges at the end of such day; (c) if on any such day the Shares is not listed on a domestic
securities exchange, the closing sales price of the Shares as quoted on the Nasdaq Stock Market, Inc. (“Nasdaq”), the National Association of Securities Dealers, Inc. OTC Bulletin Board (“OTC Bulletin Board”) or similar quotation
system or association for such day; or (d) if there have been no sales of the Shares on Nasdaq, the OTC Bulletin Board or similar quotation system or association on such day, the average of the highest bid and lowest asked prices for the Shares
quoted on Nasdaq, the OTC Bulletin Board or similar quotation system or association at the end of such day; in each case, averaged over twenty (20) consecutive business days ending on the business day immediately prior to the day as of which
“Fair Market Value” is being determined. If at any time the Shares are not listed on any domestic securities exchange or quoted on Nasdaq, the OTC Bulletin Board or similar quotation system or association, the “Fair Market Value”
of the Shares shall be the fair market value per share as determined jointly by the Company’s board of directors and the Holder.” 

(b) Section 3.5 of the Warrant is hereby amended and restated as follows: 

“[Intentionally Omitted.]” 

(c) Section 4.5 of the Warrant is hereby amended and restated as follows: 

“[Intentionally Omitted.]” 

  
 2 

 2. No Other Amendments. Except as amended hereby, the Warrant remains in full force and
effect in accordance with its original terms. 
 3. Miscellaneous. 

a. Severability. If one or more provisions of this Amendment are held to be unenforceable under applicable law, such provision shall be
excluded from this Amendment and the balance of the Amendment shall be interpreted as if such provision were so excluded and shall be enforceable in accordance with its terms. 

b. Counterparts. This Amendment may be executed in two or more counterparts, each of which shall be deemed an original, but all of which
together shall constitute one and the same instrument. 
 c. Entire Agreement. The Warrant, as amended by this Amendment, constitutes
the entire agreement of the parties with regard to the subject matter hereof and supersedes any prior oral or written agreements or understandings. 

d. Governing Law. This Amendment shall be governed by and construed in accordance with the laws of the State of California, without
regard to the conflicts of law provisions of the State of California or any other state. 
 [Signature Page Follows] 

  
 3 

 IN WITNESS WHEREOF, the parties have executed this First Amendment to Warrant to Purchase Stock
as of the date first above written. 
  

					
	THE COMPANY:
	
	LDR HOLDING CORPORATION
		
	By:	 	 /s/ Scott Way

		 	Name:	 	Scott Way
		 	Title:	 	Executive Vice President –
		 		 	General Counsel
	
	HOLDER:
	
	Comerica Ventures Incorporated
		
	By:	 	 /s/ LaReeda Rentie

		 	Name:	 	LaReeda Rentie
		 	Title:	 	Assistant Vice President

 SIGNATURE PAGE TO FIRST
AMENDMENT TO WARRANT TO PURCHASE STOCK

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00221-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00221-of-00352.parquet"}]]