North American Spine Welcome Brochure

North American Spine The Leader in Minimally Invasive Spine Care

Annette B. | Arkansas Diagnosis: Cervical herniated disc

Information and Procedure Overview

Ready to Learn More?

North American Spine has more than 8,000 successful AccuraScope® stories.

Begin your journey toward pain relief:

›› Send your MRI for a free review ›› Discuss your MRI results with your patient coordinator ›› Review your insurance, cost and financing options ›› Schedule your procedure and travel plans ›› Complete pre-clearance testing and undergo the procedure ›› Attend a post-op appointment and receive care instructions ›› Share your success story

Table of Contents Who We Are. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 What We Treat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Basic Spine Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Back Pain Statistics and Facts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 AccuraScope® Procedure for Neck Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 AccuraScope® Procedure for Upper Back Pain. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 AccuraScope® Procedure for Lower Back Pain. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 AccuraScope® Procedure Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 AccuraScope® Procedure Cost Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 NAS Research Abstracts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 AccuraScope® Procedure Typical Patient Experience. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Partner Physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Patient Coordinators. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Our Locations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Hotel Partners. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Feedback from Our Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Who We Are North American Spine brings together spine specialists from several fields dedicated to the relief of chronic back pain including Orthopedic Spine, Neurosurgery and Pain Management.

These physicians work together to provide patients with a truly multi-disciplinary case review in order to determine the most conservative way to treat their spine problems effectively. This multidisciplinary approach may include interventional pain management, orthopedic spine surgery and/ or neurosurgery, depending on the needs of the individual patient. All of their efforts are designed to tailor the appropriate treatment to each patient, rather than fitting one treatment method to every patient who walks through the door.

We are TRULY minimally invasive Unlike other practices that call themselves minimally invasive while performing traditional surgeries through smaller incisions, North American Spine is unique. We are innovative. By adopting a thorough case review in the early stages of the process, patients are directed to the appropriate treatment method—whether that means an AccuraScope® procedure or another minimally invasive procedure.

The physicians working with North American Spine have more available treatment options to offer patients than any other group. For many practices, “minimally invasive” is a meaningless marketing phrase. Such practices are often built around treating every patient with just one or two procedures.

At North American Spine, our approach recognizes the simple truth that no two spines are alike, and leads patients to the least invasive procedure that is most likely to improve their individual issues.

A Unique Approach The AccuraScope procedure for the lumbar spine takes the least invasive approach possible, through a natural opening at the base of the spinal canal (sacral hiatus), to allow simultaneous diagnosis and treatment of the various causes of nerve root compression. By entering the spinal canal through the sacral hiatus, these board certified pain management physicians can view directly, with a highdefinition scope, the inflamed and damaged tissues causing the pain and treat them at the same time. This unique approach allows us to treat multiple lumbar levels in a single procedure, with a single incision. No other practice can offer this advantage.

The AccuraScope procedure is a significant, yet natural, evolution of pain management techniques that our partner physicians have been practicing for decades. For many patients, it is no longer necessary to take the risks associated with major spine surgery. Our highly advanced procedures keep many patients from requiring a more invasive surgery. Best of all, because the AccuraScope procedure is less invasive, physicians can treat chronic pain symptoms sooner. There is no need to wait for the right treatment.

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North American Spine

The Leader in Minimally Invasive Spine Care

What We Treat Symptoms

›› Back or neck pain with or without radiating leg or arm pain

›› Back pain that involves the hips, buttocks and legs

›› Weakness/numbness in the arms, hands, legs or feet

Conditions

›› Bulging or Herniated Disc ›› Degenerative Disc Disease ›› Facet Disease ›› Failed Back Surgery Syndrome ›› Foraminal Stenosis ›› Pinched Nerve ›› Radiculopathy ›› Scar Tissue ›› Sciatica ›› Spinal Stenosis ›› And many other conditions

Free MRI Evaluation Do you need spine surgery? Before doctors can say yes, they must know what they are expected to treat during the surgery.

For example: is there a bulging disc? If so, where? Or is the pain coming from a bone spur? Or unstable vertebrae? Each of these conditions requires a different approach.

After discussing your specific case, our medical team will review your MRI or CT scan to better identify the cause(s) of pain and determine if the AccuraScope® procedure can help. Note that your MRI report must be less than 3 years old.

Basic Spine Anatomy

The spinal column extends from the base of the skull to the tailbone and is made up of thirty-three bones, known as the vertebrae.

C1-C7 Cervical Vertebrae (7)

The first seven vertebrae (cervical vertebrae) are in the neck and are numbered C1 through C7. Nerve compression in this area can cause neck pain, which may radiate down the arms to the hands and fingers.

The next twelve vertebrae make up the thoracic region (T1 through T12). The ribs attach to these vertebrae and protect the heart and lungs. Few spinal problems can occur in this region; it is usually very stable due to its support from the rib cage.

T1-T12 Thoracic Vertebrae (12)

The lumbar region is the lower back, which contains five vertebrae (L1 through L5). The lumbar spine plays a significant role in motion and flexibility. It is the source of most motion and supports most of the body weight.

Overload or taxing movements may strain the structure, compress the nerves and cause back pain, which may radiate down the legs to the feet.

The regions beneath the lumbar spine are the sacrum (S1 through S5) and coccyx (a series of small bones often called the tailbone). These are fused and do not have discs between them.

Each vertebra is composed of a body and a spinous process which protects the spinal cord and nerve roots.

L1-L5 Lumbar Vertebrae (5)

The vertebrae in the cervical, thoracic and lumbar regions are separated by discs. Discs serve as a cushion between the vertebrae, helping also to protect them and the nerves that run from the spinal cord to the rest of the body.

S1-S5 Sacrum Vertebrae (5 fused)

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North American Spine

The Leader in Minimally Invasive Spine Care

Back Pain Statistics and Facts

Am I The Only One With This Pain?

No! Nearly everyone has low back pain at some point, and your chance of having back pain increases significantly starting at age 30.

Chronic pain affects about 100 million American adults—more than the total affected by heart disease, cancer and diabetes combined.

What May Be Causing This Pain?

It’s possible that your pain is being caused by a muscle strain or injury, and will heal with therapy and rest. On the other hand, you might have chronic lower back pain from a common condition such as a bulging disc, sciatica, spinal degeneration, spinal stenosis, osteoporosis, skeletal irregularities or spondylitis.

The MRI scan is the most common method for identifying potential structural issues.

How Do You Specify What Is Causing The Pain?

Spine pain is often diagnosed through x-ray imaging, discography, CT scan, MRI scan, EMG, bone scan, thermography, ultrasound image or pain mapping.

The AccuraScope® procedure additionally uses a high-definition camera to pinpoint pain causes that may not be clear in scans or imaging.

How Did I Get This?

Some things that increase your risk are out of your control, such as getting older, inherited conditions like ankylosing spondylitis, or other conditions such as arthritis and cancer. Some back pain is caused by lifestyle, such as poor physical fitness, being overweight, smoking, or repetitive strain at your job. No matter what, you don’t deserve to stay in pain.

Chronic Pain: defined as pain that does not heal when expected, typically within 3-6 months after starting.

Will The Pain Go Away?

Some pain may feel like it will never go away, but acute pain from an injury or strain may disappear on its own after a few weeks or months, if you take proper care.

Other pain may be treated by pain medication, antiinflammatories, physical therapy, chiropractic care and other conservative treatments.

If these treatments don’t work, then your best alternative may be a procedure to correct your pain.

That’s where North American Spine can help.

North American Spine accepts most private insurance plans.

Is Spine Surgery Affordable?

You will need to decide whether spine surgery is a good investment for you. Spine surgery is often covered by major insurance carriers, and North American Spine accepts most private insurance plans as well as medical financing through a partner.

Medication and office visits are the biggest costs related to spine pain. In a recent study, AccuraScope patients were projected to save more than $23,000 over 5 years by reducing costs like these.

AccuraScope Procedure for Neck Pain ®

Cervical AccuraScope Procedure North American Spine has helped people just like you find relief with the cervical AccuraScope procedure.

If you are experiencing pain in your neck, you may suffer from a cervical herniated disc or cervical degenerative disc disease. In addition to neck pain, if the diseased or damaged disc presses on nerves adjacent to the area, you may also feel shoulder pain and weakness or numbness in your arm.

When seeking treatment, it is always best to first begin with conservative treatments. Physical therapy, chiropractic care, pain medications and epidural steroid injections may relieve your pain. However, if these measures fail to help, a minimally invasive cervical discectomy and neural decompression may be the right treatment.

Cervical AccuraScope Procedure Benefits Generally, the benefits of a minimally invasive cervical discectomy are:

›› No incision or stitches—less risk for infection ›› Faster recovery than invasive procedures ›› Identify and treat the disc or discs causing pain ›› Treat multiple discs at multiple levels of the cervical spine in one 30- to 40-minute procedure North American Spine works exclusively with boardcertified physicians and surgeons who are specialists in a wide range of state-of-the-art, minimally invasive procedures designed to alleviate chronic pain— including cervical discectomy.

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North American Spine

The Leader in Minimally Invasive Spine Care

Precise Diagnosis and Treatment for Damaged Discs in the Cervical Spine North American Spine’s cervical AccuraScope procedure is a minimally invasive procedure that is performed exclusively in the cervical spine—the area of the spine that begins at the base of the skull and encompasses seven vertebral segments that connect to the thoracic spine (upper back). It does not require an incision or stitches— which means patients have less risk for infection and usually enjoy a shorter recovery time.

One of the great benefits of the cervical AccuraScope procedure is that it allows the physician to accurately identify and precisely treat the appropriate disc or discs that are actually causing pain. After administering local and “twilight” sedation, the physician may insert a small, hollow needle anteriorly into the neck. Using fluoroscopy to precisely guide the needle to the center of the suspected disc, the physician injects a small amount of dye directly into its nucleus to see if fluid leaks from the disc. If the disc tests positive, then a laser is passed through the needle and directly into the disc where it is fired intermittently to shrink bulging disc tissue and seal the tear (herniation).

If the patient has damaged or diseased discs in more than one level of their cervical spine, the physician can treat them as well. In fact, multiple levels of the cervical spine can be treated during one procedure.

When the cervical discectomy is complete, the puncture site is covered with an ordinary Band-Aid®. The entire procedure—depending on how many levels are treated— generally takes 30 to 40 minutes.

AccuraScope Procedure for Upper Back Pain ®

Thoracic AccuraScope Procedure Patients who have pain wrapping around their chest or rib cage may be experiencing symptoms originating from the thoracic area of the spine, and may be helped by the thoracic AccuraScope procedure.

Prior to this procedure, patients should have attempted more conservative therapies such as physical therapy, pain medications and/or epidural steroid injections.

The thoracic AccuraScope procedure is performed using local anesthesia and mild (conscious) sedation. The bulging/herniated discs are treated by a small needle guided by fluoroscopy, and placed into the posterior lateral side of the spine directly into the disc tissue. Fluoroscopy, which converts x-rays into video images, is used to watch and guide the progress of the procedure. A laser fiber is then placed through the needle and when fired, it causes the disc tissue to shrink, decompressing the disc and nerve and sealing the tear.

Multiple levels can be treated during the same procedure.

The procedure takes less than 30 minutes, and the puncture site is covered by an adhesive bandage.

Patients can perform most light normal activities immediately following the procedure. A course of physical therapy (PT) beginning 1-2 weeks after the procedure is recommended.

Thoracic AccuraScope Procedure Benefits

›› Performed with a needle—no incision or stitches— decreased risk of infection.

›› Multiple levels, one procedure—other surgical techniques require multiple procedures, charged individually.

›› Superior diagnostics with dye injection—greater

accuracy than an MRI alone to confirm the disc level(s) treated are the ones actually responsible for the pain.

›› Rapid recovery—patients start PT more quickly, with faster recovery. Compare with open procedures requiring months of rehabilitation.

AccuraScope Procedure for Lower Back Pain ®

AccuraScope Procedure The AccuraScope procedure is an advanced minimally invasive procedure used to both diagnose and treat inter-vertebral lumbar discs, spinal stenosis, and many other causes of chronic back pain.

Using a live x-ray for guidance and a tiny incision, our partner physicians insert an endoscopic fiber-optic scope, the size of a coffee straw, through a small incision in the skin and into a natural opening at the base of the spine.

The physician examines the inside of the spinal canal and the discs of the lower back from both sides of the spinal canal, to identify any tears, ruptures, herniations, bulges, scar tissues or other abnormalities. He or she identifies inflammation and diagnoses the pain source in real time.

The physician then uses a number of instruments, including a laser, to shrink the damaged disc(s) or scar tissue, or treat the spinal stenosis, and relieve pressure on the spinal nerve(s).

This mild spine procedure is usually completed in 30 to 40 minutes, and many patients experience immediate relief.

Patients are returned to the recovery area and are usually discharged approximately one hour after the surgery. Patients typically walk the same day of their AccuraScope procedure, and many can resume normal activities the following day. Most patients return to work in under a week.

North American Spine has more than 8,000 successful AccuraScope patient stories.

North American Spine is the world’s sole provider of the AccuraScope procedures.

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North American Spine

The Leader in Minimally Invasive Spine Care

AccuraScope Procedure Benefits

›› Diagnosis of the cause/source of the pain ›› Earlier treatment ›› Less chance for recurrence ›› Treat multiple levels of the lumbar spine with a single incision, significantly reducing the need for multiple procedures

In layman’s terms, the primary difference between AccuraScope and t raditional laserscopic procedures is that the AccuraScope procedure allows the tiny endoscope to maneuver up and down the lower spine. This allows the physician to pinpoint and treat pain causes along the entire lumbar spine (L1-L5). No one else can treat multiple levels in a single procedure.

North American Spine’s advanced AccuraScope procedure takes traditional endoscopic spinal surgery to a whole new level by offering an even less invasive surgery, as well as multiple levels of diagnosis and repair during ONE procedure.

Traditional minimally invasive procedures enter at the specific spot suspected to be the source of pain, and can only explore one vertebrae section at a time; so if a patient has problems at m ultiple levels then they will likely require multiple surgeries. The following chart provides a comparison of the AccuraScope procedures in relation to other types of minimally invasive surgeries as well as traditional spine surgeries.

Comparison Chart: AccuraScope Procedure

Other Minimally Invasive Surgery

Traditional Spine Surgery

Success

Extremely High

Moderate

Variable

Diagnostic Value

Extremely High

None

None

Very Low

Low

Moderate

Risk Recovery

A Few Days

Weeks

Months

Negative Result

Minimal Risk

Minimal Risk

Significant Risk

Tissue Damage

None

Moderate to Significant

Extensive

Light Sedation

Variable

General

$15,000 - $39,500

$30,000 - $75,000

$60,000 - $200,000

Anesthesia Cost

North American Spine

The Leader in Minimally Invasive Spine Care

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AccuraScope Procedure Cost Analysis ®

Recent Study Reveals Cost-Savings Benefits of the AccuraScope Procedure To evaluate the benefits of the AccuraScope procedure, researchers surveyed individuals randomly selected from a group of back pain sufferers who had undergone the minimally invasive procedure between July 2010 and January 2011. Respondents were 37 to 74 years old, with an average age of 56.

Respondents reported, on average, the following results one year after the procedure: Medical Costs

›› 74% decrease in total costs associated with medical appointments, treatments and tests traditionally used to treat low back pain (even with the cost of the AccuraScope procedure factored in)

›› Those with previous failed

back surgeries reported similar successful results compared to those with no previous back surgery

Quality of Life

70 65% % 61

% DECREASE in pain*

DECREASE in annual medical visits for back pain, from 32 to 12** USE FEWER or no prescription pain medications

*According to the Visual Analogue Score (VAS) **Includes all back pain-related visits, including doctor visits, chiropractic visits, x-rays, other scans, massage therapy, and injections.

Average projected savings on out-of-pocket medical expenses after the AccuraScope procedure

›› 1 year after surgery: $3,308 ›› 3 years after surgery: $13,114 ›› 5 years after surgery: $23,190

About the Survey Group

61% 45%

Were male

Had undergone a prior lumbar procedure

NAS Research Abstracts

Many groups that talk about minimally invasive procedures have little to no clinical research to back up their claims.

The minimally invasive spine surgery experts working with North American Spine practice the most conservative, least invasive medicine possible to achieve superior results. They use an evidence-based approach that is specially tailored to the symptoms and pathology of each individual patient.

Independent, peer-reviewed research is a cornerstone of evidence-based medicine. These abstracts provide a sample of such research.

Journal of Neurosurgical Review Current Trends in Minimally Invasive Spinal Surgery Authors: Erich O. Richter, Marina V. Abramova, & Jason C. Mussell Abstract The past 30 years has seen a dramatic expansion in the technologies available to practitioners of interventional pain management for the spine. This survey article spans the historical development from spinal decompression and fixation techniques to the most recent endoscopic and laser based therapies. This review is based on the six basic mechanisms for reducing pain of spinal origin: 1) anti-inflammatory/analgesic; 2) lysis of scar/detethering; 3) decompression; 4) arthrodesis/fixation; 5) neural ablation; and 6) neuromodulation. Multiple therapeutic modalities are summarized in each of these domains including: intradiscal electrothermy, epiduroscopy with laser ablation, percutaneous or endoscopic instrumentation and arthrodesis, vertebral augmentation, interspinous process decompression, percutaneous removal of the ligamentum flavum, intrathecal medication infusion, and spinal cord or peripheral nerve neuromodulation. Intracranial pain techniques are beyond the scope of this article. Each technique is addressed from the standpoints of basic concepts and anatomy, as well as efficacy and complications.

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The Leader in Minimally Invasive Spine Care

European Journal of Pain Supplements Anterior epiduroscopic neural decompression: Eight-center experience in 154 patients Authors: Erich O. Richter, Marina V. Abramova, Fernando Cantu, Jose DeAndres, Peter Lierz, PierLuigi Manchiaro, Jean-Pierre Van Buyten, Jae-Do Kim, Jae-Ho Jang, Gu-Hee Jung, Ji-Youn Kim, Su-Jin Jang, Hector Salgado, Peter Salgado, Kenneth M. Alò Abstract In recent years, technical advances have allowed more significant structural spine surgery through small access portals.

Minimally invasive spinal surgery (MISS) is commonly thought of as posterior approaches using muscle dilating tubular retraction systems, but these approaches are best suited to a single spinal level and require bony disruption at each level treated.

Access through the sacral hiatus with a flexible endoscope allows an alternative, longitudinal approach to the entire lumbar epidural space. Surgical instruments can be introduced through the endoscope, including laser waveguide fibers. In this article, we expand upon previous reports and describe the combined clinical results of endoscopic laser decompression in 154 patients from 8 centers. All cases of anterior endoscopic neural decompression via sacral laminotomy between December 2009 and May 2011 were reviewed at participating centers and sent a follow-up questionnaire. One hundred and fifty-four cases were identified. There was a significant improvement in disability caused by low-back and/or leg pain as measured by the RMQ. The postoperative level of pain improved from 7.5 to 3.4. By the MacNab scale, success was achieved in 82%. Overall, the patients demonstrated significant clinical recovery and improvement in both quality of life and overall pain levels. 2011 European Federation of International Association for the Study of Pain Chapters. Published by Elsevier Ltd. All rights reserved.

Journal of Neurosurgical Review Epiduroscopic Laser Disc and Neural Decompression

Journal of Neurosurgical Review Minimally Invasive Lumbar Decompression for Spinal Stenosis

Authors: Jae-Do Kim, Jae-Ho Jang, Gu-Hee Jung, Ji-Youn Kim, & Su-Jin Jang

Authors: Timothy R. Deer, Nagy Mekhail, Gabriel Lopez, & Kasra Amirdelfan

Abstract This study sought to evaluate the effectiveness of epiduroscopic disc and neural decompression with laser to epiduroscopic neural decompression alone, among patients with chronic refractory low-back and/ or leg pain. A total of 109 patients with chronic low-back and/or leg pain were operated on epiduroscopically, with or without the addition of laser-based disc and neural decompression. Eleven patients were excluded because they had not yet met the minimum 6-month follow-up period criterion. The clinical outcomes of 20 epiduroscopic neural decompression (END) patients, and 78 epiduroscopic laser disc and neural decompression (ELND) patients were evaluated during a follow-up period. Outcomes were evaluated using the visual analog scale (VAS) for back and leg pain, the Roland Morris Disability Questionnaire (RMDQ), and MacNab criteria. Among END patients, the mean back and/or leg pain VAS score improved from 8.5 to 4.6 one month after the operation. For ELND patients, the mean back and/or leg pain VAS score improved from 7.6 to 4.9 one month after the operation. The long-term END follow-up patients reported mean back and/or leg pain VAS score change from the initial 8.5 to 6.1, and for ELND patients from the initial 7.6 to 3.6. Mean RMDQ scores improved from 11.3 to 9.6 with END, and from 18.8 to 11.4 with ELND during the 1-month follow-up period. However, in the long-term follow-up data, the mean RMDQ score worsened from initial means of 11.3 to 11.4 for END patients but continued to improve from the one month mean of 11.4 to 10.6 for ELND. Results using the MacNab criteria were positive in 82% of the ELND group compared to 45% with the END group. Eighty-two percent of the patients treated with ELND (laser disc and neural decompression) reported positive treatment results as opposed to 45% receiving END alone (non-laser neural decompression). Thus ELND, with its considerably higher percentage of positive outcomes, is judged to be a more effective therapeutic modality for patients with chronic refractory LBP.

Abstract Over 1.2 million patients are diagnosed with, and in active treatment for lumbar spinal stenosis (LSS) at any given time. Typically, these patients experience discomfort while walking or standing, for any length of time. The LSS treatment algorithm contains a gap of undertreated patients between epidural steroid injections (ESI) and open surgery. With the introduction of a minimally invasive lumbar decompression, or mild®, procedure (Vertos Medical) for spinal stenosis, the LSS patient no longer needs to suffer under-treatment or undergo major lumbar surgery. Mild® makes it possible to address this progressive disease with a progressive option.

Journal of Neurosurgical Review

If you are interested in learning more, please contact your patient coordinator for full articles or additional research related to your diagnosis.

AccuraScope Procedure Typical Patient Experience ®

When you are in constant back or neck pain, it’s difficult to enjoy life. Let us show you the easy path to find the best treatment for your pain.

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TALK TO A PATIENT COORDINATOR You will be assigned one of our friendly and knowledgeable patient coordinators to help you through your journey to pain relief. They will first discuss your symptoms, diagnosis, treatment and medical history to fully understand your case. They will also answer any of your questions and help to take the mystery out of the process.

80

%

of a doctor’s diagnosis comes from your history, not from medical tests1

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Communication is a critical part of the treatment process. 75% of doctors think they communicate enough. Only 21% of patients agree.2 Our patient coordinators will be here to help every step of the way.

Misdiagnosis of chronic pain from an MRI is very common. A free second opinion is one of the best investments you can make for your spine. Our highly specialized medical staff will review your MRI report and in many cases, the original films, to provide the most accurate second opinion possible.

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810 of

MRI scan

:::::::::: evaluations can miss the source of chronic pain3

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SEND YOUR MRI FOR A FREE REVIEW

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DISCUSS YOUR MRI REVIEW RESULTS WITH YOUR PATIENT COORDINATOR Your patient coordinator will call you to discuss your diagnosis, and will let you know if you are a candidate for the AccuraScope procedure.

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10

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of

MRIs submitted show conditions the AccuraScope® procedure can treat

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Your patient coordinator will check your procedure cost and insurance coverage for you. Simply take a picture of your insurance card and email it. You will receive a clear estimate of your out-of-pocket expenses. The AccuraScope® procedure is covered by most major insurance plans, and North American Spine provides many financing options.

23,190

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$

the amount the average AccuraScope patient saves over 5 years by reducing doctor visits, medication, and other related costs

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REVIEW YOUR INSURANCE, COST AND FINANCING OPTIONS

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SCHEDULE YOUR PROCEDURE AND TRAVEL PLANS The finish line is in sight—now just schedule your outpatient procedure! Once your schedule is confirmed, you can select a friend to travel with you, and book a flight and hotel. We partner with select hotels to provide an affordable, convenient, and high quality experience.

:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: PROCEDURE EVENTS

Day 1

Day 2

Day 3

Complete pre-clearance testing and pre-op appointment

Undergo the AccuraScope outpatient procedure

Attend a post-op appointment and receive care instructions

Meet your North American Spine doctor face-to-face and discuss remaining questions. Following your pre-surgery clearance (medical testing), you may undergo diagnostic pain mapping to confirm your pain source(s) prior to the AccuraScope procedure.

You will arrive at the surgical facility where staff will assist you in preparing for the procedure.

You will be placed under light general sedation and the AccuraScope procedure will be performed—typically in 30–45 minutes or less! Soon you will be up and walking, and will return to your hotel room.

The day after the AccuraScope procedure, you will visit your North American Spine doctor for a post-op evaluation. Rest, relax, and follow the instructions you are given. You’re on your way home!

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OUR GOAL: ONE TRIP, ONE PROCEDURE. ::::::::::::::::::::::::::::::::::::

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We feel our patients are our family, so we call often! We will contact you to see how you’re doing at week one, week two, one month, three months, six months, one year, and by the third year after your procedure.

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FOLLOW UP

Because North American Spine physicians can treat causes of chronic pain at multiple levels of the spine in one outpatient procedure, our goal is for you to visit only once—unlike other providers, who may expect you to schedule multiple trips.

ONE PROCEDURE

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Partner Physicians

Dr. Kenneth Alò Board Certification: Pain Medicine A recognized leader in his field, Dr. Alò manages a thriving practice, is the Director of the Section of Neuro-Cardiology at the Institute of Cardiology and Vascular Medicine at Monterrey Technical University, and participates in clinical research.

Dr. Abram Burgher

Board Certification: Anesthesiology and Pain Management In addition to his clinical practice, Dr. Burgher is dedicated to innovation in the field of pain management.

As such, Dr. Burgher serves as a clinical investigator and Director of Investigator Relations at the HOPE Research Institute, as well as Vice President for Clinical Innovations at a medical technological innovations organization that he co-founded.

Dr. Stanley Golovac

Board Certification: Anesthesiology and Pain Management Dr. Golovac is a Diplomate of the American Board of Anesthesiology and the Board of Pain Management.

He completed his education at UTESA University, and has gained extensive clinical experience in anesthesiology, emergency room medicine, and alternative services.

Dr. Alfredo Marti

Board Certification: Anesthesiology and Pain Management Dr. Marti attended the University of Miami for his undergraduate studies and went on to earn his medical degree from the University of Miami School of Medicine in 1982. Dr. Marti then completed his internship at Mount Sinai Medical Center and his residency in anesthesiology at Jackson Memorial Hospital in Miami, Florida.

Dr. Michael McKee

Board Certification: Pain Management Dr. McKee is a Diplomate of the American Academy of Pain Management and serves as the Chief of Pain Management at several hospitals. Bilingual in English and Spanish, Dr. McKee has served patients for more than 17 years and has experience as an associate professor and postdoctoral research fellow.

Dr. Damon Noto

Board Certification: Pain Management and Rehabilitation Dr. Noto combines a pursuit for the best and latest treatment techniques with a philosophy that a patient is much more than a set of symptoms. He was awarded the 2012 Patient Choice Award for his compassionate approach to his patients.

Dr. Rudolfo Panganiban

Board Certification: Pain Management and Rehabilitation and Pain Medicine Dr. Panganiban has been a partner with Comprehensive Pain Management Partners, one of Tampa Bay’s premier pain management practices. Additionally, Dr. Panganiban serves as Medical Director of Pain Management, Musculoskeletal Medicine and Rehabilitation at the Morton Plant Mease Outpatient Surgery Center.

Dr. Matt Ranson

Board Certification: Anesthesiology and Pain Management Dr. Ranson specializes in anesthesiology, interventional pain medicine, and surgical pain procedures.

Dr. Ranson attended West Virginia University and finished his anesthesiology training at Ohio State University. Dr. Ranson has also authored several articles on neuromodulation, including a volume in the new Interventional and Neuromodulatory Techniques for Pain Management series.

Dr. Vladimir Redko

Board Certification: Pain Management In practice for more than 40 years, Dr. Redko provides his patients with exceptional post-operative follow-up care and approach to pain treatment, including use of spinal cord stimulation, for which he has also published research.

Dr. Darren Schuhmacher

Board Certification: Pain Management Dr. Schuhmacher is a third-generation physician who is dedicated to helping individuals struggling with chronic pain, using a comprehensive array of interventional pain management therapies and treatments.

He was named one of D Magazine’s “Best Pain Management Physicians” in 2011.

Dr. Kelly Will

Board Certification: Pain Medicine and Anesthesiology Dr. Will has been in pain management private practice since 1989, where he has performed innovative treatments tailored to each patient. He was named one of the "Best Doctors in Dallas" by D Magazine in 2009 and 2010.

Dr. Jason A. Williams

Board Certification: Anesthesiology Dr. Williams helps patients with a wide range of pain management interventions ranging from spinal injections to the AccuraScope® procedure. He has been recognized for being at the top of his class throughout his education and has gained extensive experience.

Dr. Jeffrey Wingate

Board Certification: Orthopedic Surgery Dr. Wingate is board certified in orthopedic surgery and is a member of the American Academy of Orthopedic Surgeons. He has been designated the Chief of Surgery and Chief of Spine Surgery at multiple hospitals during his career, and has played an active role in lecturing across the medical community. With well over 10 publications and numerous research projects, Dr. Wingate is considered an authority in orthopedics and a leader in the medical community.

Patient Coordinators Our friendly patient coordinators will help find the solution that is best for you. They will hold your hand and help you do your homework, taking the mystery out of what can be a confusing and complicated process.

If you had a cousin who was a nurse and understood the intricacies of the healthcare world, a friend you could call anytime—this is the kind of resource your patient coordinator will be. Your patient coordinator will:

›› Conduct a thorough case review, asking detailed questions about your symptoms and medical history

›› Guide you through a complimentary review of your MRI

›› Assist you with insurance coverage questions ›› Help you to schedule your travel and surgery ›› Answer all of your questions along the way

Ally

Drew

Ally

Amie

Jessica

Ellie

Alison

Rayne

Shelby

Holly

Ashley

Leigh

Diane

Bridget

Ashleen

Cristi

Katie

Darby

North American Spine

The Leader in Minimally Invasive Spine Care

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Our Locations

Forest Park Medical Center Dallas, Texas Forest Park Medical Center is a new, state-of-the-art medical facility. With unsurpassed service, exemplary care and the highest quality medical environment, prepare to have your expectations exceeded. From staff to technology and techniques, Forest Park brings together the best of the best in one top-notch, full-service acute care hospital.

Located just a few minutes north of Downtown Dallas, Forest Park is near some of the finest dining, entertainment, and attractions that Texas has to offer.

This facility has been listed as one of the 25 most beautiful hospitals in the world, ranking over a tremendous number of large and small hospitals.

With luxurious patient rooms, the latest technology and staffing, Forest Park is dedicated to providing a convenient and comfortable experience for patients and their families.

Address: 11990 N. Central Expressway Dallas, TX 75243

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North American Spine

The Leader in Minimally Invasive Spine Care

Our Locations

Freedom Pain Hospital Scottsdale, Arizona Freedom Pain Hospital (FPH) is the first licensed specialty hospital in the country dedicated to patients suffering with issues and conditions related to pain. We welcome chronic pain patients with all varieties of pain syndromes, worker's comp related injuries, personal injury patients, and patients requiring medication management, and reduction or discontinuation of pain medications. Our mission is to compassionately offer our patients therapies and treatments targeted at providing them with pain relief, as well as an improved level of functioning and overall quality of life.

Freedom Pain Hospital is unlike any other hospital in existence. Rather than see one doctor for your evaluation, diagnosis, and treatment plan, you will meet with several specialists and clinicians who work in concert to create a treatment plan that is customized for you and based on your evaluation and diagnosis.

You may see a combination of physicians, therapists, specialists, and clinicians based on your primary pain complaint. Imaging, labs, and ancillary services are all on-site, making your visit as seamless as possible.

We understand and respect that your time is valuable, and in an effort to help chronic pain patients gain a higher level of functioning and increased quality of life as quickly as possible, we work efficiently through the evaluation, diagnosis, and implementation of your treatment plan.

As a patient, you are considered a part of the Freedom family, and will be treated as such. Your experience with us will be of the highest level of care, compassion, and empathy, and you will leave us with a wellness-oriented lifestyle in your grasp.

Address: 17500 N. Perimeter Drive Scottsdale, AZ 85255

North American Spine

The Leader in Minimally Invasive Spine Care

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Our Locations

Victory Medical Center

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Welcome to a higher level of health care.

The Victory difference.

For most of us, the need for medical care is a reality and necessity of modern life. What distinguishes Victory Medical Centers from other hospitals is an almost unheard of dedication to excellence on a patient-by-patient basis. Health of mind, body, and spirit has received thoughtful consideration. The result … plush, all-private, oversized patient suites, gourmet food, 1:1 nurse to patient ratio, and a facility with first-class feel that relaxes and soothes.

Even a beautiful environment is no substitute for top-notch medical care. At Victory Medical Center, we have the privilege of offering both. Our physicians and surgeons—some of the top in this region as well as nationally—were drawn here by the opportunity to provide stellar care. They utilize the latest diagnostic techniques, state-of-the-art technology, and minimally invasive treatment protocols within our advanced surgical suites in an ongoing commitment to excellence. A highly-trained and talented clinical staff partners in this innovative process.

Houston

Plano

2001 Hermann Drive Houston, TX 77004

2301 Marsh Lane Plano, TX 75093

North American Spine

The Leader in Minimally Invasive Spine Care

Philosophy

The future of care in Texas.

Healing of the body does not arise from of a singular source. Rather, medical excellence in the truest sense takes into account confidence in the care provided, comfort in surroundings, open communication and attentiveness that can best be compared to the concern afforded by a family member.

Victory Medical Centers are a part of a growing network of specialized surgical hospitals throughout Texas. Our modern, comfortable hospitals include oversized surgical suites, special procedure rooms and private inpatient suites. Each suite features complimentary wi-fi Internet, a flat-screen television, made-to-order gourmet meals and ample room for family and other visitors.

Creating the Standard in Surgical Care.

San Antonio - Landmark

Mid Cities

5330 N. Loop 1604 West San Antonio, TX 78258

1612 Hurst Town Center Drive Hurst, TX 76054

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The Leader in Minimally Invasive Spine Care

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Our Locations

Hackensack Surgery Center Hackensack, New Jersey Hackensack Surgery Center (HSC) is a premier New Jersey State licensed facility. It is fully accredited by the Accreditation Association for Ambulatory Health Care and has established a reputation as a leader in minimally invasive same-day surgery.

HSC offers three state-of-the-art o perating rooms, each equipped with the latest technology. Its experienced staff adheres to the highest professional standards. All nurses are state licensed RNs, certified in Basic Life Support or Advanced Cardiac Life Support, with years of experience in ambulatory care.

The medical staff at this facility is an alliance of physicians, regarded as “top docs” by their peers. Each physician has made a personal commitment to ensuring your safety and comfort during your stay.

Address: 19 Kotte Place Hackensack, NJ 07601

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North American Spine

The Leader in Minimally Invasive Spine Care

Our Locations

Michigan Surgical Hospital Detroit, Michigan Michigan Surgical Hospital is dedicated to providing a personal, specialized experience for all patients. As a physician-owned hospital, the staff is proud to provide individualized attention to each patient.

The facility offers surgical services, specialty clinics, medical admissions, community screenings, radiology, lab services, and patient transportation services.

The hospital’s three operating rooms feature state-ofthe-art equipment. The surgical specialists and the highly-trained staff are known for their efficiency of care and quality outcomes.

Address 21230 Dequindre Road Warren, MI 48091

North American Spine

The Leader in Minimally Invasive Spine Care

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Our Locations

New Tampa Surgery Center Wesley Chapel, Florida The modern New Tampa Surgery Center is designed to provide the best in surgical care in a comfortable, relaxed atmosphere that offers the latest in technology. The state-of-the-art medical facility is conveniently located off Interstate 75 and State Road 56 in Wesley Chapel.

The surgical specialists at New Tampa Surgery Center are experts in their fields and the highlytrained staff is known for their efficiency of care and quality outcomes. New Tampa Surgery Center is equipped with two highly-advanced operating rooms and two procedure rooms.

Address 2407 Cypress Ridge Blvd Wesley Chapel, FL 33544

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North American Spine

The Leader in Minimally Invasive Spine Care

Space Coast Surgery Center Merritt Island/Orlando, Florida The Space Coast Surgery Center is specially designed and staffed as an elective outpatient or ambulatory surgical treatment center. The modern facility stands for the best in surgical care.

Space Coast Surgery Center continually invests in the latest surgical and diagnostic technology, and has been a pioneer in performing complex surgical procedures in the outpatient setting. Patients can expect beautifully appointed patient areas, service oriented staff, and a convenient location just off exit 49 on FL-528, Courtenay Parkway.

Address 595 N. Courtenay Parkway, Suite 103 Merritt Island, FL 32953

North American Spine

The Leader in Minimally Invasive Spine Care

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Our Locations

River Oaks Surgical Center Houston, Texas River Oaks Surgical Center is conveniently located near the River Oaks area of Houston, TX and features five operating rooms along with two procedure rooms. The facility was designed with the highest quality of patient care in mind, and is why top physicians choose River Oaks Surgical Center for their patients.

This facility has received multiple awards and has an excellent reputation in the community, along with a stable and committed group of dedicated surgeons.

Address: 4120 Southwest Fwy, Suite 100 Houston, TX 77027

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North American Spine

The Leader in Minimally Invasive Spine Care

Hospital for Surgical Excellence of OakBend Medical Center Sugar Land, Texas The Hospital for Surgical Excellence is a member of the OakBend Medical Center, the largest full service healthcare facility in Fort Bend County just outside Houston, TX. The Hospital’s mission is to provide high quality healthcare for every patient. Board certified physicians at the Hospital for Surgical Excellence of OakBend have access to advanced diagnostic tools and the latest technology.

The Hospital for Surgical Excellence has six stateof-the-art operating rooms and a robust professional staff who places emphasis on exceptional one-on-one patient experiences and personal care.

Address 1211 Highway 6, Suite 70 Sugar Land, TX 77478

North American Spine

The Leader in Minimally Invasive Spine Care

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Hotel Partners

North American Spine is proud to provide a high quality experience for each patient, starting with the first phone call and continuing as a relationship long after the procedure.

We have carefully selected hotels to provide a comfortable environment, superior service and convenient location for our out-of-town patients.

Each of our locations provides a range of attractions, shopping opportunities and fine dining – allowing you to turn your procedure into an enjoyable, and potentially life-changing trip. Below are examples of accommodations in each location.

Dallas:

Houston:

San Antonio:

Residence Inn by Marriott – Dallas Park Central

Courtyard by Marriott Houston West University

Homewood Suites by Hilton San Antonio

7642 LBJ Freeway Dallas, TX 75251 972-503-1333

2929 Westpark Drive Houston, TX 77005 713-661-5669

432 W. Market Street San Antonio, TX 78205 210-222-1515

Enjoy a spacious suite with a fullyequipped kitchen, living room and work space with free Wi-Fi. The hotel also offers complimentary breakfast, light evening dinner with beer and wine, and shuttle service. Special North American Spine rate available.

The property is within walking distance of several restaurants and provides complimentary shuttle service within three miles of the hotel. Special North American Spine rate available.

Situated on the famous River Walk, this suite-style hotel provides each guest a unique lodging experience.

Lounge in suites with a separate bedroom, fully-equipped kitchen, and living area. The hotel also features a rooftop pool and fitness center, as well as a complimentary breakfast buffet.

Hackensack:

Phoenix:

Orlando:

Crowne Plaza Englewood

Sleep Inn at North Scottsdale Road

Clarion Hotel Port Canaveral Area

401 S. Van Brunt Street Englewood, NJ 07631 201-871-7116

16630 North Scottsdale Road Scottsdale, AZ 85254 480-998-9211

260 E. Merritt Island Cswy Merritt Island, FL 32952 877-424-6423

The 3.5-star hotel provides easy access to airports and all major highways in New Jersey and nearby Manhattan. Guests may enjoy an indoor pool, a spa tub and fitness facility. Wireless Internet access is complimentary in public areas.

Tampa:

Hampton Inn & Suites Tampa – Wesley Chapel 2740 Cypress Ridge Blvd Wesley Chapel, FL 33544 813-973-2288 With its convenient location, less than a mile from New Tampa Surgery Center, this highly rated hotel offers spacious guest rooms and suites as well as complimentary breakfast each morning. Special North American Spine rate available.

In addition to a convenient location, this newly-renovated hotel offers spacious guest rooms with refrigerators, microwaves and coffee makers. Guests will enjoy a complimentary hot breakfast buffet, 24-hour shuttle service, and an outdoor heated pool and Jacuzzi.

Special North American Spine rate available.

Detroit:

Westin Southfield Detroit 1500 Town Center Southfield, MI 48075 248-827-4000

Guests will enjoy sizable guest rooms, complimentary breakfast, Wi-Fi and newspaper, as well as an outdoor pool and relaxing patio area. Special North American Spine rate available.

We will provide additional hotel and travel details when you schedule your procedure.

You can find additional information about location attractions, hotel amenities and transportation at www.northamericanspine.com/locations.

Escape to the quiet suburbs of Detroit and enjoy the relaxing atmosphere at the Westin Southfield. Each luxurious guest room features the Westin Heavenly® Bed and Heavenly® bath products.

North American Spine

The Leader in Minimally Invasive Spine Care

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Feedback From Our Patients …

Curtis C.

Ke ll y K .

Kelly K. | Pennsylvania

Curtis C. | North Carolina

Diagnosis: Cervical Radiculopathy, Herniated Disc C5-6 and C6-7, Herniated Lumbar Disc L4-5

Diagnosis: Disc Bulges L3-S (Sciatica)

I was in a car accident on December 28, 2010. For the next six months, I would go to various doctors and physical therapists to determine what could be done for me. I felt like my life, as I knew it, was over.

I called North American Spine, sent them my MRI written documents and they called me back. Over the next month, they said I was a good candidate and they would do the rest.

My health insurance covered all but a portion and we borrowed the rest from family and friends.

On June 12, 2011, my husband, my daughter and myself flew out to Dallas, Texas and started on a journey of healing and recovery. Each day brings new things that I can now do again.

Thank you from the bottom of my walking feet and from the family that gets to see me laugh and smile again!

I tried all of the treatments that the doctors recommended, from conventional to alternative. I suffered through the pain for the first few months, but as it got progressively worse, I was in constant pain.

As soon as I woke up in the recovery room, the sciatic pain was gone. Since the surgery, I’ve not felt any of the same sciatic pain that had become a part of my life for the previous year.

The recovery time was remarkably short. Within a week, I began physical therapy to build my back and core muscles I had lost in my time down.

Thanks to this revolutionary procedure and the fantastic doctors and staff at North American Spine, I went surfing again for the first time since my injury. I’m happy to report that there was no pain. I can play with my five-year-old son again without telling him that I can’t because it hurts. That means everything in the world to me. It’s great being able to participate in my own life again.

Bruce T.

Annette B. Annette B. | Arkansas

Bruce T. | Indiana

Diagnosis: Cervical Herniated Disc

Diagnosis: Herniated Disc L5/S1 with Involvement of the Nerve

Chronic neck pain was intense affecting sleep, normal activities, and work. A retractable tubular procedure performed in Florida one year previously had failed to relieve the pain. I was constantly pulling down on my shoulder muscles with my hand to relieve the pressure.

I could not lift my granddaughters, play golf, or ride comfortably in a car. Working at my computer made the pain more intense.

The pain began in Sept ’09, about eight months before my procedure. Initially it wasn’t so bad and I thought I could just do some stretching and make it better. But it progressively worsened to the point that I got an MRI that December showing the bulging disk.

It took about three months for all the pain to completely disappear and it did so gradually. I am now able to do all the things I could not do before the procedure. I sleep well at night and am ready to play my first round of golf.

I just completed a Christmas album that I recorded in Nashville and I know I could not have done it without relief from the chronic pain I was in! Thank you North American Spine!

I did physical therapy which helped a little and tried epidural injections which would help for a few days to up to two weeks, but the pain came back.

For me there was a sudden relief of pain within a day of the procedure to about 30% of the pre-operation levels.

Sometime in the last three months or so the pain totally left. I haven’t taken a Tylenol or anti-inflammatory for months now and don’t feel restricted in any way. I’m an ER doctor. I see people with back pain all the time. I wish everyone I see could go to Dallas and get this done. It’s been a 100% cure. Thank you very much.

This procedure may not be suitable for every patient. All patients must be evaluated by a physician as to the appropriateness of performing the procedure. The above testimonial(s) represents the individual’s response and reaction to the procedure; however, no medical procedure is risk-free. Associated potential risks and complications should be discussed with the physician rendering this procedure. There are no promises, assurances or guarantees as to the results that may be obtained from any medical treatment or services. AccuraScope is a registered trademark of Athas Health, LLC. Tylenol is a registered trademark of McNeil Consumer Healthcare, a Division of McNeil PPC.

Notes

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North American Spine

The Leader in Minimally Invasive Spine Care

Notes

North American Spine

The Leader in Minimally Invasive Spine Care

35

Notes

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North American Spine

The Leader in Minimally Invasive Spine Care

“Low Back Pain Fact Sheet.” National Institute of Neurological Disorders and Stroke. Retrieved from: http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm “What Is Back Pain?” National Institute of Arthritis and Musculoskeletal and Skin Diseases. September 2009.

Retrieved from: http://www.niams.nih.gov/health_info/Back_Pain/back_pain_ff.asp 1 “Up to 80 percent of a doctor’s determination comes from your history, not from tests done the day you’re in the office.”

Marie Savard, M.D. Quoted in Landau, MD, “Medical mystery: when you can’t get a diagnosis.”

MORE Magazine: For women of style & substance. Retrieved online at http://www.more.com/medical-mystery-diagnosis 2 Fong Ha J, Longnecker N. Doctor-Patient Communication: A Review. Ochsner J. 2010 Spring; 10(1): 38–43.

Retrieved online from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096184/.

75% of the orthopedic surgeons surveyed believed that they communicated satisfactorily with their patients, but only 21% of the patients reported satisfactory communication with their doctors.

3

Sandhu HS, Sanchez-Caso LP, Parvataneni HK, Cammisa FP Jr, Girardi FP, Ghelman B., Association between findings of provocative discography and vertebral endplate signal changes as seen on MRI., J Spinal Disord., Oct;13(5):438-43, 2000. A study of 53 patients with severe back pain had MRI evaluations with no source of pain identified; 41 of these had chronic pain confirmed through a provocative discogram, indicating 78% false negative MRI evaluation. Retrieved online from http://www.diagnosemypain.com/questions.html

Stock images by: © Can Stock Photo Inc.

North American Spine

The Leader in Minimally Invasive Spine Care

North American Spine 10740 North Central Expressway, Suite 275 Dallas, TX 75231 877.474.2225 | 214.261.3600 | northamericanspine.com NAS-WELKIT01