Document:

EX-4.6

 Exhibit 4.6 
 AMENDED AND RESTATED 
 FIRST REFUSAL AND CO-SALE AGREEMENT 

THIS AMENDED AND RESTATED FIRST REFUSAL AND CO-SALE AGREEMENT (this “Agreement”), is made as of
September 11, 2007, by and among LDR Holding Corporation, a Delaware corporation (the “Company”), each of the individuals and entities listed on Schedule A attached hereto (the
“Investors”), and each of the individuals listed on Schedule B attached hereto (the “Common Holders”). Capitalized terms used but not otherwise defined herein shall have the meanings ascribed to
them in that certain Series C Preferred Stock Purchase Agreement dated as of the date hereof (the “Purchase Agreement”) by and among the Company and certain of the Investors. The Common Holders and the Investors are sometimes
referred to herein individually as “Stockholder” and collectively as the “Stockholders.” 
 RECITALS 
 WHEREAS, the Company and certain of its Stockholders are
parties to that certain First Refusal and Co-Sale Agreement dated as of April 10, 2006 (the “Prior Agreement”); 
 WHEREAS, the Company desires to sell shares of Series C Preferred Stock pursuant to the terms of the Purchase Agreement and the amendment and restatement of the Prior Agreement as set forth herein
is a condition to the Closing; 
 WHEREAS, the parties hereto desire to restrict the sale, assignment, transfer,
encumbrance or other disposition of the shares of the Common Stock, Series A-1 Preferred Stock, Series A-2 Preferred Stock, Series B Preferred Stock, Series C Preferred Stock and all other
securities convertible into, exchangeable for, exercisable for or issued in exchange for or in respect of shares of Common Stock, in each case whether now owned or hereafter acquired by the Common Holders and the Investors (collectively, the
“Stock”), and to provide for certain rights and obligations in respect thereto as hereinafter provided; 

WHEREAS, pursuant to Section 3.6 of the Prior Agreement, the Prior Agreement may be amended by a written instrument executed
by the holders of (i) at least 66% of the shares of Common Stock (determined on an As Exchanged Basis (as defined in the Prior Agreement)) and (ii) at least 66% of the shares of Preferred Stock (determined on an As Exchanged Basis (as
defined in the Prior Agreement)); and 
 WHEREAS, the undersigned Stockholders represent (i) at least 66% of the
shares of Common Stock (determined on an As Exchanged Basis (as defined in the Prior Agreement)) and (ii) at least 66% of the shares of Preferred Stock (determined on an As Exchanged Basis (as defined in the Prior Agreement)) and such
Stockholders desire to amend the Prior Agreement as set forth below, on behalf of themselves and the other Stockholders party to the Prior Agreement. 

 AGREEMENTS 
 NOW, THEREFORE, in consideration of the premises, and the mutual promises and agreements contained herein, the parties hereto hereby agree as follows: 

ARTICLE 1 
 RESTRICTIONS ON TRANSFERS 
 1.1 General Prohibition on
Transfers; Permitted Transfers. 
 (a) Except as otherwise permitted hereby, no Stockholder shall directly or indirectly
sell, assign, pledge or encumber or otherwise transfer to any person (a “Transferee”) any shares of Stock unless the Stockholder has complied with all of the terms of this Agreement. Any purported sale, assignment, pledge,
encumbrance or other transfer in violation of any provision of this Agreement shall be void and ineffectual and shall not operate to transfer any interest or title to the purported Transferee. 

(b) The restrictions contained in this Agreement with respect to transfers by Stockholder of shares of Stock shall not apply to:
(i) any transfer of Stock by a Stockholder to any such Stockholder’s spouse, parents, siblings (by blood, marriage or adoption) or lineal descendants (by blood, marriage or adoption); (ii) any transfer of Stock by a Stockholder to a
trust, partnership, corporation, limited liability company or other similar entity for the benefit of such Stockholder or such Stockholder’s spouse, parents, siblings or lineal descendants; (iii) any transfer of Stock by a Stockholder or,
upon a Stockholder’s death, to the executors, administrators, testamentary trustees, legatees or beneficiaries of such Stockholder; (iv) any transfer of Stock by a Stockholder to any person who controls, is controlled by or is under common
control with such Stockholder (within the meaning of the Securities Act of 1933, as amended); (v) any distribution of Stock to the members, partners or stockholders of a Stockholder; and (vi) any transfer of stock by a Stockholder
(A) pursuant to a merger or consolidation of the Company with or into another corporation or corporations, (B) pursuant to the winding up and dissolution of the Company, (C) at, and pursuant to, a Qualified Public Offering (as defined
in the Company’s Certificate of Incorporation, as the same may be amended and/or restated from time to time), or (D) in connection with a transaction in which stock of the Company having more than 50% of the voting power of all the then
outstanding stock of the Company is transferred; provided, that in each of clauses (i) through (vi), each Transferee, donee, heir or distributee shall, as a condition precedent to such transfer, become a party to this Agreement by
executing an Adoption Agreement substantially in the form attached hereto as Annex A and shall have all of the rights and obligations of a Stockholder hereunder; and provided further, that in each of the cases of (A), (B) and
(D) of clause (vi) hereof, the Company’s stockholders of record as constituted immediately prior to such event will, immediately after such event, hold less than a majority of the voting power of the surviving or acquiring entity.

  
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 1.2 Right of First Refusal on Shares of Stock. Except as otherwise
permitted in Section 1.1(b) of this Agreement, transfers of shares of Stock by a Stockholder shall not be permitted unless the selling Stockholder has complied with this Section 1.2. Any Stockholder who intends to sell (or
otherwise transfer) any of such Stockholder’s shares of Stock (the “Proposed Seller”), shall give written notice (the “Seller’s Notice”) to the Company and each of the Investors stating that
the Proposed Seller intends to make such a sale or transfer, identifying the party who made the bona fide offer (the “Proposed Transferee”), specifying the number of shares of Stock proposed to be purchased or acquired
pursuant to the offer (the “First Refusal Shares”), and specifying the per share purchase price which the Proposed Transferee has offered to pay for the First Refusal Shares (the “Sale Price”). A copy
of the offer, if available, and a statement of the number of shares held by each Investor shall be attached to the Seller’s Notice. If a copy of the offer is not available, a statement of the terms of the offer and any material facts shall be
attached to the Seller’s Notice. 
 (a) Right of First Refusal. 

(i) Company’s First Right of Refusal. The Company shall have the irrevocable and exclusive option to purchase, upon
delivery to the Proposed Seller within 10 days of its receipt of the Seller’s Notice, all or a portion of the First Refusal Shares. The Company shall deliver a notice (the “Company Notice”) to the Proposed Seller, each
of the Investors of its election to purchase the First Refusal Shares within such 10-day period, together with payment to the Proposed Seller of the Sale Price therefor. If the Company fails to purchase all of the First Refusal Shares by exercising
the option granted herein within the period provided, the Company shall so notify each Investor (the “Additional Transfer Notice”) and the First Refusal Shares shall be subject to the options granted to the Investors pursuant
to this Agreement. 
 (ii) Investors’ Right of Refusal. To the extent that the Company does not purchase all
of the First Refusal Shares, each Investor shall have the irrevocable and exclusive option to purchase up to that number of the First Refusal Shares not purchased by the Company (the “Remaining First Refusal Shares”) at the
Sale Price as equals the product of (A) the number of remaining First Refusal Shares multiplied by (B) a fraction, the numerator of which shall be the number of shares of Stock (on an As Exchanged Basis (as defined below) owned by such
Investor and the denominator of which shall be the number of shares of Stock (on an As Exchanged Basis) owned by all of the Investors (the “Proportionate Share”). Within 20 days after delivery of the Additional Transfer
Notice, each Investor shall deliver to the Company and the Proposed Seller a written notice stating whether it elects to exercise its option under this Section 1.2(a)(ii) and the maximum number of shares (up to all of such
Investor’s Proportionate Share) that it is willing to purchase, and such notice shall constitute an irrevocable commitment to purchase such shares. For purposes of the Agreement, the term “As Exchanged Basis” shall mean
(i) with respect to the Common Stock, all of the then outstanding shares of Common Stock plus the aggregate number of shares of Common Stock issuable upon the exercise of the outstanding options to exchange the then outstanding shares or
Class A Stock of LDR Medical SAS., a company organized under the laws of the French Republic (“LDR Medical”) for shares of Common Stock pursuant to the Amended and Restated Put-Call Agreement dated as of
September 11, 2007 by and between the Company, LDR Medical and each shareholder and holder of warrants to acquire shares of LDR Medical, (the “Put-Call Agreement”), and (ii) with respect to the Company’s
Preferred Stock, all of the then outstanding shares of shares of Preferred Stock plus the aggregate number of shares of Preferred Stock issuable upon the exercise of the outstanding options to exchange the then outstanding shares or Class B, Class C
and Class D Stock of LDR Medical for shares of Series A-2 Preferred Stock pursuant to the Put-Call Agreement. 

  
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 (iii) Under/Oversubscription of First Refusal Shares. If an Investor
does not elect to purchase its full Proportionate Share, the Proposed Seller shall deliver another written notice to each Investor that has elected to purchase its full Proportionate Share (a “Fully Exercising Holder”)
stating the number of unpurchased Remaining First Refusal Shares. Each Fully Exercising Holder shall be entitled, by delivering written notice to the Proposed Seller within 5 calendar days following the delivery of such notice, to purchase up to all
of the Remaining First Refusal Shares at the Sale Price. In the event of an oversubscription, the oversubscribed amount shall be allocated among such Fully Exercising Holders pro rata based on the number of shares of Stock (on an As Exchanged Basis)
owned by each of them. The delivery of the notice of election under this Section 1.2 shall constitute an irrevocable commitment to purchase such shares. 
 (iv) Determination of Shares for Pro Rata Calculation. For the purposes of determining the number of shares an Investor is entitled to sell or purchase pursuant to this
Section 1.2, the shares held by an Investor shall be deemed to include any shares of Stock (on an As Exchanged Basis) held by members, partners, officers, employees and affiliates of an Investor that are not themselves Investors
(“Affiliates”) and any members, partners, officers or employees of such Investor’s Affiliates. 

(b) Sale of Unsubscribed First Refusal Shares. If any First Refusal Shares are not elected to be purchased pursuant to
Sections 1.2(a) or 1.2(b), (such shares, the “Unsubscribed First Refusal Shares”) then, subject to Section 1.3 hereof, the Proposed Seller shall be free, for a period of 90 calendar days from
the date of the Seller’s Notice, to sell the unsubscribed First Refusal Shares to the Proposed Transferee, at a price equal to or greater than the Sale Price, and upon the terms no more favorable to the Proposed Transferee individually or in
the aggregate than those specified in the Notice. Any transfer of the First Refusal Shares by the Proposed Seller after the end of such 90-day period or any change in the terms of the proposed sale as set forth in the Notice which are more favorable
to the Proposed Transferee individually or in the aggregate shall require a new notice of intent to transfer to be delivered to the Company and the Investors and shall give rise anew to the rights provided in the preceding sections. 

(c) Consideration for Purchase of First Refusal Shares. If the Investors and/or Company elect to purchase any or all of the
First Refusal Shares mentioned in the Seller’s Notice, such Investor and/or Company shall have the right to purchase the First Refusal Shares for cash consideration whether or not part or all of the consideration specified in the Seller’s
Notice is other than cash. If part or all of the consideration to be paid for the First Refusal Shares as stated in the Seller’s Notice is other than cash, the price stated in such Seller’s Notice shall be deemed to be the sum of the cash
consideration, if any, specified in such Seller’s Notice, plus the fair market value of the non-cash consideration. The fair market value of the non-cash consideration shall be determined by the Board of Directors of the Company, and its
judgment as to the fair market value of such non-cash consideration shall be binding upon the Proposed Seller and the other Investors. 

  
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 1.3 Right of Co-Sale of Common Stock. 

(a) Non-Participating Holders’ Right of Co-Sale. Subject to Section 1.4, in the event that all of the First
Refusal Shares are not purchased by the Investors or the Company as provided in Section 1.2 and (ii) these Unsubscribed First Refusal Shares include Shares of Common Stock (the “Common First Refusal Shares”),
the Proposed Seller shall deliver a notice to each Investor who did not purchase shares pursuant to Section 1.2(b) (each, a “Non-Participating Holder”) informing it of the number of Common First Refusal Shares he
still holds and intends to sell to the Proposed Transferee (the “Common Co-Sale Shares”). Each Non-Participating Holder shall have the right, exercisable upon written notice to the Company and the Proposed Seller within 5
calendar days after the giving of such notice by the Proposed Seller, to participate in the Proposed Seller’s sale of Common Co-Sale Shares at the Sale Price. The delivery of the notice of election under this Section 1.3 shall
constitute an irrevocable commitment to sell such shares of Common Stock. To the extent one or more of the Non-Participating Holders exercise such right of co-sale participation in accordance with the terms and conditions set forth below, the number
of shares of Common Stock which the Proposed Seller may sell to the Proposed Transferee shall be correspondingly reduced. The right of co-sale participation of each of the Investors shall be subject to the terms and conditions set forth in this
Section 1.3. 
 (b) Number of Shares Available to Non-Participating Holders. Each Non-Participating
Holder may elect to sell all or any part of that number of shares of Common Stock of the Company held by such Non-Participating Holder equal to the product obtained by multiplying (i) the aggregate number of Common Co-Sale Shares by (ii) a
fraction, the numerator of which is the number of shares of Stock (on an As Exchanged Basis) of the Company at the time owned by such Non-Participating Holder, and the denominator of which is the aggregate number of shares of Stock (on and As
Exchanged Basis) of the Company at the time owned by the Proposed Seller and all of the Non-Participating Holders wishing to participate in the sale of Common Co-Sale Shares. 
 (c) Effecting the Co-Sale. 
 (i) Transfer to Proposed
Seller. Each of the Non-Participating Holders shall effectuate the sale by promptly delivering to the Proposed Seller for transfer to the Proposed Transferee one or more certificates, properly endorsed for transfer, which represent the
number of shares of Common Stock (or shares of Preferred Stock convertible into such number of shares of Common Stock) which the Non-Participating Holders elect to sell. 
 (ii) Transfer to Proposed Transferee. The stock certificates which the Non-Participating Holders deliver to the Proposed Seller shall be transferred by the Proposed Seller to the Proposed
Transferee in consummation of the sale of the Common Stock pursuant to the terms and conditions specified in the notice to the Non-Participating Holders and the Proposed Seller shall promptly thereafter remit to each Non-Participating Holder that
portion of the sale proceeds to which the Non-Participating Holder is entitled by reason of its participation in such sale. To the extent that any prospective purchaser or purchasers prohibit such assignment or otherwise refuse to purchase shares or
other securities from any Investor exercising its rights of co-sale hereunder, the Proposed Seller shall not sell to such prospective purchaser or 

  
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 purchasers any Stock unless and until, simultaneously with such sale, the Proposed Seller shall purchase
such shares or other securities from such Non-Participating Holder for the same consideration and on the same terms and conditions as the proposed transfer described in the Seller’s Notice. 

1.4 Right of Co-Sale in a Significant Transaction. 
 (a) Series C Holders’ Right of Co-Sale. Notwithstanding Section 1.3, in the event that one or more Stockholders (the “Selling Stockholders”) intends
to sell (or otherwise transfer) shares of Stock in a transaction (or series of related transactions) representing in the aggregate ten percent (10%) or more of the Stock of the Company on a fully-diluted basis (the “Selling
Stockholder Co-Sale Shares”), the Selling Stockholders shall deliver a notice (a “Significant Transaction Notice”) to each holder of Series C Preferred Stock (each, a “Series C Holder”)
informing it of the number of Selling Stockholder Co-Sale Shares the Selling Stockholders intend to sell to the proposed acquirer (the “Proposed Significant Transferee”) and specifying the per share purchase price which the
Proposed Significant Transferee has offered to pay for the Selling Stockholder Co-Sale Shares. Each Series C Holder shall have the right, exercisable upon written notice to the Company and the Selling Stockholders within 20 calendar days after the
giving of such notice by the Selling Stockholders, to participate in the Selling Stockholders’ sale of Selling Stockholder Co-Sale Shares at the per share purchase price which the Proposed Significant Transferee has offered to pay for the
Selling Stockholder Co-Sale Shares. The delivery of the notice of election under this Section 1.4 shall constitute an irrevocable commitment to sell such shares of Stock. To the extent one or more of the Series C Holders exercise such
right of co-sale participation in accordance with the terms and conditions set forth below, the number of Selling Stockholder Co-Sale Shares which the Selling Stockholders may sell to the Proposed Significant Transferee shall be correspondingly
reduced. In the event that a transaction meets the requirements of the first sentence of this Section 1.4, the co-sale rights contained in this Section 1.4 shall be exclusive with respect to such transaction and
Section 1.3 shall not apply with respect thereto. The right of co-sale participation of each of the holders of Series C Preferred Stock shall be subject to the terms and conditions contained in this Section 1.4. 

(b) Number of Shares Available to Series C Holders. Each Series C Holder may elect to sell all or any part of that number of
shares of Stock in accordance with this Section 1.4 of the Company held by such Series C Holder equal to the product obtained by multiplying (i) the number of shares of Stock (on an As Exchanged Basis) of the Company at the time
owned by such Series C Holder, by (ii) a fraction, the numerator of which is the aggregate number of Selling Stockholder Co-Sale Shares, and the denominator of which is the aggregate number of shares of Stock (on an As Exchanged Basis) of the
Company at the time owned by such by the Selling Stockholders (the “Series C Co-Sale Shares”). In the event that the Series C Holders elect to sell an aggregate number of shares of Stock pursuant to this
Section 1.4 in excess of the number of Selling Stockholder Co-Sale Shares, then each Series C Holder electing to participate shall be entitled to sell a number of shares of Stock equal to multiplying (i) the number of Selling
Stockholder Co-Sale Shares by (ii) a fraction, the numerator of which is the number of Series C Co-Sale Shares for such Series C Holder, and the denominator of which is the aggregate number of Series C Co-Sale Shares held by all Series C
Holders electing to participate in the co-sale right pursuant to this Section 1.4. In such case, the Selling Stockholders will not be entitled to sell any Selling Stockholder Co-Sale Shares. 

  
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 (c) Effecting the Significant Transfer Co-Sale. 

(i) Transfer to Selling Stockholders. Each of the participating Series C Holders shall effectuate the sale by promptly
delivering to the Selling Stockholders for transfer to the Proposed Significant Transferee one or more certificates, properly endorsed for transfer, which represent the number of shares of Stock which the Series C Holders elect to sell. 

(ii) Transfer to Proposed Significant Transferee. The stock certificates which the participating Series C Holders deliver
to the Selling Stockholders shall be transferred by the Selling Stockholders to the Proposed Significant Transferee in consummation of the sale of the Stock pursuant to the terms and conditions specified in the Significant Transaction Notice and the
Selling Stockholders shall promptly thereafter remit to each participating Series C Holder that portion of the sale proceeds to which the participating Series C Holder is entitled by reason of its participation in such sale. To the extent that any
prospective purchaser or purchasers prohibit such assignment or otherwise refuse to purchase shares or other securities from any participating Series C Holder exercising its rights of co-sale hereunder, the Selling Stockholders shall not sell to
such prospective purchaser or purchasers any Stock unless and until, simultaneously with such sale, the Selling Stockholders shall purchase such shares or other securities from such Series C Holder for the same consideration and on the same terms
and conditions as the proposed transfer described in the Significant Transaction Notice. 
 1.5 Additional
Transactions. The exercise or non-exercise of the rights of an Investor hereunder to participate in one or more sales of Stock made by the Proposed Seller shall not adversely affect their rights to participate in subsequent sales by a
Stockholder. 
 1.6 Prohibited Transfers. 
 (a) Grant. In the event that any Proposed Seller or Selling Stockholder should sell any Stock in contravention of the participation rights of the Investors under Section 1.3 or
Section 1.4, as applicable (a “Prohibited Transfer”), the Investors, as applicable, shall have the put option provided in Section 1.5(b). 

(b) Put Option. In the event of a Prohibited Transfer, the Investors shall have the option to sell to the Proposed Seller or
Selling Stockholders, as applicable, a number of shares of Stock of the Company equal to the number of shares that the Investors would have been entitled to sell had such Prohibited Transfer been effected in accordance with Section 1.3 or 1.4
hereof, as applicable, on the following terms and conditions: 
 (i) The price per share at which the shares are to be sold to
the Proposed Seller or Selling Stockholders shall be equal to the price per share paid to the Proposed Seller or Selling Stockholders, as applicable, by the third party purchaser or purchasers of the Proposed Seller’s or Selling
Stockholders’ Stock. 

  
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 (ii) The Investors shall deliver to the Proposed Seller or Selling Stockholder, as
applicable, within 30 days after they have received notice from the Proposed Seller or Selling Stockholders or otherwise become aware of the Prohibited Transfer, the certificate or certificates representing the shares to be sold, each certificate to
be properly endorsed for transfer. 
 (iii) The Proposed Seller or Selling Stockholders, as applicable, shall, upon receipt of
the certificates for the shares, pay the aggregate purchase price therefor provided for in this Section 1.5, by delivery of consideration in the same form as such Proposed Seller or Selling Stockholders, as applicable, received for the
Stock sold in the Prohibited Transfer, and shall reimburse the Investors and the Company for any additional expenses, including legal fees and expenses, incurred in effecting such purchase and resale. 

ARTICLE 2 
 LEGENDED CERTIFICATES 
 2.1 Legend. During the term of
this Agreement, each certificate representing shares of capital stock held by parties hereto will bear a legend in substantially the following form: 
 “THIS CERTIFICATE AND THE SHARES REPRESENTED HEREBY MAY NOT BE SOLD, ASSIGNED, TRANSFERRED, ENCUMBERED, OR IN ANY MANNER DISPOSED OF EXCEPT IN CONFORMITY WITH THE TERMS OF A FIRST REFUSAL AND CO-SALE
AGREEMENT AMONG THE HOLDER (OR THE PREDECESSOR IN INTEREST TO THE SHARES), THE COMPANY AND CERTAIN OTHER STOCKHOLDERS OF THE COMPANY. THE COMPANY WILL UPON WRITTEN REQUEST FURNISH A COPY OF SUCH AGREEMENT TO THE HOLDER HEREOF WITHOUT CHARGE.”

 The legend required under this Section 2.1 hereof shall be removed upon termination of this Agreement in
accordance with the provisions of Section 3.1. 
 ARTICLE 3 

GENERAL 
 3.1 Termination. This Agreement shall terminate upon the occurrence of any of the following events: 
 (a) the liquidation, dissolution or indefinite cessation of the business operations of the Company, or a Liquidation Event (as defined in the Company’s Certificate of Incorporation, as the same may
be amended from time to time); 
 (b) the execution by the Company of a general assignment for the benefit of creditors or the
appointment of a receiver or trustee to take possession of the property and assets of the Company; or 
 (c) the consummation of
a Qualified Public Offering (as defined in the Company’s Certificate of Incorporation, as the same may be amended from time to time), or 

  
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 (d) the written agreement signed by (i) the Stockholders holding at least 66% of the
Preferred Stock (on an As Exchanged Basis) then held by the Stockholders voting together as a single class, on an as-converted to Common Stock basis and (ii) the Stockholders holding at least 66% of the Common Stock (on an As Exchanged Basis)
then held by the Stockholders voting together as a single class and (iii) Stockholders holding at least a majority of the Series C Preferred Stock held by the Stockholders voting together as a separate series. 

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

	 	(a)	If to the Company: 

 LDR Holding
Corporation 
 4030 W. Braker Lane, Suite 360 
 Austin, Texas 78759 
 Fax: (512) 344-3350 

Attn: Chief Executive Officer 
 with a copy (which shall not constitute notice) to: 
 Andrews Kurth LLP

 111 Congress Avenue, Suite 1700 
 Austin, TX 78701 
 Fax: (512) 320-9292 

Attn: Carmelo M. Gordian 
  

	 	(b)	If to the Investors: 

 At the
address set forth below such Investor’s name on Schedule A hereto. 
 with a copy (which shall not constitute
notice) to: 
 DLA Piper Rudnick Gray Cary US LLP 
 1221 South MoPac Expressway, Suite 400 
 Austin, TX 78746 

Fax: (512) 457-7001 
 Attn: John J. Gilluly, III 

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

Heller Ehrman LLP 
 7 Times Square 
 New York, NY 10036-6524 

Fax: (212) 703-8942 
 Attn: Kevin T. Collins 
 with a copy (which shall not constitute notice) to:

 Médus, Devaux Sorensen 
 84, rue de Grenelle 
 75007 Paris, France 

Fax: (33) (144) 90 00 60 
 Attn : Jean-Louis Medus 
 Notices provided in accordance with this
Section 3.2 shall be deemed delivered upon personal delivery, on three business days after deposit in the mail or upon actual receipt by facsimile if received during the recipient’s normal business hours, or at the beginning of the
recipient’s next business day after receipt if the facsimile is not received during the recipient’s normal business hours. All notices by facsimile shall be confirmed promptly after transmission in writing by 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. 
 3.3 Successors and Assigns. This Agreement and the rights and obligations of the parties hereunder shall inure to the benefit of, and be binding upon, their respective successors, assigns
and legal representatives; provided, however, and other than as set forth in Section 1.1(b) hereunder, the first refusal and co-sale rights hereunder may be assigned only by an Investor to a transferee or assignee of such
Investor’s shares of Stock of the Company who, after such assignment or transfer, holds at least 100,000 shares of the Stock of the Company (subject to appropriate adjustments for stock splits, stock dividends, combinations and other
recapitalizations) and who executes an Adoption Agreement in the form attached as Annex A. By execution hereof or of an Adoption Agreement, each party hereto hereby appoints the Company as its attorney-in-fact for the sole purpose of
executing Adoption Agreements with any subsequent permitted transferees. 
 3.4 Optional Escrow. At the request of
any Stockholder, an escrow shall be set up to effect the transfer of any certificates or funds hereunder. Costs of such escrow shall be borne by all of the parties participating therein based on the aggregate value of the shares held by them which
are to be purchased or sold thereunder. 
 3.5 Severability. In the event one or more of the provisions of this
Agreement should for any reason be held to be invalid, illegal or unenforceable, such provision shall be excluded from this Agreement and the balance of this Agreement shall be interpreted as if such provision were excluded and shall be enforceable
in accordance with its terms. 

  
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 3.6 Amendments and Waivers. Any amendment, waiver or modification of this
Agreement shall be effective only if evidenced by a written instrument executed by (i) the Stockholders holding at least 66% of the Preferred Stock (on an As Exchanged Basis) then held by the Stockholders voting together as a single class on an
as-converted to Common Stock basis and (ii) the Stockholders holding a majority of the Common Stock (on an As Exchanged Basis) then held by the Stockholders voting together as a single class on an as-converted to Common Stock basis;
provided, however, that any amendment, waiver or modification to Section 1.4 shall be effective only if evidenced by a written instrument executed by the Stockholders holding a majority of the Series C Preferred Stock then
held by the Stockholders voting as a separate class. Any waiver hereunder shall be effective only if evidenced by a written instrument executed by the holders of at least 66% of the shares of Stock held by all the Investors or by the holders of at
least 66% of the shares of Common Stock held by all the Common Holders, as the case may be, whose rights are being waived. Notwithstanding the foregoing, Schedule A may be amended from time to time to add subsequent Investors subject to the
consent of the Stockholders holding at least 66% of the Preferred Stock (on an As Exchanged Basis) then held by the Stockholders voting together as a single class on an as-converted to Common Stock basis, so long as the Investors holds equity
securities of the Company, and Schedule B hereto may be amended from time to time with no further action on the part of the parties hereto to add subsequent Common Holders (each a “New Party”), provided that such New
Party shall have executed and delivered an Adoption Agreement substantially in the form attached hereto as Annex A. Upon the execution and delivery of an Adoption Agreement by a New Party reasonably acceptable to the Company, such New
Party shall be deemed to be a party hereto as if such New Party’s signature appeared on the signature pages hereto. By their execution hereof or of an Adoption Agreement, each of the parties hereto appoints the Company as its attorney-in-fact
for the purpose of executing any Adoption Agreement which may be required to be delivered hereunder. Any amendment or waiver effected in accordance with this Section 3.6 shall be binding upon each then-current Investor and Common
Stockholder, each future Investor and Common Stockholder, and the Company. Any amendment, waiver or modification not effected in accordance with this Section 3.6 shall be null and void. 

3.7 Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of Delaware,
without regard to conflicts of law principles. 
 3.8 Waiver of Jury Trial. TO THE FULLEST EXTENT
PERMITTED BY APPLICABLE LAW, THE PARTIES TO THIS AGREEMENT WAIVE THEIR RESPECTIVE RIGHTS TO A JURY TRIAL OF ANY CLAIM OR CAUSE OF ACTION ARISING OUT OF OR BASED UPON THIS AGREEMENT, INCLUDING CONTRACT, TORT, BREACH OF DUTY AND ALL OTHER CLAIMS. THIS
WAIVER IS A MATERIAL INDUCEMENT FOR THE PARTIES TO ENTER INTO THIS AGREEMENT. EACH PARTY HAS REVIEWED THIS WAIVER WITH ITS COUNSEL AND, BY ITS EXECUTION OF THIS AGREEMENT CONFIRMS THAT IT KNOWINGLY AND VOLUNTARILY WAIVES ITS JURY TRIAL RIGHTS
FOLLOWING CONSULTATION WITH COUNSEL. 
 3.9 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 

 3.10 Counterparts. This Agreement may be executed in two or more counterparts,
each of which shall be deemed an original but all of which, when taken together, shall constitute one and the same instrument. 

3.11 Remedies. The parties hereto shall have all remedies for breach of this Agreement available to them as provided by law
or equity. Without limiting the generality of the foregoing, the parties agree that in addition to any other rights and remedies available at law or in equity, the parties shall be entitled to obtain specific performance of the obligations of each
party to this Agreement and immediate injunctive relief and that, in the event any action or proceeding is brought in equity or to enforce the same, no party will urge, as a defense, that there is an adequate remedy at law. 

3.12 Titles and Subtitles. The titles and subtitles used in this Agreement are used for convenience only and do not
constitute a part of this Agreement. 
 3.13 Entire Agreement. This Agreement (including the Schedules hereto)
constitutes the full and entire understanding and agreement among the parties hereto with respect to the opportunity of the Company and the Investors to participate in sales of Stock by Stockholders and all other written or oral agreements relating
to such opportunity (including without limitation the Prior Agreement) are expressly cancelled. 
 3.14 Telecopy Execution
and Delivery. A facsimile, telecopy or other reproduction of this Agreement may be executed by one or more parties hereto, and an executed copy of this Agreement may be delivered by one or more parties hereto by facsimile or similar
electronic transmission device pursuant to which the signature of or on behalf of such party can be seen, and such execution and delivery shall be considered valid, binding and effective for all purposes. At the request of any party hereto, all
parties hereto agree to execute an original of this Agreement as well as any facsimile, telecopy or other reproduction hereof. 

3.15 Future Securityholders. The Company hereby agrees that, as a condition precedent to any issuance of any capital stock
of the Company, the Company shall require any holder of such capital stock to be become a “Common Holder” or “Investor”, as the case may be, under this Agreement prior to or on the date of such acquisition. 

[Signature Pages Follow] 

  
 12 

 IN WITNESS WHEREOF, the parties have executed this Amended and Restated First Refusal
and Co-Sale Agreement on the day and year indicated above. 
  

			
	COMPANY:
	
	LDR Holding Corporation
		
	By:	 	  

		 	Steven I. Whitlock
		 	Secretary

 [SIGNATURE PAGE TO AMENDED
AND RESTATED FIRST REFUSAL AND CO-SALE AGREEMENT] 

 IN WITNESS WHEREOF, the parties have executed this Amended and Restated First Refusal
and Co-Sale Agreement as of the date first above written. 
  

			
	INVESTORS:
	
	Telegraph Hill Partners SBIC, L.P.
	By:	 	Telegraph Hill Partners SBIC, LLC
	Its:	 	General Partner
		
	By:	 	 
		 	Robert G. Shepler
		 	Manager
	
	THP Affiliates Fund, LLC
	By:	 	 Telegraph Hill Partners Investment
 Management, LLC

	Its:	 	Manager
	By:	 	Telegraph Hill Management Company LLC
	Its:	 	Manager
		
	By:	 	 
		 	Robert G. Shepler
		 	Manager
	
	Telegraph Hill Partners II, L.P.
	By:	 	 Telegraph Hill Partners II Investment
 Management, LLC

	Its:	 	General Partner
	By:	 	Telegraph Hill Management Company LLC
	Its:	 	Manager
		
	By:	 	 
		 	Robert G. Shepler
		 	Manager
	
	THP II Affiliates Fund, LLC
	By:	 	 Telegraph Hill Partners II Investment
 Management, LLC

	Its:	 	Manager
	By:	 	Telegraph Hill Management Company LLC
	Its:	 	Manager
		
	By:	 	 
		 	Robert G. Shepler
		 	Manager

  

[SIGNATURE PAGE TO AMENDED AND RESTATED
FIRST REFUSAL AND CO-SALE AGREEMENT] 

 IN WITNESS WHEREOF, the parties have executed this Amended and Restated First Refusal
and Co-Sale Agreement as of the date first above written. 
  

			
	INVESTORS:
	
	AUSTIN VENTURES VIII, L.P.
		
	By:	 	 AV Partners VIII, L.P.
 its
General Partner

		
	By:	 	 
	Name:	 	 
	Title:	 	 

  

[SIGNATURE PAGE TO AMENDED AND RESTATED
FIRST REFUSAL AND CO-SALE AGREEMENT] 

 IN WITNESS WHEREOF, the parties have executed this Amended and Restated First Refusal
and Co-Sale Agreement as of the date first above written. 
  

			
	INVESTORS:
	
	PATH4 INNOVATIONS LP
		
	By:	 	
Path4, LLC
 its General Partner

		
	By:	 	 
	Name:	 	 
	Title:	 	 

  

[SIGNATURE PAGE TO AMENDED AND RESTATED
FIRST REFUSAL AND CO-SALE AGREEMENT] 

 IN WITNESS WHEREOF, the parties have executed this Amended and Restated First Refusal
and Co-Sale Agreement as of the date first above written. 
  

			
	INVESTORS:
	
	FCPR R CAPITAL TECHNOLOGIES
		
	By:	 	 Rothschild & Cie Gestion
 its Managing Company

		
	By:	 	 
	Name:	 	 
	Title:	 	 
	
	FCPR R CAPITAL PRIVE TECHNOLOGIES
		
	By:	 	 Rothschild & Cie Gestion
 its Managing Company

		
	By:	 	 
	Name:	 	 
	Title:	 	 

  

[SIGNATURE PAGE TO AMENDED AND RESTATED
FIRST REFUSAL AND CO-SALE AGREEMENT] 

 IN WITNESS WHEREOF, the parties have executed this Amended and Restated First Refusal
and Co-Sale Agreement as of the date first above written. 
  

			
	INVESTORS:
	
	 PINTO TECHNOLOGY VENTURES, L.P., a
 Delaware Limited Partnership

	
	 By: PINTO TECHNOLOGY VENTURES, GP,
 L.P., its General Partner

	
	 By: PINTO TV GP COMPANY, LLC, its
 General Partner

		
	By:	 	 
	Name:	 	Matthew S. Crawford
	Title:	 	Managing Director

  

[SIGNATURE PAGE TO AMENDED AND RESTATED
FIRST REFUSAL AND CO-SALE AGREEMENT] 

 IN WITNESS WHEREOF, the parties have executed this Amended and Restated First Refusal
and Co-Sale Agreement as of the date first above written. 
  

			
	INVESTORS:
	
	VERWALTUNGSGESELLSCHAFT AD. KRAUTH
		
	By:	 	 
	Name:	 	 
	Title:	 	 

  

[SIGNATURE PAGE TO AMENDED AND RESTATED
FIRST REFUSAL AND CO-SALE AGREEMENT] 

 IN WITNESS WHEREOF, the parties have executed this Amended and Restated First Refusal
and Co-Sale Agreement as of the date first above written. 
  

			
	INVESTORS:
	
	PONTHIEU VENTURES
		
	By:	 	 
	Name:	 	 
	Title:	 	 

  

[SIGNATURE PAGE TO AMENDED AND RESTATED
FIRST REFUSAL AND CO-SALE AGREEMENT] 

 IN WITNESS WHEREOF, the parties have executed this Amended and Restated First Refusal
and Co-Sale Agreement as of the date first above written. 
  

			
	 INVESTORS:
  

DALHIA A SICAR SCA
  
 By: Dalhia Gestion,
 its Managing Company

		
	By:	 	 
	Name:	 	 
	 Title:
	 	 

  

[SIGNATURE PAGE TO AMENDED AND RESTATED
FIRST REFUSAL AND CO-SALE AGREEMENT] 

 IN WITNESS WHEREOF, the parties have executed this Amended and Restated First Refusal
and Co-Sale Agreement on the day and year indicated above. 
  

					
	 COMMON HOLDERS:
  

PATH4 LLC

		
	By:	 	 
		 	Name:	 	 
		 	Title:	 	 

  

	
	  
	Stephen H. Hochschuler, M.D.

  

	
	  
	Daniel L. Peterson, M.D

  

	
	  
	John K. Stokes, M.D.

  

	
	  
	Mark Richards

  

	
	  
	Christophe Lavigne

  

	
	  
	Hervé Dinville

  

	
	  
	Patrick Richard

  

	
	  
	Jean-Louis Medus

  

[SIGNATURE PAGE TO AMENDED AND RESTATED
FIRST REFUSAL AND CO-SALE AGREEMENT] 

 SCHEDULE A 

SCHEDULE OF INVESTORS 
  

																					
	 Investor
	  	Shares of
Common	 	  	Shares of
Series A-1	 	  	Shares of
Series A-2	 	  	Shares of
Series B	 	  	Shares of
Series C	 
	 Telegraph Hill Partners

SBIC, LP
 360 Post Street
 Suite 601

San Francisco, CA 94108

Fax: (415) 765-6983

Attn: Jeanette Welsh
	  	 	0	  	  	 	0	  	  	 	0	  	  	 	0	  	  	 	2,484,979	  
						
	 THP Affiliates Fund, LLC

360 Post Street
 Suite 601
 San Francisco, CA 94108

Fax: (415) 765-6983

Attn: Jeanette Welsh
	  	 	0	  	  	 	0	  	  	 	0	  	  	 	0	  	  	 	90,129	  
						
	 Telegraph Hill Partners II, LP

360 Post Street
 Suite 601
 San Francisco, CA 94108

Fax: (415) 765-6983

Attn: Jeanette Welsh
	  	 	0	  	  	 	0	  	  	 	0	  	  	 	0	  	  	 	12,598,237	  
						
	 THP II Affiliates Fund, LLC

360 Post Street
 Suite 601
 San Francisco, CA 94108

Fax: (415) 765-6983

Attn: Jeanette Welsh
	  	 	0	  	  	 	0	  	  	 	0	  	  	 	0	  	  	 	277,299	  
						
	 Austin Ventures VIII, L.P.

300 W. 6th Street, Suite 2200
 Austin, TX 78701
 Fax: (512) 476-3952

Attn: Joe Aragona
	  	 	2,138,851	  	  	 	6,672,071	  	  	 	966,954	  	  	 	6,006,006	  	  	 	2,145,923	  
						
	 Path4 Innovations LP

4030 W. Braker Lane, Suite 360

Austin, Texas 78759

Fax: (512) 344-3350

Attn: General Partner
	  	 	0	  	  	 	1,112,012	  	  	 	0	  	  	 	1,001,001	  	  	 	0	  

  
 Schedule A-1

																					
	 FCPR R Capital Technologies

42 rue d’Anjou,

75008
 Paris, France
 Fax: 00 33 1 4074 8820

Attn: Pierre Remy
	  	 	1,576,220	  	  	 	958,717	  	  	 	11,852,408	  	  	 	456,887	  	  	 	370,011	  
						
	 FCPR R Capital Privé Technologies

42 rue d’Anjou,

75008
 Paris, France
 Fax: 00 33 1 4074 8820

Attn: Pierre Remy
	  	 	252,046	  	  	 	153,295	  	  	 	1,895,536	  	  	 	73,055	  	  	 	59,173	  
						
	 Pinto Technology Ventures, L.P.

1000 Main, Suite 3250

Houston, TX 77002

Fax: (713) 209-7599

Attn: Matthew Crawford
	  	 	603,275	  	  	 	2,224,024	  	  	 	272,721	  	  	 	2,002,002	  	  	 	2,145,923	  
						
	 Verwaltungsgellschaft AD.

KRAUTH
 Wandsbeker Königstr. 27-29
 22041 Hamburg

Fax: +49 (40) 6588-1238

Attn: Björn Breiter
	  	 	990,096	  	  	 	0	  	  	 	447,630	  	  	 	2,119,767	  	  	 	0	  
						
	 Dalhia A Sicar SCA1

50 av JF Kennedy, L-2951

Luxemberg
 Fax: +33 1 53 01 38 16
 Attn: Armando
Geday
	  	 	0	  	  	 	0	  	  	 	2,662,600	  	  	 	0	  	  	 	1,287,553	  
						
	 Ponthieu Ventures

50 Avenue des Champs-Elyses

75008 Paris, France

Fax: +33 1 45 63 85 28

Attn: Emmanuel Roth
	  	 	0	  	  	 	0	  	  	 	0	  	  	 	3,179,650	  	  	 	0	  
						
	 Total
	  	 	5,560,488	  	  	 	11,120,119	  	  	 	18,097,849	  	  	 	14,838,368	  	  	 	21,459,227	  

  

	1 	Dalhia A Sicar SCA currently holds warrants to purchase 53,500 shares of Médical Class B Stock and 14,500 shares of Médical Class C Stock. Upon exercise
of those warrants, Dalhia A Sicar SCA will exchange those shares of Médical capital stock for 2,662,600 shares of the Company’s Series A-2 Preferred Stock. 

  
 Schedule A-2

 SCHEDULE B 

SCHEDULE OF COMMON HOLDERS 
  

					
	 Common Holder Name
	  	Holding Common Stock	 
	
Path4, LLC
	  	 	2,780,030	  
	 Stephen H. Hochschuler, M.D.
	  	 	309,353	  
	 Daniel L. Peterson, M.D.
	  	 	55,601	  
	 John K. Stokes, M.D.
	  	 	55,601	  
	 Mark Richards
	  	 	1,737	  
	 Christophe Lavigne23
	  	 	7,839,008	  
	 Hervé Dinville3
	  	 	8,408,530	  
	 Patrick Richard3
	  	 	4,489,026	  
	 J. Huppert3
	  	 	284,428	  
	 P. Bernard3
	  	 	142,214	  
	 Taylor Bryant Pty, Ltd3
	  	 	117,468	  
	 Jan de Decker3
	  	 	117,468	  
	 M. Ameil3
	  	 	569,522	  
	 Jean-Louis Medus3
	  	 	462,040	  
	 Rupert Griffiths3
	  	 	78,313	  
	 Xavier Bellot3
	  	 	158,582	  
	 Stephane Menard3
	  	 	8,810	  
	 Alexis Mercier3
	  	 	17,620	  
	 Frederic Dugrillon3
	  	 	17,620	  
	 Alain Roussel3
	  	 	29,367	  
	 Michael Labrum3
	  	 	17,620	  
	 Dominique Ferrari3
	  	 	82,228	  
	 Rodolphe Dagnaud3
	  	 	17,620	  
	 Julien Clause3
	  	 	17,620	  

  

	2 	Represents the number of shares of Holding such Common Holder will hold upon exchange of all shares and the exercise of all warrants. 

	3 	Christophe Lavigne also has options to purchase 639,617 shares of the Company’s Common Stock. 

  
 Schedule B-1

					
	 Emmanuelle Arnon3
	  	 	17,620	  
	 Jose Thevenin3
	  	 	11,747	  
	 Jean-Jaques Coll3
	  	 	11,747	  
	 Camille Marguier3
	  	 	17,620	  
	 Christophe Garnier3
	  	 	17,620	  
	 Sophie Stefanutti3
	  	 	3,524	  
	 Cedric Demonsand3
	  	 	2,349	  
	 Catherine Rodriguez-Chevreau3
	  	 	2,349	  
	 Veronique Cesar3
	  	 	2,349	  
	 Annabelle Debauchez3
	  	 	2,349	  
	 Estelle Arbrun3
	  	 	2,349	  
	 Karine Thioust3
	  	 	2,349	  
	 Julien Jordy3
	  	 	2,349	  
	 Agnes Koch3
	  	 	2,349	  
	 Sebastien Bizot3
	  	 	2,349	  
	 TOTALS
	  	 	26,178,445	  

  
 Schedule B-2

 Annex A 
 ADOPTION AGREEMENT 
 This Adoption Agreement (“Adoption
Agreement”) is executed by the undersigned (the “Transferee”) pursuant to the terms of the First Refusal and Co-Sale Agreement dated as of September 11, 2007 (the “Agreement”) by and
among the Company and certain of its Stockholders. 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 Transferee agrees as
follows: 
 1. Acknowledgement. Transferee acknowledges that Transferee is acquiring certain shares of the
capital stock of the Company (the “Stock”), subject to the terms and conditions of the Agreement. 

2. Agreement. As partial consideration for such transfer, Transferee (i) agrees that the Stock acquired by
Transferee shall be bound by and subject to the terms of the Agreement, and (ii) hereby adopts the Agreement with the same force and effect as if Transferee were originally a party thereto. 

3. Notice. Any notice required or permitted by the Agreement shall be given to Transferee at the address listed beside
Transferee’s signature below. 
 4. Joinder. The spouse of the undersigned Transferee, if applicable,
executes this Adoption Agreement to acknowledge its fairness and that it is in such spouse’s best interests and to bind to the terms of the Agreement such spouse’s community interest, if any, in the Stock. 

EXECUTED AND DATED this             day of
                                    ,
            . 
  

					
	TRANSFEREE
		
	By:	 	 
		 	Name:	 	 
		 	Title:	 	 
		 	Address:	 	 
		 		 	 
		 	Fax:	 	 
	
	Spouse: (if applicable):
		
	Name:	 	 

  

					
	 ACKNOWLEDGED AND ACCEPTED:
  

LDR Holding Corporation

			
	 By:
	 	 	 	 
		 	 Name:
	 	 
		 	 Title:
	 	 

  
 Annex A-1EX-4.7

 Exhibit 4.7 
 THIS WARRANT AND THE SHARES ISSUABLE HEREUNDER HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “ACT”), OR ANY APPLICABLE STATE SECURITIES LAWS, AND, EXCEPT AND
PURSUANT TO THE PROVISIONS OF SECTION 5.4 BELOW, MAY NOT BE OFFERED, SOLD OR OTHERWISE TRANSFERRED WITHOUT AN EFFECTIVE REGISTRATION THEREOF UNDER THE ACT AND ANY APPLICABLE STATE SECURITIES LAWS, OR PURSUANT TO RULE 144 OR AN EXEMPTION FROM THE
REGISTRATION REQUIREMENTS OF THE ACT AND ANY APPLICABLE STATE SECURITIES LAWS. 
 THE SECURITIES REPRESENTED BY THIS WARRANT ARE SUBJECT TO A
LOCK-UP PERIOD OF UP TO 180 DAYS FOLLOWING THE EFFECTIVE DATE OF A REGISTRATION STATEMENT OF THE COMPANY FILED UNDER THE ACT AS SET FORTH IN SECTION 3.5.6 OF THIS WARRANT. SUCH LOCK-UP PERIOD IS BINDING ON TRANSFEREES OF THESE SECURITIES.

 WARRANT TO PURCHASE STOCK 
  

			
	Corporation:	  	LDR HOLDING CORPORATION, a Delaware corporation
	Number of Shares:	  	154,506
	Class of Stock:	  	Series C Preferred Stock
	Warrant Price:	  	$1.165 per share
	Issue Date:	  	November 23, 2009
	Expiration Date:	  	November 23, 2016 (Subject to Section 5.1)

 THIS WARRANT TO PURCHASE STOCK (THIS “WARRANT”) CERTIFIES THAT, for good and valuable
consideration, the receipt of which is hereby acknowledged, COMERICA BANK, a Texas banking association, or its assignee (“Holder”), is entitled to purchase the number of fully paid and nonassessable shares of the class of securities (the
“Shares”) of LDR HOLDING CORPORATION (the “Company”) at the Warrant Price, all as set forth above and as adjusted pursuant to the terms of this Warrant, subject to the provisions and upon the terms and conditions set forth in
this Warrant. 
 ARTICLE 1 
 EXERCISE 
 1.1 Method of Exercise. Holder may exercise this Warrant
by delivering this Warrant and 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). Holder shall
also deliver to the Company a check, wire transfer (to an account designated by the Company) or other form of payment acceptable to the Company for the aggregate Warrant Price for the Shares being purchased. 

1.2 Intentionally Omitted. 
 1.3 Delivery of Certificate and New Warrant. Within 30 days after Holder exercises this Warrant and the Company receives payment of the aggregate Warrant Price, the Company shall deliver to Holder
certificates for the Shares acquired and, if this Warrant has not been fully exercised and has not expired, a new warrant representing the Shares not so acquired. 
 1.4 Replacement of Warrants. In the case of loss, theft or destruction of this Warrant, upon delivery of an indemnity agreement reasonably satisfactory in form and amount to the Company or, in the
case of mutilation, upon surrender and cancellation of this Warrant, the Company at its expense shall execute and deliver, in lieu of this Warrant, a new warrant of like tenor. 
 1.5 Acquisition of the Company. 
 1.5.1
“Acquisition.” For the purpose of this Warrant, “Acquisition” means (a) the acquisition of the Company by means of any transaction or series of related transactions (including, without limitation, any stock
acquisition, reorganization, merger or consolidation) unless the Company’s stockholders of 

  
 1 

 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 Company’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 the Company of shares of its
capital stock to investors in bona fide equity financing transactions, or in an initial public offering, shall not be deemed an Acquisition for this purpose) or (b) a sale, exclusive license, pledge, conveyance or other disposition of all or
substantially all of the assets of the Company, including a sale, exclusive license, pledge, conveyance or other disposition of all or substantially all of the assets of the Company’s subsidiaries, if such assets constitute substantially all of
the assets of the Company and such subsidiaries taken as a whole. 
 1.5.2 Treatment of Warrant in the Event
of an Acquisition. The Company shall give Holder written notice at least 20 days prior to the closing of any proposed Acquisition. The Company will use commercially reasonable efforts to cause (i) the acquirer of the Company,
(ii) successor or surviving entity or (iii) parent entity in an Acquisition (the “Acquirer”) to assume this Warrant as a part of the Acquisition. 

(a) If the Acquirer assumes this Warrant, then this Warrant shall be exercisable for the same securities, cash, and
property as would be payable for the Shares issuable upon exercise of the unexercised portion of this Warrant as if such Shares were outstanding on the record date for the Acquisition and subsequent closing. The Warrant Price shall be adjusted
accordingly, and the Warrant Price and number and class of Shares shall continue to be subject to adjustment from time to time in accordance with the provisions hereof. 

(b) If the Acquirer refuses to assume this Warrant in connection with the Acquisition, the Company shall give Holder an
additional written notice at least ten (10) days prior to the closing of the Acquisition of such fact. In such event, notwithstanding any other provision of this Warrant to the contrary, Holder may immediately exercise this Warrant in the
manner specified in this Warrant with such exercise effective immediately prior to closing of the Acquisition. If Holder elects not to exercise this Warrant, then this Warrant will terminate immediately prior to the closing of the Acquisition.
Notwithstanding any other provision of this Warrant to the contrary if the Acquirer refuses to assume this Warrant in connection with such Acquisition, other than in connection with an Excluded Acquisition (as defined below), then effective as of
the date that is ten (10) days prior to the closing of such Acquisition, the Holder shall have the option to elect (i) that the Warrant Price be adjusted, without further action of any party, to $0.01 per share or (ii) to put this
Warrant to the Company for a per Share amount equal to the difference between the Acquisition consideration payable for one Share and the Warrant Price. As used herein, an “Excluded Acquisition” means, an Acquisition where the
consideration that the holders of the Shares are entitled to receive on account of the Shares consists entirely of cash and/or shares of common stock that are publicly traded on a national exchange and where the shares, if any, receivable by the
Holder of this Warrant were the Holder to exercise this Warrant in full immediately prior to the closing of such Acquisition may be publicly re-sold by the Holder in their entirety within the three (3) months following such closing pursuant to
Rule 144 or an effective registration statement under the Act. 
 ARTICLE 2 

ADJUSTMENTS TO THE SHARES 
 2.1 Stock Dividends, Splits, Etc. If the Company declares or pays a dividend on the Shares payable in common stock, or other securities, or subdivides the outstanding Shares, then upon exercise of
this Warrant, for each Share acquired, Holder shall receive, without cost to Holder, the total number and kind of securities to which Holder would have been entitled had Holder owned the Shares of record as of the date the dividend or subdivision
occurred. 
 2.2 Reclassification, Exchange or Substitution. Upon any reclassification, exchange, substitution, or other
event that results in a change of the number and/or class of the securities issuable upon exercise or conversion of this Warrant, Holder shall be entitled to receive, upon exercise or conversion of this Warrant, the number and kind of securities and
property that Holder would have received for the Shares if this Warrant had been exercised immediately before such reclassification, exchange, substitution, or other event. Such an event shall include any 

  
 2 

 automatic conversion of the outstanding or issuable securities of the Company of the same class or series as
the Shares to common stock pursuant to the terms of the Company’s Certificate of Incorporation upon the closing of a registered public offering of the Company’s common stock. The Company or its successor shall promptly issue to Holder a
new warrant for such new securities or other property. The new warrant shall provide for adjustments which shall be as nearly equivalent as may be practicable to the adjustments provided for in this Article 2 including, without limitation,
adjustments to the Warrant Price, the number of securities or property issuable upon exercise of the new warrant and expiration date. The provisions of this Section 2.2 shall similarly apply to successive reclassifications, exchanges,
substitutions, or other events. 
 2.3 Adjustments for Combinations, Etc. If the outstanding Shares are combined or
consolidated, by reclassification, reverse split or otherwise, into a lesser Number of Shares, the Warrant Price shall be proportionately increased. If the outstanding Shares are split or multiplied, by reclassification or otherwise, into a greater
Number of Shares, the Warrant Price shall be proportionately decreased. 
 2.4 Adjustments for Diluting Issuances. In the
event of the issuance (a “Diluting Issuance”) by the Company, after the Issue Date of this Warrant, of securities at a price per share less than the Warrant Price, then the number of shares of common stock issuable upon conversion of the
Shares shall be adjusted in accordance with those provisions of the Company’s Third Amended and Restated Certificate of Incorporation, as amended from time to time (the “Certificate of Incorporation”), a copy of which in effect as of
the Issue Date is attached hereto as Exhibit A, which apply to Diluting Issuances as if the Shares were outstanding on the date of such Diluting Issuance. The provisions set forth for the Shares in the Company’s Certificate of
Incorporation relating to the above in effect as of the Issue Date may not be amended, modified or waived, without the prior written consent of Holder unless such amendment, modification or waiver affects the rights associated with the Shares in the
same manner as such amendment, modification or waiver affects the rights associated with all other shares of the same series and class as the Shares granted to the Holder. Under no circumstances shall the aggregate Warrant Price payable by the
Holder upon exercise of this Warrant increase as a result of any adjustment arising from a Diluting Issuance. 
 2.5 No
Impairment. The Company shall not, by amendment of its Certificate of Incorporation or through a reorganization, transfer of assets, consolidation, merger, dissolution, issue, or sale of securities or any other voluntary action, avoid or seek to
avoid the observance or performance of any of the terms to be observed or performed under this Warrant by the Company, but shall at all times in good faith assist in carrying out all the provisions of this Article 2 and in taking all such action as
may be necessary or appropriate to protect Holder’s rights under this Article 2 against impairment. 
 2.6 Certificate as
to Adjustments. Upon each adjustment of the Warrant Price, the Company at its expense shall promptly compute such adjustment, and furnish Holder with a certificate signed by its Chief Financial Officer setting forth such adjustment and the facts
upon which such adjustment is based. The Company shall, upon written request, furnish Holder a certificate setting forth the Warrant Price in effect upon the date thereof and the series of adjustments leading to such Warrant Price. 

2.7 Fractional Shares. No fractional Shares shall be issuable upon exercise of this Warrant and the Number of Shares to be issued
shall be rounded down to the nearest whole Share. If a fractional share interest arises upon any exercise of this Warrant, the Company shall eliminate such fractional share interest by paying Holder an amount computed by multiplying the fractional
interest by the fair market value, as determined by the Company’s Board of Directors, of a full Share. 
 ARTICLE 3

 REPRESENTATIONS AND COVENANTS OF THE COMPANY 

3.1 Representations and Warranties. The Company hereby represents and warrants to, and agrees with, the Holder as follows:

 3.1.1 The initial Warrant Price referenced on the first page of this Warrant is not greater than the price per
share last paid by the holders of Series C Preferred Stock. 

  
 3 

 3.1.2 All Shares which may be issued upon the exercise of the purchase right
represented by this Warrant, and all securities, if any, issuable upon conversion of the Shares, shall, upon issuance, be duly authorized, validly issued, fully paid and nonassessable, and free of any liens and encumbrances except for restrictions
on transfer provided for herein or under applicable federal and state securities laws. 
 3.1.3 The
Company’s capitalization table delivered to Holder as of the Issue Date is true and complete as of the Issue Date. 
 3.2
Notice of Certain Events. If the Company proposes at any time (a) to declare any dividend or distribution upon its stock, whether in cash, property, stock, or other securities and whether or not a regular cash dividend; (b) to offer
for subscription pro rata to the holders of any class or series of its stock any additional shares of stock of any class or series or other rights; (c) to effect any reclassification or recapitalization of stock; or (d) to merge or
consolidate with or into any other corporation, or sell, lease, license, or convey all or substantially all of its assets, or to liquidate, dissolve or wind up, then, in connection with each such event, the Company shall give Holder (1) at
least 20 days prior written notice of the date on which a record will be taken for such dividend, distribution, or subscription rights (and specifying the date on which the holders of stock will be entitled thereto) or for determining rights to
vote, if any, in respect of the matters referred to in (a) and (b) above; and (2) in the case of the matters referred to in (c) and (d) above at least 20 days prior written notice of the date when the same will take place
(and specifying the date on which the holders of stock will be entitled to exchange their stock for securities or other property deliverable upon the occurrence of such event). Upon request, the Company shall provide Holder with such information
reasonably necessary for Holder to evaluate its rights as a holder of this Warrant or Warrant Shares in the case of matters referred to (a), (b), (c) and (d) herein above. 

3.3 Information Rights. So long as the Holder holds this Warrant and/or any of the Shares, the Company shall deliver to the Holder
(a) promptly after mailing, copies of communications sent to the stockholders of the Company updating such stockholders on the Company’s business generally (but for the avoidance of doubt excluding any stockholder consents sent to such
stockholders), (b) within one hundred fifty (150) days after the end of each fiscal year of the Company, the annual audited financial statements of the Company certified by independent public accountants of recognized standing and
(c) within forty-five (45) days after the end of each of the first three quarters of each fiscal year, the Company’s quarterly, unaudited financial statements. In addition, and without limiting the generality of the foregoing, so long
as the Holder holds this Warrant and/or any of the Shares, the Company shall afford to the Holder the same access to information concerning the Company and its business and financial condition as would be afforded to a holder of the class of Shares
under applicable state law and/or any agreement with any holder of the class of Shares. 
 3.4 Registration Under the Act.
The Company agrees that the Shares or, if the Shares are convertible into common stock of the Company, such common stock, shall be deemed “Registrable Securities” or otherwise entitled to “piggy back” registration rights in
accordance with the terms of the that certain Investors Rights Agreement between the Company and its investors dated as of September 11, 2007 (the “Agreement”), a copy of which is attached hereto as Exhibit B. The Company
agrees that no amendments will be made to the Agreement which would have an adverse impact on Holder’s registration rights hereunder this provision. Holder shall be deemed to be a party to the Agreement solely for the purpose of the
above-mentioned registration rights. 
 3.5 Market Standoff. In connection with Section 4.5, below, the Company shall
use its best efforts in its negotiations with the Company’s lead underwriter in a Qualified Pubic Offering (as defined below) to limit the market standoff period to not more than 120 days. The Company agrees to use its best efforts to ensure
that all shares of its capital stock (upon issuance) shall be subject to a market standoff provision on terms substantially similar to those set forth above. 

  
 4 

 ARTICLE 4 
 INVESTMENT REPRESENTATIONS AND COVENANTS OF HOLDER. 
 With respect to the
acquisition of this Warrant and any of the Shares, Holder hereby represents and warrants to, and agrees with, the Company as follows: 
 4.1 Purchase Entirely for Own Account. This Warrant is issued to Holder in reliance upon Holder’s representation to the Company that this Warrant and the Shares will be acquired for investment
for Holder’s, or its affiliate’s, own account, not as a nominee or agent, and not with a view to the resale or distribution of any part thereof other than to an affiliate, and that Holder has no present intention of selling, granting any
participation in, or otherwise distributing the same other than to an affiliate. By executing this Warrant, Holder further represents that Holder does not have any contract, undertaking, agreement or arrangement with any person, other than an
affiliate, to sell, transfer or grant participations to such person or to any third person with respect to any of the Shares. 

4.2 Reliance upon Holder’s Representations. Holder understands that this Warrant and the Shares are not registered under the
Act on the ground that the issuance of such securities is exempt from registration under the Act, and that the Company’s reliance on such exemption is predicated on Holder’s representations set forth herein. 

4.3 Accredited Investor Status. Holder represents to the Company that Holder is an Accredited Investor (as defined in the Act).

 4.4 Restricted Securities. Holder understands that this Warrant and the Shares are “restricted securities”
under the federal securities laws inasmuch as they are being acquired from the Company in a transaction not involving a public offering and that under such federal securities laws and applicable regulations such securities may be resold without
registration under the Securities Act only in certain limited circumstances. 
 4.5 Market Standoff. Holder hereby agrees
that, during the period of up to 180 days following the date of the Qualified Pubic Offering (as defined in the Certificate of Incorporation), it shall not, to the extent requested by the Company and such underwriter, directly or indirectly sell,
offer to sell, contract to sell (including, without limitation, any short sale), grant any option to purchase or otherwise transfer or dispose of (other than to donees who agree to be similarly bound) any securities of the Company held by it at any
time during such period except Common Stock included in such registration; provided, however, that: 
 (a)
such agreement shall be applicable only to the first such registration statement of the Company; 
 (b) all
officers, directors and 1% stockholders of the Company enter into similar agreements; and 
 (c) any
discretionary waiver or termination of such agreement by the Company of the underwriters shall apply to all persons subject to such agreement on a pro rata basis among all parties bound by such agreement. 

In order to enforce the foregoing covenant, the Company may impose stop-transfer instructions with respect to the Shares until the end of
such period. 
 Notwithstanding the foregoing, the obligation described in this Section 4.5 shall not apply to a
registration relating solely to employee benefit plans on Form S-1 or Form S-8 or similar forms which may be promulgated in the future, or a registration relating solely to an SEC Rule 145 transaction on Form S-4 or similar forms which my be
promulgated in the future. 
 ARTICLE 5 
 MISCELLANEOUS 
 5.1 Term; Exercise Upon Expiration. This Warrant is
exercisable in whole or in part, at any time and from time to time on or before the Expiration Date set forth above; provided, however, that if the Company completes its initial public offering within the one-year period immediately prior to
the Expiration Date, the Expiration Date shall automatically be extended until the first anniversary of the effective date of the Company’s initial public offering. The Company agrees that Holder may terminate this Warrant, upon notice to the
Company, at any time in its sole discretion. 

  
 5 

 5.2 Legends. This Warrant and the Shares (and the securities issuable, directly or
indirectly, upon conversion of the Shares, if any) shall be imprinted with a legend in substantially the following form: 
 THIS
WARRANT AND THE SHARES ISSUABLE HEREUNDER HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “ACT”), OR ANY APPLICABLE STATE SECURITIES LAWS, AND, EXCEPT AND PURSUANT TO THE PROVISIONS OF SECTION 5.4 BELOW, MAY NOT
BE OFFERED, SOLD OR OTHERWISE TRANSFERRED WITHOUT AN EFFECTIVE REGISTRATION THEREOF UNDER THE ACT AND ANY APPLICABLE STATE SECURITIES LAWS, OR PURSUANT TO RULE 144 OR AN EXEMPTION FROM THE REGISTRATION REQUIREMENTS OF THE ACT AND ANY APPLICABLE
STATE SECURITIES LAWS. 
 THE SECURITIES REPRESENTED BY THIS WARRANT ARE SUBJECT TO A LOCK-UP PERIOD OF UP TO 180 DAYS FOLLOWING
THE EFFECTIVE DATE OF A REGISTRATION STATEMENT OF THE COMPANY FILED UNDER THE ACT AS SET FORTH IN SECTION 4.5 OF THIS WARRANT. SUCH LOCK-UP PERIOD IS BINDING ON TRANSFEREES OF THESE SECURITIES. 

5.3 Compliance with Securities Laws on Transfer. This Warrant and the Shares issuable upon exercise of this Warrant (and the
securities issuable, directly or indirectly, upon conversion of the Shares, if any) may not be transferred or assigned in whole or in part without compliance with applicable federal and state securities laws by the transferor and the transferee. The
Company shall not require Comerica Bank (“Bank”) or a Bank Affiliate (as defined herein) to provide an opinion of counsel or investment representation letter if the transfer is to Bank’s parent company, Comerica Incorporated
(“Comerica”), or any other affiliate of Bank (“Bank Affiliate”). 
 5.4 Transfer Procedure. After
receipt of the executed Warrant, Bank will transfer all of this Warrant to Comerica Ventures Incorporated, a non-banking subsidiary of Comerica and a Bank Affiliate (“Ventures”). Subject to the provisions of Section 5.3, Holder may
transfer all or part of this Warrant or the Shares issuable upon exercise of this Warrant (or the securities issuable, directly or indirectly, upon conversion of the Shares, if any) by giving the Company notice of the portion of this Warrant being
transferred setting forth the name, address and taxpayer identification number of the transferee and surrendering this Warrant to the Company for reissuance to the transferee(s) (and Holder, if applicable); provided, however, that Holder may
transfer all or part of this Warrant to its affiliates, including, without limitation, Ventures, at any time without notice or the delivery of any other instrument to the Company, and such affiliate shall then be entitled to all the rights of Holder
under this Warrant and any related agreements, and the Company shall cooperate fully in ensuring that any stock issued upon exercise of this Warrant is issued in the name of the affiliate that exercises this Warrant. The terms and conditions of this
Warrant shall inure to the benefit of, and be binding upon, the Company and the holders hereof and their respective permitted successors and assigns. Notwithstanding the foregoing, unless the Company is filing financial information with the SEC
pursuant to the Securities Exchange Act of 1934, as amended, the Company shall have the right to refuse to transfer any portion of this Warrant to any person who directly competes with the Company. 

5.5 Notices. All notices and other communications from the Company to the Holder, or vice versa, shall be deemed delivered and
effective when given personally or mailed by first-class registered or certified mail, postage prepaid, or sent via a nationally recognized overnight courier service, fee prepaid, or on the first business day after transmission by facsimile, at such
address or facsimile number as may have been furnished to the Company or the Holder, as the case may be, in writing by the Company or such Holder from time to time. Effective upon the receipt of executed Warrant and initial transfer described in
Article 5.4 above, all notices to the Holder shall be addressed as follows until the Company receives notice of a change of address in connection with a transfer or otherwise: 

  
 6 

 Comerica Ventures Incorporated 

Attn: Warrant Administrator 
 1717 Main Street, 5th Floor, MC 6406 
 Dallas, Texas 75201 

Facsimile No. (214) 462-4459 
 All notices to the Company shall be addressed as follows: 
 LDR HOLDING
CORPORATION 
 Attn: Chief Financial Officer 
 4030 West Braker Lane, Ste 360 
 Austin, TX 78759 

Facsimile No. (512) 344-3350 
 5.6 Amendments; Waiver. This Warrant and any term hereof may be amended, changed, waived, discharged or terminated only by an instrument in writing signed by the party against which enforcement of
such amendment, change, waiver, discharge or termination is sought. 
 5.7 Attorneys’ Fees. In the event of any
dispute between the parties concerning the terms and provisions of this Warrant, the party prevailing in such dispute shall be entitled to collect from the other party all costs incurred in such dispute, including reasonable attorneys’ fees.

 5.8 Governing Law. This Warrant shall be governed by and construed in accordance with the laws of the State of
Delaware, without giving effect to its principles regarding conflicts of law. 
 5.9 Confidentiality. The Company hereby
agrees to keep the terms and conditions of this Warrant confidential. Notwithstanding the foregoing confidentiality obligation, the Company may disclose information relating to this Warrant as required by law, rule, regulation, court order or other
legal authority, provided that (i) the Company has given Holder at least ten (10) days’ notice of such required disclosure, and (ii) the Company only discloses information that is required, in the opinion of counsel reasonably
satisfactory to Holder, to be disclosed. 
 [Balance of Page Intentionally Left
Blank] 

  
 7 

 
			
	LDR HOLDING CORPORATION
		
	By:	 	 /s/ Christophe Lavigne

	Name:	 	Christophe Lavigne
	Title:	 	President and CEO
	
	COMERICA BANK
		
	By:	 	 /s/ Donna Day

	Name:	 	Donna Day
	Title:	 	Vice President

 [Signature Page to Warrant to Purchase Stock] 

  
 8 

 APPENDIX I 
 NOTICE OF EXERCISE 
 1. The undersigned hereby elects to purchase
                    shares of the
                    stock of LDR HOLDING CORPORATION pursuant to the terms of the attached Warrant, and tenders herewith payment of the
purchase price of such shares in full. 
 2. Please issue a certificate or certificates representing said shares in the name of
the undersigned or in such other name as is specified below: 
 Comerica Ventures Incorporated 

Attn: Warrant Administrator 
 1717 Main Street, 5th Floor, MC 6406 
 Dallas, Texas 75201 

Facsimile No. (214) 462-4459 
 3. The undersigned represents it is acquiring the shares solely for its own account and not as a nominee for any other party and not with a view toward the resale or distribution thereof except in
compliance with applicable securities laws. 
  

	
	COMERICA VENTURES INCORPORATED or Assignee
	
	  
	(Signature)
	
	  
	(Name and Title)
	
	  
	(Date)

  
 Appendix I

 Exhibit A 
 Anti-Dilution Provisions 
 Certificate of Incorporation (including all amendments
thereto) – ATTACHED HERETO 

  
 Exhibit A

 Page 1 

 Exhibit B 
 Registration Rights 
 Investor Rights Agreement (including all amendments thereto)
– ATTACHED HERETO 

  
 Exhibit C

 Page 1

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