Rodan and Fields Dermatologists

1. www.northamericanspine.com
North American Spine
Information and Procedure Overview
1-877-474-2225
214-261-3600

2. Feedback from our patients…
I had my first back surgery 3 years ago and did well for the first 6 ….headed back …..home with no pain whatsoever, did not even take a
months; then the pain returned. The pain never went away and I Tylenol…walking straight for the first time in many months.
was using more pain medication than prescribed. I found Dr - Bob
Rothstein who performed his procedure. The pain was almost
immediately resolved. I was able to discontinue all pain Within the month and a half since surgery I have been able to return to
medications. He not only helped me with my back pain, he gave my workout routine and even some diving.
me my life back. - SSG Sean (US Army, Kosovo)
- Mike
…I am pain free.
- Walter
Thanks. You’ve given me back my life. This is truly a miracle!
- Boyd
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
You have changed my life. Now I can play with my son and wife. ….more than I could have ever expected with instant relief…..
- Christian - Martha
The best feeling in the world is to be free from pain…..life I have been able to do things with my children and husband that I
changing….better than it has been in a long, long time. haven’t been able to do for years.
- Sandy & Shaun - Bernadine
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3. Back Pain Facts & Statistics
• 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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4. Basic Spine Anatomy
• The spinal column extends from the base of the skull to the tailbone and is made up of thirty- Spinal Column w/
three bones known as the vertebrae. The first seven vertebrae (the cervical vertebrae) are in Vertebrae
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 Cross-Section of the Spine
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.
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5. Spinal Issues Addressed by North American Spine
Cross Section of Lumbar
 Problems in Cervical, Thoracic, and Lumbar/Sacral regions of the Vertebrae
spine, including:
• “Sciatica” Nerve Roots being
• Back pain with or without radiating leg pain compressed by
herniated disc
• 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 Disc Herniation
• Spinal Stenosis
• Degenerative Disc Disease Nucleus
Intervertebral
• Arthritis of the Spine Disc
Annulus
• Pinched Nerve
• Scar Tissue
• Foraminal Stenosis
• Facet Disease
Ruptured or Herniated Disc
Small, spongy discs cushion the individual bones that form the spine, or
backbone. When these discs are healthy, they act as shock absorbers
for the spine and keep the spine flexible. When a disc breaks down, or
is damaged, it may tear, bulge or break open. This is called a herniated
disc. It may also be called a bulged, slipped or ruptured disc.
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6. Common Spinal Problems
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
Common Spinal Problems
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.
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7. The AccuraScopeTM Procedure
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 Inserting the endoscope thru the natural opening
both sides of the spinal canal, to identify any tears, ruptures, herniations, bulges, or provides direct access to the disc space.
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, A side view of the spinal canal showing the
and most can return within one week. endoscope under the spinal cord / dural sac and
nerve roots, easily accessing the herniated
North American Spine is the world’s sole provider of the AccuraScope™ procedure. or ruptured disc.
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8. The AccuraScopeTM Benefits
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, especially
when compared to “minimally invasive” procedures
• The normal structure of the disc is maintained
• Less pain after the procedure
• Rapid recovery
• Highly successful
In layman’s terms, the primary difference between the
AccuraScope™ and traditional Laserscopic procedures is
that the AccuraScope™ procedure follows laterally, along a
natural opening in the spinal column, thereby allowing
both the diagnosis and the treatment along the entire
lumbar path (L1 – L5). No one else can treat multiple
levels in a single procedure.
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9. The AccuraScopeTM Benefits, Cont’d
The AccuraScope™ Discectomy and Neural Decompression (“D.N.D.”) Benefits, Continued:
North American Laserscopic Spine Institute’s revolutionary AccuraScope™ procedure takes traditional Endoscopic spinal
surgery to a whole new level by offering an even less invasive surgery (leading to even faster recovery) as well as
multiple 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 a
time; so if a patient has problems at multiple levels then they will likely require multiple surgeries. The following chart
provides a comparison of the AccuraScopeTM procedure in relation to other types of minimally invasive surgeries as well
as traditional spine surgeries:
AccuraScope™ Other Minimally Invasive Traditional Spine
Procedure Surgery 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
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10. Alternative Procedure Comparisons
Most people are unaware that it is back surgeries that cause much or most of patients recovery issues. The actual “fixes” at the
source are generally similar among the procedures (i.e. the removal of unwanted tissue), but the invasiveness and associated
trauma 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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11. StimPathTM Diagnostic Pain Mapping
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.
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12. 5-Day Process
So, you want to schedule for a procedure, what now? This is how the process works:
 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!
Contact us at:
1-877-474-BACK
877-678-7880 Fax
www.NorthAmericanSpine.com
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13. Our Physicians
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 Alpha
Omega Alpha honor society, which is limited to the top of the graduating class. He then completed two separate residency
programs in Internal Medicine and Anesthesiology and ultimately became specialty board certified in three specialties – Internal
Medicine, 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 of
the hospital’s Pain Management Program. While in private practice Dr. Reed has continued working with ongoing research and has
published and presented papers on various topics in pain management and more specifically has interests in the use of implantable
neurostimulators for the control of pain. He developed the use of implantable stimulators for the problem of various types of
severe, 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 implantable
neurostimulation. 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.
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14. Our Physicians
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.
Ken Alo, M.D.
Education:
Dr. Aló graduated from Texas A&M University College of Medicine and completed his General Surgery Internship, Anesthesiology
Residency, and Interventional Pain Fellowship at The Methodist Hospital, and Baylor College of Medicine Affiliated Hospitals in the
Texas Medical Center. He is board certified and has been active in supporting the American Academy of Pain Medicine, the
American Neuromodulation Society, the National Pain Foundation, the International Neuromodulation Society, The International
Association 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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15. 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 his
anesthesiology 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 the
American 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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16. More feedback from our patients…
Patient Feedback…
Patient Feedback…
I wanted to take this time and opportunity to thank you and all of your staff
regarding the laser back surgery that was performed on me on August 8th, I wanted to contact the clinic to relay the 3 month progress of my
2008. I had no idea how much my life had changed due to pain until after the procedure. I now exercise at the level I was accustomed to 10
surgery, when all the pain was gone. I had dealt with the pain for so long it years ago. I do a fairly vigorous weight and cardio routine and can
had changed my entire life style without even realizing it. I couldn’t or once again complete the daily regimen without prolonged and
wouldn’t bend over to tie my shoe laces because of the pain in my entire intense pain. I would estimate the reduction of discomfort to be
back. It had just become a habit to place my foot on my nightstand in order 85-90%, allowing me to live a normal life again. The cervical DND
to tie my shoes. Playing with my grandchildren was no longer an option procedure is far and away a better option than those I received at
because of the constant pain I was always in. Even bending over the sink to several facilities in my hometown. Less invasive and, so far, more
brush my teeth every morning had become so painful that by the time I effective than the foraminotomy or fusion I had performed in
finished brushing my teeth I had to go lay down. I was constantly missing recent years.
days off work due to the excruciating pain on a daily basis. - Matt M
Pain had changed my entire life. I no longer wanted to visit friends because I
knew my back was going to start hurting, and I did not want to take the
morphine and drive. It was a monumental chore just getting up to go to work Patient Feedback…
and by the time I got off work I was so drained of energy I could do nothing
but go home take the morphine and lay down to get prepared for the next I cannot begin to express my gratitude for the renewed quality to
day. I am thanking you from my heart because I now have my life back. I am my life that you and your staff have given me. The chain of events
totally pain free and I do mean PAIN FREE. In my heart, I know that you and that led me to all of you can only be explained by divine
your staff are a God send to me. I laugh more now, My face no longer shows intervention (my 2 guardian angels - my mother and
the pain I was in, where family would constantly ask, “Are you OK?” because
grandmother). As a pharmacist I've seen the end results of many
you look like you are in great pain.
patients who went through the traditional form of spinal surgery.
The endless chain of narcotic pain meds, back braces, depression
I cannot thank you and your staff enough for giving me my life back. If you
ever need a testimony of how GREAT your procedure is, please don’t ever
and the little quality left in their lives that seems to go on and on.
hesitate to call upon me. I came close to being there myself but backed out last minute and
then I found all of you. Thank you for being here for me. I will
Grateful from my Heart, Thank you, Thank you, Thank, you continue to spread the word and hopefully others will get their
- Steven C. Vestal lives back also.
- Claudia
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17. Our Locations Forest Park Medical Center—Dallas, Texas
Forest Park Medical Center in Dallas is a
new, state-of-the-art medical facility.
With unsurpassed service, exemplary
care and the highest quality medical
facility, 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.
• 24 inpatient beds
• 16 state of the art fully integrated
operating suites
• 19-bay preoperative and
postoperative area
With state of the art Operating
• Full service kitchen
Rooms and luxurious Patient
Rooms, comfort is afforded with
• Ancillary services
ease. Located just minutes North
of Downtown Dallas, Forest Park is
• Imaging center with MRI, CT and
R&F Room
near some of the finest dining and Forest Park Medical Center
entertainment Texas has to offer. 11990 North Central Expressway
• On-site, fully staffed Emergency Dallas, Texas 75243
Room
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18. 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 luxurious
Patient Rooms, comfort is afforded with ease. Located
near Downtown Houston adjacent to Reliant Stadium
in 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
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