Guide to Minimally Invasive Spine Surgery

Guide to Minimally Invasive Spine Surgery

Table of contents Message from the CEO 02 About minimally invasive spine surgery 03 Why choose Laser Spine Institute? 05 Is minimally invasive spine surgery right for you? 06 Streamlined patient experience 07 State-of-the-art facilities 08 Meet our surgeons 09 Patient stories 12 Frequently asked questions 13 1

Message from Chief Executive Officer Bill Horne Like many of you, I have lived with chronic pain. I had been an active and athletic person, but then a neck injury began taking a toll on my daily activities. It was affecting my work as well as my personal life. I had neck and shoulder pain that radiated down my arm and created the sensation of an electric charge as well as a loss of feeling in my fingers, pain that progressively worsened over a nine-month period. I did everything I could to alleviate my pain, short of a surgical procedure, including physical therapy, electrical stimulation, ultrasound, traction and epidural steroid injections, but they were only temporary fixes. I received the same diagnosis and treatment after meeting with four different surgeons. They wanted to take a bone out of my hip, cut the front of my neck 6 inches, fuse the bone to the vertebrae and place a steel plate and six screws to hold everything in place. Although this major procedure seemed terrifying, I felt that it was my only hope and I needed to book the surgery. Luckily, about one week before my surgery date, I met a friend for lunch and he told me about a spine procedure that his wife had just gone through that had provided significant improvement. I found out that it was Dr. James St. Louis who performed the procedure, and I canceled my previous surgical date immediately. I met with Dr. St. Louis who diagnosed my three herniated discs that were impinging on the nerve and causing most of my pain. When the surgery was complete, I could feel relief in the operating room. I walked a mile that evening and returned to work and all my usual daily activities much quicker than I could ve imagined. Years later, I am able to enjoy traveling, spending time with my wife and children, and playing many rounds of golf. I was so impressed with this minimally invasive spine procedure that I became a managing partner for Laser Spine Institute. As the CEO and walking testimonial for Laser Spine Institute, I want to spread the word about minimally invasive spine surgery and share my story with potential patients all over the world. Laser Spine Institute offers a state-of-the-art medical destination with five-star amenities for those who suffer from neck and back pain. Congratulations on taking the next step toward finding pain relief! 2

About minimally invasive spine surgery Laser Spine Institute s minimally invasive procedures are the safe and effective alternative to open neck or back surgery. Each month, more people come to Laser Spine Institute to relieve their neck and back pain than to any other spine surgery provider in the nation. Advantages of our minimally invasive spine surgery: Outpatient procedure Board-certified surgeons No lengthy recovery Less than 1-inch incision 94% patient satisfaction Providing relief for these conditions: Spinal stenosis Sciatica Herniated/bulging disc Scoliosis Arthritis of the spine Pinched nerve Bone spurs Facet disease Degenerative disc disease Foraminal stenosis Annular tear Laser Spine Institute specializes in minimally invasive procedures. Endoscopic procedures Foraminotomy To relieve pressure on nerves compressed by the intervertebral foramen. Laminotomy To relieve pressure on the spinal cord compressed by spinal stenosis. Endoscopic Discectomy To remove the portion of a herniated or bulging disc that is pressing on a nerve root or the spinal cord. Surgeons utilize X-ray monitoring and fiber-optic devices in order to see precisely what is compressing the nerve and to remove it without causing any destabilization of the spine. Facet Thermal Ablation To debride the facet joint and deaden the nerve utilizing a laser and irrigation inside a 3 millimeter tube. Minimally invasive stabilization procedures Decompression with an Interlaminar Stabilization Device This procedure helps relieve pain associated with spinal stenosis. Through a small incision, the surgeon first decompresses the affected areas eliminating the source of pain. Once the stenosis has been decompressed, he will insert the coflex device, which will help to stabilize the spine and maintain the decompression without limiting the patient s range of motion. Anterior Cervical Discectomy and Fusion (ACDF) A less invasive alternative to traditional open neck fusion to relieve neck pain weakness, and tingling associated with herniated disc or degenerative disc disease. During the ACDF procedure, the damaged disc is removed and implants are inserted to help stabilize your bones. 3

Minimally invasive stabilization procedures continued Cervical Disc Replacement A cervical disc replacement is a minimally invasive procedure in which an unhealthy vertebral disc is substituted with a new, artificial disc. Transforaminal Lumbar Interbody Fusion (TLIF) A less invasive alternative to traditional open back fusion to relieve back pain caused by spondylolisthesis, degenerative disc disease, or a herniated disc. During the TLIF procedure, the damaged disc is removed and implants are inserted to help stabilize your bones. Lateral Lumbar Interbody Fusion (LLIF) A minimally invasive spine surgery that accesses the spine through small incisions on the side of the body. This procedure avoids separating the low back muscles, cutting bone, or moving aside blood vessels as required for other spine fusion procedures. Disc treatment SI Joint Fusion A sacroiliac (SI) joint fusion is a minimally invasive procedure, where the sacrum and the pelvis are joined through a small incision. Because there is typically limited mobility in the SI joint without the procedure, most patients will not lose any range of motion. RegenaDISC An innovative and preventive treatment that offers you the chance to improve your spine health. RegenaDISC regenerates the spinal disc and promotes long-term spine health by using the patient s own cells through stem cell treatment. Laser-based vs. Laser-assisted Laser Spine Institute performs laser-based and laser-assisted procedures. Most of Laser Spine Institute s surgical procedures are not laser-based; rather they are laser-assisted. In fact, Laser Spine Institute uses a laser in its surgical procedures only about 20 percent of the time. The laser is used to deaden the nerve endings and remove impingements to help relieve painful symptoms. 4

Why choose Laser Spine Institute? Laser Spine Institute successfully performs more minimally invasive spine surgeries each month than any other spine surgery provider in the nation, setting us apart as the leader in endoscopic spine surgery. Below you will find distinguishing facts and figures about Laser Spine Institute: 1. Our dedication to minimally invasive procedures has made Laser Spine Institute the largest spine surgery center in the nation. This advantage grows every week, leading to a higher level of expertise, as Laser Spine Institute helps thousands of patients get their lives back. 2. Laser Spine Institute has built its comprehensive medical facilities to provide an integrated service within the walls of each surgery center, or by trusted service providers nearby. Provided services include: complete clinical evaluation, state-of-the-art imaging, diagnostic testing, pain management, surgery and postoperative assessment.* 3. With decades of combined experience in advanced techniques, our surgeons led by Chairman, Department of Surgery, Dr. Michael Weiss perform more minimally invasive procedures each month than any other spine surgery center in the nation. 4. More than 87 percent of patients report improvement in their quality of life within three months of having their surgery, and some patients report improvement immediately. 5. More than 60 percent of patients travel from out of state and 2 percent from outside the country seeking Laser Spine Institute s unique, expert treatment and unparalleled service. 6. More than 600 dedicated employees including 31 expert surgeons and physicians, and more than 225 medical professionals have devoted their careers exclusively to Laser Spine Institute and to ensuring delivery of our Above and Beyond service for the complete comfort of our patients and their families. Relief for patients without the complications of traditional open back surgery. Hospital stay Minimally invasive procedures None Traditional open back surgery 2 5 days Infection rate 0.10% 4.5% Complication rate 4% 31% * Some patients individual medical conditions may require additional testing that Laser Spine Institute will facilitate through a third-party service provider. 5

Is minimally invasive spine surgery right for you? The first easy step toward determining if Laser Spine Institute s minimally invasive approach is right for you is having your MRI or CT scan reviewed by one of our board-certified physicians or medical professionals. For your convenience, we offer three ways you can take advantage of this complimentary service. Review by phone The MRI Review Department reviews hundreds of cases on a daily basis delivered from around the world. Our expert physicians review MRI and CT scan films, CDs and reports to assess the prospective patient s pathology to determine if Laser Spine Institute can help. One-on-one initial medical consultation One-on-one initial consultations are available at each of our facilities. This is a unique opportunity to meet with a Laser Spine Institute medical professional to review reports, discuss pathology and symptoms, and determine if a minimally invasive procedure is the right solution for you. Medical seminar Laser Spine Institute s seminar staff works to educate those who suffer from neck and back pain. The program begins with face-to-face discussions with a physician to assess each potential patient s pathology and symptoms in order to make an initial determination about candidacy for a Laser Spine Institute procedure. Visit SpineSeminar.com to view upcoming seminars in our surgery center locations. 6

Streamlined patient experience Through our streamlined patient experience, patients receive all necessary treatments related to their spine condition in as little as one week. Receiving the highest quality of care, patients go from evaluation to recovery and return to their lives after the Laser Spine Institute experience. PAIN ARRIVE FOR SURGERY RELIEF Contact Laser Spine Institute and speak with Patient Care Coordinator Send MRI for review Discuss condition, medical history, and surgery options Speak with Medical Clearance and Scheduling DAY 1 2 Arrive at Laser Spine Institute Meet with Hospitality Associate to discuss appointments See physician to review MRI and other records Undergo physical exam and diagnostic testing* DAY 3 Preoperative and Anesthesia SURGERY Postoperative recovery DAY 4 5 Rest & Recovery in hotel or home Visit Laser Spine Institute for follow-up exam** Return home AFTER RETURN HOME FROM SURGERY Receive follow-up calls from Patient Services Meet with your primary care physician within 2 weeks Patient Services Specialist will provide continuous support and postoperative care. Laser Spine Institute Spinal Diagnostics Center Spinal Diagnostics, a division of Laser Spine Institute, was established with the primary goal of optimizing surgical outcomes by serving the preoperative needs of surgical patients. Many patients seeking treatment at Laser Spine Institute have clearly identifiable areas of anatomic compression, allowing straightforward surgical treatment decisions. However, Laser Spine Institute has found that approximately 60 percent of patients have subtle or complex MRI findings that require additional evaluation prior to receiving a surgical order. Who needs additional diagnostic testing? The most common indications that a patient would need additional diagnostic testing* are MRI findings of multilevel degenerative disc disease, producing more than one area of nerve root compression. Information provided through a diagnostic selective nerve root block can isolate the primary area of pain from a particular spinal level, allowing the surgery to be directed at the optimal site. Because of the focally decompressive nature of minimally invasive procedures, this step can be essential to the surgical order. Common diagnostic procedures performed at Laser Spine Institute are diagnostic facet injections, selective nerve root blocks, and discograms. Diagnostic procedures are performed by a physician with specialized training and experience. Our dedicated state-of-the-art procedure suite is equipped with fluoroscopic X-ray equipment to safely and accurately complete each procedure. These procedures are reserved for those patients medically cleared and scheduled for minimally invasive treatment. * Some patients individual medical conditions may require additional testing that Laser Spine Institute will facilitate through a third-party service provider. **Some patients may require an experience that exceeds five days and others may require as few as four days. Patients may be required to rest 48 hours post-surgery. 7

State-of-the-art facilities Laser Spine Institute has built its comprehensive medical facilities to provide an integrated experience where all required services are coordinated for the patient, including: complete clinical evaluation, state-of-the-art imaging, diagnostic testing, pain management, surgery and postoperative assessment. Our dedicated employees including an expert surgical team led by Chairman, Department of Surgery, Dr. Michael Weiss; esteemed medical professionals; and patient care personnel devote their professional skills exclusively to Laser Spine Institute, ensuring delivery of our Above and Beyond service for the complete comfort of our patients and their families. You will receive the best quality of care and feel comfortable in our environment. From the moment you walk in the door, our professional staff welcomes you and guides you throughout the Laser Spine Institute experience. Our commitment to advanced spine surgery has made Laser Spine Institute the largest health care provider of this technique in the nation. This advantage grows every week, leading to a higher level of expertise, as Laser Spine Institute helps thousands of patients get their lives back. Facilities 1 Houston 2 Oklahoma City 3 Philadelphia 4 Scottsdale, Ariz. 5 Tampa, Fla. 1 2 3 4 5

Meet our surgeons The surgeons at Laser Spine Institute specialize exclusively in relieving neck and back pain through minimally invasive, outpatient procedures. Our surgeons led by Chairman, Department of Surgery, Dr. Michael Weiss perform more minimally invasive procedures each month than any other spine surgery center in the nation. Michael Weiss, D.O., FAOAO Chairman, Department of Surgery Board certified in Orthopedic Surgery by the American Osteopathic Board of Orthopedic Surgery Fellow, American Osteopathic Academy of Orthopedics President of the American Osteopathic Academy of Orthopedics, Spinal Surgery Section Member, North American Spine Society Board of Trustees, Florida Osteopathic Medical Association Craig Wolff, M.D. Orthopedic Spine Surgeon Board certified in Orthopedic Surgery by the American Board of Physician Specialties Graduated Magna Cum Laude from Princeton University Fellow, American Academy of Minimally Invasive Spinal Medicine and Surgery Listed in peer-reviewed Best Doctors database by Best Doctors Inc., 2005 06. Mark A. Flood, D.O. Chief of Surgical Innovation Board certified by the American Osteopathic Board of Orthopedic Surgery Fellowship trained in Scoliosis and Pediatric Orthopedic Surgery Member, American Osteopathic Board of Orthopedic Surgery Vernon Morris, M.D. Orthopedic Spine Surgeon Board certified in Orthopaedic Surgery by the American Board of Orthopaedic Surgery Board certified in Pain Management AMA Physician s Recognition Award Member, Florida Medical Association 9

Meet our surgeons Zoltan Bereczki, D.O. Orthopedic Spine Surgeon Board certified in Orthopedic Surgery by the American Osteopathic Board of Orthopedic Surgery Member, American Academy of Orthopaedic Surgeons Member, North American Spine Society Timothy Luke, M.D. Orthopedic Spine Surgeon Named America s Top Orthopedist 2008 Two-time winner of Patients Choice, a coveted award received by less than 6 percent of physicians nationwide Member, American Association of Orthopedic Surgeons Stefan Prada, M.D. Orthopedic Spine Surgeon Board certified in Orthopaedic Surgery by the American Board of Orthopaedic Surgery Fellow, American Academy of Orthopaedic Surgeons Decorated military service member Kit C. McCalla, D.O., MBA Orthopedic Spine Surgeon Board certified by the American Osteopathic Board of Orthopedic Surgery Board certified by the National Board of Osteopathic Medical Examiners Member, American Academy of Orthopaedic Surgeons Keith Girton, M.D. Orthopedic Spine Surgeon Board certified by the American Board of Orthopaedic Surgery Board certified by the American Board of Independent Medical Examiners Member, American Academy of Orthopaedic Surgeons Bruce D. Moffatt, M.D. Neurosurgeon Board certified in Neurological Surgery by the American Board of Neurological Surgery Fellow, American Association of Neurological Surgeons Member, Congress of Neurological Surgeons and the North American Spine Society Jeffrey P. Nees, M.D. Neurosurgeon Diplomate, American Board of Neurological Surgery Jed P. Weber, M.D. Neurosurgeon Board certified by the American Board of Neurological Surgery 10

Laser Spine Institute has helped more than 35,000 patients find pain relief.

Patient stories Laser Spine Institute gave me my life back. I m still going strong because of them. Steve Lombardi, Nesquehoning, Pa.* Steve Lombardi works in construction as a manager and is accustomed to manual labor. Steve enjoys lazy, sunny days, riding his motorcycle with his wife. He wasn t able to do many of the things he loved because much of his time was spent in a significant amount of back pain. After being told that surgery was not an option by multiple physicians, Steve contacted Laser Spine Institute. Laser Spine Institute was able to give Steve relief from his back pain. Steve now says he can go anywhere and do anything. I know I made the right choice, Steve says. After I had back surgery, I had immediate relief. I was 100% pain free. Karen Speicher, Riverview, Fla.* Karen Speicher, a business consultant and volleyball coach, suffered from back pain for six years. The pain seeped into all avenues of her life from her work to her family. The pain affected her health and caused Karen to suffer from depression. She called Laser Spine Institute and was thrilled that she was a candidate for surgery. Karen awoke from surgery with immediate relief. She urges others not to wait years to find relief from chronic neck and back pain. Don t wait, Karen says. Take your life back. I would recommend Laser Spine Institute to my patients. Charles Young, M.D., Rawlins, Wyom.* Charles Young, M.D., spent five years in pain, with the last two years being almost unbearable. Because of his pain, he was forced to close his private practice. As a physician, Charles knew he needed to get help but was hesitant to have surgery especially a fusion. After talking to Laser Spine Institute, Charles opted for a minimally invasive spine surgery approach. After his surgery, Charles felt immediate pain relief. He reopened his private practice, and says he would recommend Laser Spine Institute to any of his patients suffering from neck or back pain. You can find more inspiring patient stories on our website, where you can watch patient testimonial videos or read our thousands of patient testimonials. Visit LaserSpineInstitute.com for more patient success stories. *Individual spine conditions, treatment and recovery times may vary. Each patient s experience with minimally invasive spine surgery will differ. 12

Frequently asked questions We understand that you want to be fully informed before making a decision about surgery. We have listed a few of the questions we receive on a daily basis. For more frequently asked questions, please visit LaserSpineInstitute.com or contact a Patient Care Coordinator. Q: How do you differ from your competition? A: Unlike the approach of some providers, orthopedic surgeons perform our minimally invasive spine procedures. Our esteemed surgical team performs the procedures with a smaller incision of less than 1 inch. Q: Why aren t more surgeons performing this type of procedure? A: These state-of-the-art procedures are specialized and perfected by Laser Spine Institute. This type of surgery employs advanced medical technology, and Laser Spine Institute is at the forefront of this movement. Although training is available at minimally invasive residency programs, there is a steep learning curve to master these procedures. In addition, most programs do not provide enough patient volume for a resident to achieve the level of expertise that characterizes our surgeons. A traditional spine surgeon would have to sacrifice his practice and be trained by a senior surgeon at a facility specializing in these procedures. Many surgeons do not want to make that kind of commitment. While similar procedures are offered by other practitioners, our highly skilled surgeons are able to advance the minimally invasive approach to spine care through their extensive experience at Laser Spine Institute. The advancement that our surgeons practice here would take years to develop in other practices. Q: How should I prepare for surgery? A: If a patient is planning to have surgery, he or she must discontinue all anti-inflammatories, multivitamins and herbal supplements 14 days prior to surgery. If a patient is taking anticoagulants, such as Plavix or Coumadin, he or she must obtain a clearance from the prescribing physician prior to discontinuing those medications. Laser Spine Institute provides a medical consultation and clearance department that will communicate with you over the phone and answer any questions that you may have in regard to medication or treatment prior to arrival. Finally, patients must bring a friend or family member to accompany them for the day of surgery. Q: What are my limitations after minimally invasive spine surgery, and how long will I be out of work? A: We recommend you lift no more than 10 pounds for at least six weeks, and that you return to normal activities gradually to allow for maximum healing. Patients who have desk jobs can normally return to work within two weeks and patients with physically strenuous jobs should wait at least six weeks, depending on the job. Each patient s surgery and job differs; subsequently, the time in which one may return to normal daily activities depends on an individual s work environment and the type of surgery performed. Q: Is minimally invasive spine surgery covered by health care insurance? A: Our team works with insurance companies to make our outpatient surgery more accessible to you. Your maximum financial responsibility will be determined by your individual health insurance coverage, and can be discussed at any time with one of our Patient Care Coordinators. To confirm your health insurance benefits, call today to speak to a Laser Spine Institute Patient Care Coordinator. 13

Join our online community. Find us on Facebook and become a fan Facebook.com/LaserSpine Follow us on Twitter Twitter.com/LaserSpine Keep up to date on our blog LaserSpineWellness.com Attend a complimentary medical seminar SpineSeminar.com Review our procedures and patient stories on YouTube YouTube.com/user/LaserSpineInstitute 6.01.2013 14

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