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.

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.

CardioPhotonics' HeartLight monitors fluid volumes in real time and is normalized to patients during surgery. The company believes that the ability to accurately assess the patient’s condition and consequently avoid the over- or underadministration of fluids will reduce post-surgical complications that can prolong hospital stay and increase health care costs.

Noteworthy news from medtech start-ups. This month we profile Cardiophotonics, whose HeartLight monitor measures patient fluid volumes in real time and NeoTract, which is developing a minimally invasive device for treating benign prostatic hyperplasia.