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.