Guide to Endoscopic Spine Surgery

Table of contents
Message from the CEO 02

About endoscopic spine surgery

03

Why choose Laser Spine Institute?

06

Is endoscopic spine surgery right for you?

07

Streamlined patient experience

08

Meet our surgeons

09

State-of-the-art facilities

12

Patient stories

13

Frequently asked questions

15

Message from Chief Executive Officer Bill Horne

Like many of you, I have lived with chronic pain. Being an active and athletic person, a neck injury was 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 causing a feeling of an electric charge as well as a loss of feeling in my fingers, which 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 and had significant improvement. I found out that it was Dr. James St. Louis who performed the procedure, and I cancelled my previous surgical date immediately. I met with Dr. St. Louis who diagnosed my three herniated discs that were impinging the nerve and causing most of my pain. When the surgery was complete, I could feel relief in the operating room. I walked one mile that evening, returned to work the next day, started working out with weights five days later, and played a round of golf 10 days after surgery! Three 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 endoscopic spine surgery and share my story with potential patients all over the world. Whether you choose our location in Tampa, FL; Scottsdale, AZ; Philadelphia, PA; or Oklahoma City, OK; Laser Spine Institute offers a state-of-the-art medical destination with five-star amenities for those who suffer from back and neck pain. Congratulations on taking the next step toward becoming free of the pain!

About endoscopic spine surgery

Laser Spine Institutes minimally invasive procedures are the safe and effective alternative to open back or neck surgery. Each month, more people come to Laser Spine Institute to relieve their neck and back pain than to any other spine surgery center in the nation.

Advantages of our endoscopic spine surgery:

Outpatient procedure No lengthy recovery Less than 1-inch incision No fusions or hardware 93.8% patient satisfaction

Providing relief for these conditions:

Spinal stenosis Bulging/herniated discs Pinched nerves Degenerative disc disease Bone spurs Sciatica Arthritis of the spine Facet disease Foraminal stenosis

Laser Spine Institute specializes in four types of endoscopic surgeries.

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-optics 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 2mm tube. Nearly all surgical procedures are performed at Laser Spine Institute with local anesthetic and intravenous sedation. In the operating room, a small incision is made, and a series of tubes, increasing in size, are placed over the first tube, one at a time, to slowly create an opening to the spine. This practice allows the surgeons to perform spinal procedures with minimal damage to the surrounding muscles. Through the last translucent working tube (18mm in diameter), a laser, camera, suction, irrigation and other small surgical instruments can be inserted. The procedure is conducted under X-ray guidance and the patient is comfortable throughout the procedure.

Laser Spine Institute specializes in four types of endoscopic surgeries.

Once the procedures are complete, the tube is slowly removed allowing the muscles to move back into place. Only a stitch or two is used to close the incision. Approximately an hour after recovery, the patient with their companion is free to return home or to their hotel room. Following a day of rest and recovery, the patient will meet with the surgeons nurse and medical assistant who will evaluate the incision, change the bandage, and provide wound care instructions and dressing material. The patient is also given detailed instructions on postoperative care recommendations and follow-up protocol. It is imperative that these guidelines are adhered in order to ensure patient safety and prevent postsurgical complications. Finally, the patient is provided with individualized activity instructions to reintegrate normal activities once they return home.

Condition treated Spinal Stenosis Herniated/Bulging Discs Pinched Nerves Bone Spurs Degenerative Facet Joints Sciatica Arthritis of the Spine Facet Arthritis Facet Disease Facet Hypertrophy Facet Joint Syndrome Foraminal Stenosis

Foraminotomy
laser-assisted

Laminotomy
laser-assisted

Endoscopic Discectomy
laser-assisted

Facet Thermal Ablation

laser-based

Why choose Laser Spine Institute?

Laser Spine Institute successfully performs more endoscopic spine surgeries each month than any other spine surgery center in the nation, setting us apart as the leader in endoscopic spine surgery. Below you will find a few 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 families get their lives back. 2. Laser Spine Institute has built its comprehensive medical facilities to provide an integrated service within the walls of each surgical 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. Laser Spine Institute patients report industry-leading results for patient experience that are almost 30 points higher than the national hospital average. 4. All surgeons complete Laser Spine Institutes proprietary fellowship training, led by Chairman of Surgery Emeritus, Founder Dr. James St. Louis, two-time recipient of the Physician of the Year award in 2005 and 2008 by the American Association of Physician Specialists in the field of Orthopedic Surgery. 5. Over 87% of patients report improvement in their quality of life within three months of having their surgery and some patients report improvement at the moment of their surgery. 6. Over 70% of patients travel from out-of-state and 10% from outside the country seeking Laser Spine Institutes unique expert treatment and unparalleled service. 7. 427 dedicated employees including 21 expert surgeons and physicians, and nearly 200 medical professionals, who have dedicated their careers exclusively to Laser Spine Institute ensuring complete comfort and the delivery of our Above and Beyond Service for patients and their families.

Relief without the complications of open back surgery or fusion

Minimally invasive endoscopic procedures
Hospital stay Infection rate Complication rate None 0.1% 4%

Open back/fusion
25 days 27% 31%

* Some patients individual medical conditions may require additional testing that Laser Spine Institute will facilitate
through a third-party service provider.

Is endoscopic spine surgery right for you?

This first easy step in determining if Laser Spine Institutes endoscopic approach is right for you is having your MRI or CT scans 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 studies 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 patients pathology to determine if Laser Spine Institute can help.

One-on-one medical consultation

One-on-one consultations are available in each of our surgical facilities as well as our medical consultation centers in Fort Lauderdale, San Diego, and The Villages. This is a unique opportunity to meet with a Laser Spine Institute medical professional to review reports, discuss the patients pathology and symptoms, and determine if an endoscopic procedure is the right solution for you.

Medical seminar
Laser Spine Institute seminar staff travels the continental United States and Canada educating those who suffer from back and neck pain. The program begins with personal face-to-face discussions with a physician to assess each potential patients pathology, symptoms assessment and initial determination of candidacy for a Laser Spine Institute procedure. Visit SpineSeminar.com to view upcoming seminars throughout North America.

Streamlined patient experience

Through our streamlined process, patients receive all necessary treatments related to their spinal 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.

Day One and Two

Evaluation Physical and Diagnostic testing

Day Three
Surgery

Day Four
Rest and recovery

Day Five
Postoperative appointment

Some patients individual medical conditions may require additional testing that Laser Spine Institute will facilitate through a third-party service provider.

Once the patient is discharged and returns home, a patient services liaison continues to provide continuous patient support and superior postoperative care. In doing so, the liaison plays a key role in all aspects of patient recovery and outcome, helping each patient optimize improvement in their quality of life.

Laser Spine Institute spinal diagnostic center

Spinal Diagnostics is a division of Laser Spine Institute, established to serve the preoperative needs of surgical patients with the primary goal of optimizing surgical outcomes. The majority of patients seeking treatment at Laser Spine Institute have clearly identifiable areas of anatomic compression, allowing straight-forward surgical treatment decisions. However, a few patients have subtle or complex MRI pathoanatomy, which requires 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 those with 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. Due to the focally decompressive nature of endoscopic 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 (SNRB), and discograms. All diagnostic procedures are performed by a board-certified 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 endoscopic treatment.

* Diagnostic procedures in Philadelphia and Oklahoma City are facilitated by Laser Spine Institute through a third-party provider. 8

Meet our surgeons

The surgeons at Laser Spine Institute specialize exclusively in relieving back and neck pain through minimally invasive, outpatient procedures. With more than 70 years of combined experience in these advanced techniques, our surgeonsled by Chairman of Surgery Emeritus, Founder Dr. James St. Louisperform more endoscopic procedures each month than any other spine surgery center in the nation.

James St. Louis, D.O.

Chairman of Surgery Emeritus, Founder
Board certified in Orthopedic Surgery by The American Board of Physician Specialists Appointed to the state Board of Osteopathic Medicine by the governor of Florida 2005 and 2008 Physician of the YearAmerican Association of Physician Specialists Meritorious Service Award United States Army

Craig Wolff, M.D.

Orthopedic Spine Surgeon
Board certified in Orthopedic Surgery by The American Board of Physician Specialists Graduated Magna Cum Laude from Princeton University Fellow, American Academy of Minimally Invasive Spinal Medicine and Surgery Named One of the Best Doctors in America for 200506Best Doctors Inc.

Michael Weiss, D.O., FAOAO

Chairman 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

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 Award for Physician Recognition Member, Florida Medical Association

Meet our surgeons

Zoltan Bereczki, D.O.
Orthopedic Spine Surgeon
Member, American Academy of Orthopedic Surgeons Member, American Osteopathic Academy of Orthopedic Surgeons Member, American Osteopathic Association Licensed Doctor of Osteopathic Medicine in Florida

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

Stefan Prada, M.D.

Orthopedic Spine Surgeon
Board certified in Orthopaedic Surgery by The American Board of Orthopaedic Surgery Fellow, American Academy of Orthopedic Surgeons Decorated Military Service Member

Mark A. Flood, D.O.

Orthopedic Spine Surgeon
Board certified in Orthopedic Surgery Fellowship trained in Spine Surgery Fellowship trained in Scoliosis and Pediatric Orthopedic Surgery Member, American Osteopathic Board of Orthopedic Surgery

Timothy Luke, M.D.

Orthopedic Spine Surgeon
Named Americas Top Orthopedist2008 Two-time winner of Patients Choice, a coveted award received by less than 6% of physicians nationwide Member, North American Spine Society Member, American Association of Orthopedic Surgeons Member, American Medical Association

Kit C. McCalla, D.O., M.B.A.

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 Member, American Osteopathic Association

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State-of-the-art facilities
Laser Spine Institute has built its comprehensive medical facilities to provide an integrated service 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 employeesincluding an expert surgical team led by Chairman of Surgery Emeritus, Founder Dr. James St. Louis, esteemed medical professionals and patient care personnel dedicate their time and energy exclusively to Laser Spine Institute, ensuring complete comfort and delivery of Above and Beyond service for 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 endoscopic 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.

Surgical Centers
1. Oklahoma City, Oklahoma 2. Philadelphia, Pennsylvania 3. Scottsdale, Arizona 4. Tampa, Florida

Consultation Centers
5. Fort Lauderdale, Florida 6. San Diego, California 7. The Villages, Florida

7 4 5

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Patient stories
Captain Norm Isaacs story
It is hard to describe a man like Captain Norm Isaacs. If you were to meet him, you would quickly realize that a life with back pain was not an option for Norm. He has lived an exciting life from signing a contract with the New York Yankees right out of high school to working as a flight instructor to becoming a professional big game fisherman. Since 1986, Norm has dedicated his life to his career of professional big game fishing and shows on Fox Sports Network such as Big Game Fishing the World, Big Game Bites and Inside Big Game Fishing. Big game fishing involves tremendous physical strength and balance hooking up fish like 800-pound marlin, which would be a difficult task for anyone to accomplish. Living an active lifestyle for many years, Norm experienced low back pain and pinched nerves down his right leg that worsened over time. He was diagnosed with degenerative disc disease, bulging disc, foraminal & spinal stenosis and facet hypertrophy. Between fishing excursions, Norm tried several different forms of conservative treatment like chiropractic, physical therapy and acupuncture to relieve the aggravating pain. He was apprehensive at the thought of spine surgery and concerned it would affect his career and true passion for fishing. Norm knew that after failing conservative treatment it was the best option. Once he came to Laser Spine Institute, he was pleasantly surprised by the atmosphere, caring staff, and five-star service he received throughout his outpatient treatment. In September 2008, Dr. James St. Louis performed a laminotomy & foraminotomy and a few days later, Norm was amazed at the difference. He commented that you dont realize how much you missed feeling good until you feel good! Ten months after his surgery, Norm stressed that his back is no longer bothered by bending down and picking up fish or spending days on the boat. He mentions that Laser Spine Institute is nothing short of a miracle. Excited about his life after the surgery, he commented on his experience saying, Absolutely a life-changing experience. Im back on the boats. Im back to doing the things I normally do. Im back to playing golf and Im not hurting.

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Patient stories
Ingrid Honzaks story
Ingrid Honzak, 59, finished the 2007 New York City Marathon six weeks after her endoscopic spine surgery at Laser Spine Institute. Her surgeon performed a laminotomy and foraminotomy on the left side of her lumbar spine in September prior to the November race. One year later, Ingrid reports great improvement with little to no pain in her lower back and left leg. For over 10 years, she suffered from lumbar pain and a pinched nerve, which affected her left leg. The pain went from tolerable to unbearable early last year. Ingrid was chosen out of 100,000 applicants to run the marathon but she grew weary of her current condition. She was concerned about running on pavement, which has a greater impact on muscles and joints than mountain trail racing. With limited improvement from conservative treatment, Ingrid contacted Laser Spine Institute to have a procedure scheduled in anticipation of the big race. She submitted her MRI for review by Laser Spine Institute Medical Director, Dr. Michael Perry. During the conversation regarding her candidacy, Ingrid voiced her concern regarding the ability to participate in the marathon in November. Encouraged by the fact most patients walk the day of surgery, she knew Laser Spine Institute was the best option. After a complete medical evaluation and surgical consultation, Ingrid had minimally invasive endoscopic spine surgery at Laser Spine Institute in Tampa, Florida. She was comforted by the caring clinical nursing staff and the anesthesiologist who held her hand throughout the surgery. Her hopes were fulfilled when she was able to walk the day of her surgery. After her postoperative appointment, Ingrid returned home to continue physical therapy and training. In response to her Laser Spine Institute experience, she commented, It is amazing what they can do! While they might not be able to fix everyone, the experience for me was fabulous! I have never been treated so well at a medical facility. I can remember the anesthesiologist holding my hand before surgery and it truly comforted me. Everyone at Laser Spine Institute was very kind to me. I would encourage anyone who is interested in having back or neck surgery to contact them. After her surgery at Laser Spine Institute, Ingrid returned to work within one week and training in only four weeks. A combination of stationary bike riding and intense water aerobics including water-jogging with a weight belt prepared her for the race. Reunited with her true passion of running, Ingrid crossed the finish line with the same tremendous sense of accomplishment.

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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 www.LaserSpineInstitute.com or contact a Patient Coordinator. Q: How long have your surgeons been performing this procedure? A: Our surgeons have over 70 years of combined experience performing these procedures. Members of the surgical team have been proprietary fellowship trained at our facility, in addition to bringing significant experience with minimally invasive endoscopic surgical techniques gained at other respected healthcare providers. They are also highlighted by over four decades of general surgical experience to add to their procedure-specific experience.

Q: Why arent more doctors performing this type of procedure? A: These sophisticated 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. Though 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 the 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, multi-vitamins, and herbal supplements fourteen days prior to surgery. If a patient is taking anti-coagulates, such as Plavix or Coumadin, he or she must obtain a clearance from their 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 regards to medication or treatment prior to arrival. Finally, every patient must bring a friend or family member to accompany them for the day of surgery.

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Frequently asked questions

Q: When may I resume my normal/physical activity?

A: After experiencing endoscopic spine surgery at Laser Spine Institute, most patients are able to walk under their own power the day of surgery. The next day is a day of rest and recovery. Finally, there is a postoperative appointment, and then patients are discharged. Patients with a job that requires little or no manual labor may return to that job within a matter of days. Our physicians will limit lifting to 15 pounds for the first few weeks. Gradually, the patient may return to normal physical activity as their body strengthens itself. Patients typically experience a full recovery in between four to six weeks. However, it is important to follow the instructions of our licensed medical professionals as each patient has a different path to recovery.

Q: Is endoscopic spine surgery covered by healthcare insurance? A: Laser Spine Institute accepts most insurance. Our team has worked with health insurance companies to make our outpatient surgery more accessible to you. The result is that out-of-pocket expenses have dropped significantly over the past year. In fact, average out-of-pocket costs for Laser Spine Institute patients have decreased from 90% to 30% since 2008. To confirm your health insurance benefits, call today to speak to a Laser Spine Institute Patient Coordinator.

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Join our online community.

Find us on Facebook and become a fan www.facebook.com/laserspine Keep up to date on our blog blogs.laserspineinstitute.com Follow us on Twitter www.twitter.com/laserspine Find a free medical seminar in your area www.SpineSeminar.com

Contact
www.LaserSpineInstitute.com 1-866-847-4816

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