North American SpineInformation and Procedure Overview

1-877-474-2225214-261-3600

www.northamericanspine.com

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I had my first back surgery 3 years ago and did well for the first 6months; then the pain returned. The pain never went away and Iwas using more pain medication than prescribed. I found DrRothstein who performed his procedure. The pain was almostimmediately resolved. I was able to discontinue all painmedications. He not only helped me with my back pain, he gaveme my life back.

- Mike

A true ‘miracle’……was using a wheelchair and a shut in….Now walking…going to activities.- Yvonne & Joe

You have truly given my life back!! It’s just great to feel alive again.- Don

….more than I could have ever expected with instant relief…..- Martha

I have been able to do things with my children and husband that I haven’t been able to do for years.- Bernadine

You have changed my life. Now I can play with my son and wife.- Christian

The best feeling in the world is to be free from pain…..life changing….better than it has been in a long, long time.- Sandy & Shaun

…I am pain free.

- Walter

….headed back …..home with no pain whatsoever, did not even take a Tylenol…walking straight for the first time in many months.- Bob

Thanks. You’ve given me back my life. This is truly a miracle!- Boyd

Within the month and a half since surgery I have been able to return to my workout routine and even some diving.- SSG Sean (US Army, Kosovo)

Feedback from our patients…

• More than 86 million Americans suffer from pain.

• One Third of all adult Americans have had back pain in last 30 days.

• The cover and feature story of Newsweek issue dated April 26, 2004 was Treating Back Pain: The New Debate Over an Affliction Shared by 65 Million Americans.

• The back pain epidemic continues to grow year by year. According to the National Institute of Health: Back pain is the #2 reason why people visit a doctor.

• Back pain is also the #1 reason why people will stay home from work.

• 85% of ALL people will suffer some moderate to severe back pain at some point in their lives.

• Back pain is the #2 reason for hospitalization (2nd to pregnancy).

• Each year, low back conditions cost an estimated $100 billion in medical costs and loss in productivity.

• The most common form of back pain is caused by symptoms from Degenerative Disc Disease—including disc herniations (ruptures) and disc bulges.

• Over 90% of disc herniations (ruptures) occur in the lowest two levels of the lumbar spine, between L4/L5 and L5/S1.

• North American Spine’s AccuraScope™ Procedure is the least invasive and most effective way to treat problems in the lumbar spine.

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Back Pain Facts & Statistics

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• 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. The first seven vertebrae (the 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 ribcage.

• 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 they do not have discs between them.

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

Spinal Column w/ Vertebrae

Cross-Section of the Spine

Basic Spine Anatomy

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Problems in Cervical, Thoracic, and Lumbar/Sacral regions of the spine, including:

• “Sciatica”

• Back pain with or without radiating leg pain

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

• Numbness in the leg(s) or feet

• Weakness of the muscles of the leg(s)

• Bulging Disc

• Spinal Stenosis

• Degenerative Disc Disease

• Arthritis of the Spine

• Pinched Nerve

• Scar Tissue

• Foraminal Stenosis

• Facet Disease

Ruptured or Herniated DiscSmall, spongy discs cushion the individual bones that form the spine, orbackbone. When these discs are healthy, they act as shock absorbersfor the spine and keep the spine flexible. When a disc breaks down, oris damaged, it may tear, bulge or break open. This is called a herniateddisc. It may also be called a bulged, slipped or ruptured disc.

Spinal Issues Addressed by North American Spine

Cross Section of Lumbar Vertebrae

Nerve Roots being compressed by herniated disc

Disc Herniation

Nucleus

Annulus

Intervertebral Disc

Lower Back Problems (lumbar):

• Disc Herniation occurs when a disc extrudes into the spinal canal. It is also referred to as a bulging disc, ruptured disc or slipped disc. As a disc degenerates, it can herniate (the inner core extrudes) back into the spinal canal. A lumbar herniated disc can cause pain to radiate all the way down the legs and into the foot. In the area of the cervical spine, the pain would radiate from the neck down the arm into the fingers.

• Degenerative Disc Disease refers to the gradual deterioration of the disc between the vertebrae. As we age, the water and protein content of the body's cartilage changes. This change results in weaker, thinner and more fragile cartilage. Because both the discs and the joints that stack the vertebrae (facet joints) are partially composed of cartilage, these areas are subject to wear and tear over time (degenerative changes).

• Spondylolisthesis is the slippage of one vertebrae upon another. There are multiple "types" of slippage. The degenerative type is commonly seen in the elderly population and the "isthmic" type is commonly seen in the younger population. In the degenerative "older" type, the patient usually has symptoms of spinal stenosis with increased chance of back pain. If the slippage is unstable, back pain becomes more significant. The isthmic (younger) type of slippage is likely present from early adulthood; patients tend to become symptomatic in their 20s or 30s.

• Spinal Stenosis is a common problem noted in the elderly population. Stenosis is basically a fancy term for a narrowing of the spinal canal. As we age, the joints in the spine become arthritic and form bone spurs; the ligaments "thicken" and the discs collapse and "protrude" into the spinal canal. The spinal canal has a limited amount of space, and as the bony spurs, discs and ligaments invade the canal, the nerves have less room available to them. The increasing pressure on the nerves causes some back and mostly leg pain which usually worsens with standing or walking; the leg pain is usually relieved by sitting or lying down.

Common Spinal Problems

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Common Spinal Problems

The AccuraScope™ Discectomy and Neural Decompression (“D.N.D.”) Procedure:

• The AccuraScope™ D.N.D. is a Minimally Invasive, Natural Opening procedure used to both diagnose and treat Inter-vertebral discs and Spinal Stenosis of the lumbar spine.

• Using live x-ray for guidance, the physician inserts an endoscopic fiber optic scope, like a small tube, through a small incision in the skin, into a natural opening at the base of the spine.

• The doctor examines the inside of the spine and the discs of the lower back, from both sides of the spinal canal, to identify any tears, ruptures, herniations, bulges, or other abnormalities.

• The doctor actually finds inflammation and actually diagnoses the source of pain.

• The doctor then uses a number of instruments to shrink the damaged disc(s), or spinal stenosis, and relieve pressure on the spinal nerve(s).

• The procedure is usually completed in 30-45 minutes. Many patients experience immediate relief with this procedure.

• Patients are returned to a recovery area and are usually discharged approximately one hour after surgery. Patients can walk the same day as their procedure, and can start gentle physical therapy exercises the next day.

• Many patients can return to work and resume normal activities the following day, and most can return within one week.

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

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Inserting the endoscope thru the natural opening provides direct access to the disc space.

A side view of the spinal canal showing the endoscope under the spinal cord / dural sac and nerve roots, easily accessing the herniatedor ruptured disc.

The AccuraScopeTM Procedure

The AccuraScope™ Discectomy and Neural Decompression (“D.N.D.”) Benefits:

D.N.D. is a Minimally Invasive, Natural Opening procedure that results in:

• Tiny incision

• Diagnosis of the cause / source of the pain

• Earlier treatment

• Potentially immediate relief

• Less chance for recurrence

• Minimal scarring

• Minimal risk of damage to muscles, bone, nerves or blood vessels, especiallywhen compared to “minimally invasive” procedures

• The normal structure of the disc is maintained

• Less pain after the procedure

• Rapid recovery

• Highly successful

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In layman’s terms, the primary difference between theAccuraScope™ and traditional Laserscopic procedures isthat the AccuraScope™ procedure follows laterally, along anatural opening in the spinal column, thereby allowingboth the diagnosis and the treatment along the entirelumbar path (L1 – L5). No one else can treat multiplelevels in a single procedure.

The AccuraScopeTM Benefits

The AccuraScope™ Discectomy and Neural Decompression (“D.N.D.”) Benefits, Continued:

North American Laserscopic Spine Institute’s revolutionary AccuraScope™ procedure takes traditional Endoscopic spinalsurgery to a whole new level by offering an even less invasive surgery (leading to even faster recovery) as well asmultiple levels of diagnosis and repair during ONE surgery.

The other minimally invasive procedures enter vertically (think epidural) and can only explore one vertebrae section at atime; so if a patient has problems at multiple levels then they will likely require multiple surgeries. The following chartprovides a comparison of the AccuraScopeTM procedure in relation to other types of minimally invasive surgeries as wellas traditional spine surgeries:

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AccuraScope™Procedure

Other Minimally Invasive Surgery

Traditional Spine Surgery

Success: Extremely High Moderate Variable

Diagnostic Value: Extremely High None None

Risk: Very Low Low Moderate

Recovery: A Few Days Weeks Months

Negative Result: Minimal Risk Minimal Risk Significant Risk

Tissue Damage: None Moderate to Significant Extensive

Anesthesia: Light Sedation Variable General

Cost: $19,500 - $33,500 $28,500 - $75,000 $125,000 - $200,000

The AccuraScopeTM Benefits, Cont’d

Most people are unaware that it is back surgeries that cause much or most of patients recovery issues. The actual “fixes” at thesource are generally similar among the procedures (i.e. the removal of unwanted tissue), but the invasiveness and associatedtrauma of the procedure dictates 90% or more of the outcome.

The pictures below depict the relative invasiveness of the three most common back surgery alternatives:

Traditional “Open Back” Other Endoscopic AccuraScope™

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Alternative Procedure Comparisons

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While a traditional spine surgery would be considered successful if surgeons can correct the structural findings of the MRI, the procedure may do absolutely nothing to relieve that patient’s pain! In fact, up to 40% of traditional spine surgeries fail to resolve the patient’s pain because the structural findings on the MRI did not correlate with the patient’s pain source. We do not consider that a success.

That’s why locating the precise source of a patient’s pain is the first step in the North American Spine treatment process. Developed by Dr. Ken Alo, the StimPathTM Diagnostic Pain Mapping system uses proprietary algorithms and neuro-stimulator technology to isolate the origin of your pain. This approach fits with our entire philosophy: using conservative, unique, innovative, and superior techniques to better treat your pain minimally invasively.

The first step in the process is a consult with the physician. They will discuss your case with you in great detail, asking a series of questions designed to outline a preliminary treatment plan. The physician will use the StimPathTM system to isolate the cause(s) of your pain and based on those findings, schedule you for the appropriate procedure(s) to treat those pathologies and relieve your pain.

The StimPathTM system has been in use for nearly 15 years, and has been shown to indicate the source of pain in 9 out of 10 patients, giving patients more specific pain diagnoses and better treatment outcomes.

StimPathTM Diagnostic Pain Mapping

Sunday: Arrive in Dallas or Houston

Monday: Physician Consult, Full History & Physical, Formulate Treatment Plan, Initial Diagnostic Mapping

Tuesday: Further Diagnostic Mapping (as needed)

Wednesday: Further Diagnostic Mapping (as needed), Therapeutic Treatments – Facets, DND, Cervical Discectomy, Thoracic Discectomy (as needed)

Thursday: Therapeutic Treatments – Facets, DND, Cervical Discectomy, Thoracic Discectomy (as needed)

Friday: Post-Op Care, Return Home, Get back to enjoying life!

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So, you want to schedule for a procedure, what now? This is how the process works:

Contact us at:1-877-474-BACK

877-678-7880 Faxwww.NorthAmericanSpine.com

5-Day Process

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Ken Reed, M.D.

Education:Dr. Reed was an honors graduate of the University of Texas Medical Branch in Galveston Texas having been elected to the AlphaOmega Alpha honor society, which is limited to the top of the graduating class. He then completed two separate residencyprograms in Internal Medicine and Anesthesiology and ultimately became specialty board certified in three specialties – InternalMedicine, Anesthesiology and Pain Management.

Relevant Experience:Since 1988 Dr. Reed has been on the medical staff of Presbyterian Hospital of Dallas where he has previously served as the head ofthe hospital’s Pain Management Program. While in private practice Dr. Reed has continued working with ongoing research and haspublished and presented papers on various topics in pain management and more specifically has interests in the use of implantableneurostimulators for the control of pain. He developed the use of implantable stimulators for the problem of various types ofsevere, intractable headaches; techniques which are now used around the world. He continues ongoing research in these fields.Additionally, he is a recognized teaching specialist for training physicians in these specialized techniques of implantableneurostimulation. Dr. Reed was named one of the Best Doctors in Dallas by D Magazine in 2009 and 2010.

Kelly Will, M.D.

Education:Dr. Will received his B.A. in Biology from Austin College in 1980. From there, Dr. Will went on to earn a Doctor of Medicine degree from University of Texas Medical Branch at Galveston in 1984. He performed a General Surgery Internship at University of Nevada—Las Vegas and his Anesthesia and Pain Management Residency at the University of Kansas Medical Center—Kansas City, where he was chief resident for 2 years. Upon graduating from residency in 1989, Dr. Will was presented with the Outstanding Graduating Resident Award.

Relevant Experience: Dr. Will has been in Pain Management private practice since 1989, where he has performed innovative treatments tailored to each patient. These treatments employ a combination of various injection therapies such as epidural steroid injections or selective root blocks as well as implantable spinal cord stimulation techniques. Dr. Will was named one of the Best Doctors in Dallas by D Magazine in 2009 and 2010.

Our Physicians

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Robert Bulger, M.D.

Dr. Robert Bulger is a Midwest native, and attended the prestigious Mayo Medical School. He trained in Internal Medicine and Anesthesiology at Emory University in Atlanta. Following that, Dr. Bulger completed a Pain Management Fellowship at Penn State.

He is a recognized expert in Discography, and has lectured locally and nationally on his refinement of this technique. Dr. Bulger is called upon by many of the prominent spine surgeons in the Dallas Metroplex for assistance with the management and treatment of complex spinal pain, as well as other pain syndromes.

Dr. Bulger is board certified in both Anesthesiology and Pain Management by the ABMS, and has been selected as one of D Magazine's Best Doctors in Dallas for the past 6 years. He has been in private practice since 1986.

Our Physicians

Ken Alo, M.D.

Education:Dr. Aló graduated from Texas A&M University College of Medicine and completed his General Surgery Internship, AnesthesiologyResidency, and Interventional Pain Fellowship at The Methodist Hospital, and Baylor College of Medicine Affiliated Hospitals in theTexas Medical Center. He is board certified and has been active in supporting the American Academy of Pain Medicine, theAmerican Neuromodulation Society, the National Pain Foundation, the International Neuromodulation Society, The InternationalAssociation for the Study of Pain, The American Pain Foundation, and the American Pain Society in various roles.

Relevant Experience:Specializing in the Interventional Management of Pain, Dr. Aló believes enhanced knowledge, improved communication, and systematic diagnostic and therapeutic evaluations offer pain patients an expedited opportunity to reduce suffering and maximize quality of life. He remains active as the Director of the Section of Neuro-Cardiology at the Institute of Cardiology and Vascular Medicine - Monterrey Technical University and is participating in clinical research at the Methodist Hospital Research Institute in the Texas Medical Center. Dr. Aló has also recently joined Ascendant Neuro as Director of Neuromodulation and Clinical Research.

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Our Physicians

Steven Watson, M.D., PhD.

Education:Dr. Watson earned his medical degree from Wright State School of Medicine in Dayton, Ohio. Dr. Watson completed hisanesthesiology residency from Indiana University School of Medicine. He earned a pharmacy degree at the University of Cincinnati.He also holds a PhD. in pharmacokinetics from Northeast Louisiana University School of Pharmacy. He is board certified from theAmerican Board of Anesthesiology, the American Board of Pain Medicine and the American Board of Interventional Pain Physicians.

Relevant Experience:Dr. Watson is an interventional pain management physician performing minimal Invasive Endoscopic Discectomy on the Lumbar,Thoracic and Cervical Spine regions. These procedures effectively treat low back and leg pain in patients who have herniated discs,spinal stenosis and even previous spine surgery, including fusions.

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More feedback from our patients…

I wanted to take this time and opportunity to thank you and all of your staffregarding the laser back surgery that was performed on me on August 8th,2008. I had no idea how much my life had changed due to pain until after thesurgery, when all the pain was gone. I had dealt with the pain for so long ithad changed my entire life style without even realizing it. I couldn’t orwouldn’t bend over to tie my shoe laces because of the pain in my entireback. It had just become a habit to place my foot on my nightstand in orderto tie my shoes. Playing with my grandchildren was no longer an optionbecause of the constant pain I was always in. Even bending over the sink tobrush my teeth every morning had become so painful that by the time Ifinished brushing my teeth I had to go lay down. I was constantly missingdays off work due to the excruciating pain on a daily basis.

Pain had changed my entire life. I no longer wanted to visit friends because Iknew my back was going to start hurting, and I did not want to take themorphine and drive. It was a monumental chore just getting up to go to workand by the time I got off work I was so drained of energy I could do nothingbut go home take the morphine and lay down to get prepared for the nextday. I am thanking you from my heart because I now have my life back. I amtotally pain free and I do mean PAIN FREE. In my heart, I know that you andyour staff are a God send to me. I laugh more now, My face no longer showsthe pain I was in, where family would constantly ask, “Are you OK?” becauseyou look like you are in great pain.

I cannot thank you and your staff enough for giving me my life back. If youever need a testimony of how GREAT your procedure is, please don’t everhesitate to call upon me.

Grateful from my Heart, Thank you, Thank you, Thank, you- Steven C. Vestal

Patient Feedback…

I cannot begin to express my gratitude for the renewed quality tomy life that you and your staff have given me. The chain of eventsthat led me to all of you can only be explained by divineintervention (my 2 guardian angels - my mother andgrandmother). As a pharmacist I've seen the end results of manypatients who went through the traditional form of spinal surgery.The endless chain of narcotic pain meds, back braces, depressionand the little quality left in their lives that seems to go on and on.I came close to being there myself but backed out last minute andthen I found all of you. Thank you for being here for me. I willcontinue to spread the word and hopefully others will get theirlives back also.- Claudia

Patient Feedback…

I wanted to contact the clinic to relay the 3 month progress of myprocedure. I now exercise at the level I was accustomed to 10years ago. I do a fairly vigorous weight and cardio routine and canonce again complete the daily regimen without prolonged andintense pain. I would estimate the reduction of discomfort to be85-90%, allowing me to live a normal life again. The cervical DNDprocedure is far and away a better option than those I received atseveral facilities in my hometown. Less invasive and, so far, moreeffective than the foraminotomy or fusion I had performed inrecent years.- Matt M

Patient Feedback…

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Our Locations Forest Park Medical Center—Dallas, Texas

Forest Park Medical Center in Dallas is anew, state-of-the-art medical facility.With unsurpassed service, exemplarycare and the highest quality medicalfacility, prepare to have yourexpectations exceeded. From staff totechnology and techniques, Forest Parkbrings together the best of the best inone top-notch, full-service acute carehospital.

With state of the art OperatingRooms and luxurious PatientRooms, comfort is afforded withease. Located just minutes Northof Downtown Dallas, Forest Park isnear some of the finest dining andentertainment Texas has to offer.

• 24 inpatient beds

• 16 state of the art fully integrated operating suites

• 19-bay preoperative and postoperative area

• Full service kitchen

• Ancillary services

• Imaging center with MRI, CT and R&F Room

• On-site, fully staffed Emergency Room

Forest Park Medical Center11990 North Central Expressway

Dallas, Texas 75243

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Our Locations University General Hospital—Houston, Texas

University General Hospital is one of the premier surgical hospitals in the Southern United States, engineered to cater to the patients and their loved ones.

This 72-bed hospital has a full array of services including inpatient and outpatient medical treatments and surgeries, six state-of - the-art operating suites, two cardiac catheterization labs, endoscopy suite,pulmonary medicine, sleep center suites, diagnostic imaging, laboratory, as well as other ancillary services.With state of the art Operating Rooms and luxuriousPatient Rooms, comfort is afforded with ease. Locatednear Downtown Houston adjacent to Reliant Stadiumin the medical district.

• 6 state of the art fully integrated operating suites

• Complete lab and imaging center

• Fully Digital ancillary services

• Concierge Services to assist you with travel and local arrangements

• Five- star décor and spacious rooms

• Made-to-order meals and room service

• Free valet parking