Once considered the high flying segment of the musculoskeletal industry, the spine industry has finally hit a wall as procedure volumes stall, implant prices tumble, and payors push back on authorizing expensive operations for back pain such as spinal fusion. As economic woes heighten, hand in hand with persistent unemployment just as health care and regulatory reforms kick in, many left the North American Spine Society meeting in early October wondering where the bright spots are in this industry.

Injectable products that can alleviate pain and even reverse the disease process are on the horizon for treating degenerative orthopedic and spinal conditions, such as damaged articular joint cartilage and deteriorated spinal discs. With no available long-term treatment options for these conditions short of invasive surgical procedures like joint replacement or spinal fusion, injectable technologies that offer the possibility of being used upstream in the continuum of care are potential billion-dollar market opportunities. In fact, in a post health care reform environment, injectable therapies may prove to be the most cost-effective way for treating many degenerative conditions.

While products for fusing the spine remain the backbone of the booming market for spinal implants and instruments, there's a new focus on motion preservation. These technologies--for lumbar and cervical disc replacement, nucleus replacement, posterior stabilization,and pedicle screw-based systems--promise a host of new procedures to treat patients with symptomatic back pain who are earlier in the degenerative process.

A preview of the emerging health care companies profiled in the current issue of Start-Up. This month's profile group, The New Movement in Spine, features profiles of Archus Orthopedics Inc., AxioMed Spine Corp., Gelifex Inc. and Replication Medical Inc. Plus these Start-Ups Across Health Care: Advanced Circulatory Systems Inc., Ambrx Inc., Clearant Inc., Compound Therapeutics Inc., Hydra Biosciences Inc., NanoBio Corp., Phenomix Corp. and VisEn Medical Inc.