Once a small manufacturer of custom products, Alphatec was acquired by HealthpointCapital in 2005 with the goal of turning the company into a major player in spine. Alphatec's strategy has been to target important new technology areas, such as minimally invasive surgery and biologics, with a special focus on elderly patients and the specific problems they face. A merger with Scient'x brought Alphatec additional products for its pipeline and, more importantly, a commercial infrastructure in Europe. Like other spine companies, Alphatec faces a host of issues, including pricing pressures, pushback on covered procedures by payors, and uncertainty at the FDA. Adding to the challenge for Alphatec: its role as a publicly traded company. A company whose product development efforts more closely resemble that of a venture-backed start-up went public, partly to raise the capital to fuel strong growth. But like any publicly traded company, Alphatec's stock has been on a roller coaster since its IPO in 2006. Last spring, the company missed its numbers and the stock took a huge hit. Critics charge that the company has lagged in product development; while company officials insist that the pipeline is rich, believing that the strong pipeline will push Alphatec into the front ranks of the industry.

By focusing on an overlooked but critical element of spinal anatomy, the facet joint, Archus is applying established principles of total joint replacement to create a new opportunity in spine, while also expanding the potential opportunities in disc replacement.

Biomet's recent acquisition of spine company InterporeCross expands its existing line of spine products but really is best seen as a follow-on to its recent buyout of its long-term alliance with German drug company Merck KGAA. Indeed, InterporeCross' major contribution in spine will come not in hardware, but in its strong orthobiologics program.

The spinal orthopedics business, long focused on traditional fixation tools such as screws, dowels, cements, and more recently, interbody fusion cages, has been undergoing a slow evolution that also incorporates a biological approach to bone healing. Orthovita believes its glass/resin-based bioactive materials mimic the biology of bone healing better than previous synthetics, and that these materials can more easily incorporate biologic agents for an added bone-healing boost. Now the company faces the challenge of generating the data that will differentiate it from a host of competitors making similar claims and enable it to penetrate a market inherently slow to adopt new technology.