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.

This article first appeared in the March 2009 issue of Start-Up. The current economic crisis is hard on everyone, including investors and start-ups. But the news isn't all bad for medical device VCs. Those with capital will find the prices to be right in today's depressed economy. On the flip side, those venture firms without new funds or sufficient reserve capital will get penalized by declining valuations and punitive terms offered up by some new investors in their companies. Medical device companies, meanwhile, face tougher scrutiny from investors. During all this, both VCs and start-ups must answer new questions being posed by regulatory bodies, public investors, corporate acquirers, and potential customers.

The current economic crisis is hard on everyone, including investors and start-ups. But the news isn't all bad for medical device VCs. Those with capital will find the prices to be right in today's depressed economy. On the flip side, those venture firms without new funds or sufficient reserve capital will get penalized by declining valuations and punitive terms offered up by some new investors in their companies. Medical device companies, meanwhile, face tougher scrutiny from investors. During all this, both VCs and start-ups must answer new questions being posed by regulatory bodies, public investors, corporate acquirers, and potential customers.

Artificial discs are experiencing a cooling trend owing to an expected reduction in CMS reimbursement for both cervical and lumbar disc replacement. Many motion preservation companies are reaching critical regulatory milestones that will likely require a step-up in funding to conduct the large scale clinical studies needed to gain PMA approval. Today, companies in this sector are faced with the troubling task of either scaling back R&D programs to conserve cash or raising additional capital to take the next steps.