WARSAW2051
`NuVasive, Inc. v. Warsaw Orthopedic, Inc.
`Case IPR2013-00206
`
`Page 1
`
`

`

`South Texas Spinal Clinic, P.A. l Spinal Surgery, Spine Surgeons, Texas Spine Care
`
`Page 2 of 2
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`South Texas Spinal Clinic Surgeons often confer about such surgical situations, valuing each other's professional
`opinions and finding strength in collaborating. The South Texas Spinal Clinicis a leader in identifying specialized
`techniques in spinal surgery, pain management, electro-diagnostic medicine and physcial therapy. They believe
`their Nuvasive affiliation will open up many new possibilities and provide even better outcomes for their patients
`in the future.
`
`Though they come from different backgrounds, the physicians at South Texas Spinal Clinic share a warm
`camaraderie and dedication to their field. They're also in agreement about the strss factor in their medical
`specialty: They say it's a big responsibility to navigate surgical instruments in an area as sensitive as the
`vertebral column. But the rewards that come from eliminating back, neck and leg pain and the opportunity to
`help patients resume their normal activities make it all worthwhile.
`
`In addition to having impressive scholastic credentials, the spine surgeons at South Texas Spinal Clinic are
`members of prestigious organizations, including the North American Spine Society and the Society of Lateral
`Access Surgeons (SOLAS), which promotes the XLIF technique and helps keep physicians advised of the latest
`research and innovations in the surgical field. As for awards, it would take pages to list them and these
`physicians never tire of talking about the vistas that are opening up in their field thanks to research and modern
`technology. And without a doubt, all the innovation is good news for patients who might feel intimidated by
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`Q.’r-‘Akn
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`traditional spinal surgery.
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`For more information about NuVasive and minimally invasive spinal surgery, visit www.nuvasive.com. Since its
`discovery, the procedure has continually grown more refined and safer with spinal implant companies such as
`NuVasive leading the way.
`
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`http ://WWW.spinaldoc.com/NuVasiVeiSpinaliSurgery.php
`
`CONFIDENTIAL
`
`7/12/2013
`
`MNUV5059288
`
`Page 2
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`Page 2
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`
`AL RESEARCH FOUNDATION
`
`Direct Lateral Interbody Fusion A prooch in the Treatment of 0
`Patient Suffering from Degener'oIve Lumbar Scoliosis Stenosis Lumber
`Rodiculopo’rhy, and Neurogenic Cloudico’rion
`Michael W. Hosz, MD
`
`Background Context: Several recent surgical advances allow patients to be treated in a less invasive manner,
`yet still afford the patient the significant benefits that have been afforded in the past by other techniques. These
`advances have changed our treatment of adolescent scoliosis. A deformity can often be better corrected
`and anterior surgery avoided by utilizing pedicle screw instrumentation technology and segmental posterior
`instrumentation.
`
`Purpose: To demonstrate the utility of a new approach for minimally invasive spinal fusion.
`
`Methods: Case report of a patient presenting with ongoing back pain and lower extremity pain who underwent
`
`a minimally invasive interbody fusion.
`
`Results: The patient showed significant improvement of both axial back pain as well as her lower extremity
`symptoms.
`
`Case Report
`
`Aseventy-seven year old female presented with
`
`ongoing back and lower extremity pain.
`
`She
`
`was diagnosed with degenerative lumbar scoliosis,
`
`stenosis,
`
`as well
`
`as
`
`lumbar
`
`radiculopathy and
`
`neurogenic claudication.
`
`Since
`
`she had failed
`
`treatment,
`conservative
`nonoperative
`extensive
`surgical intervention became an option for her.
`
`Various
`considered.
`
`options were
`treatment
`surgical
`First,
`the goal of surgery had to be
`
`determined. One goal was to decompress the nerves.
`It was hoped that by decompressing the nerves,
`the
`lower extremity symptoms would improve.
`Options for decompressing the nerves would be via
`laminectomy or foraminotomy. However, her second
`chief complaint was that of axial back pain. Axial
`back pain can originate from many sources, including
`the arthritic changes associated with degenerative
`
`scoliosis. Axial back pain would not be relieved
`by nerve decompression. A third concern was the
`possibility of her lumbar scoliosis progressing even
`further without any surgical intervention. Fusion of
`the vertebrae would be indicated to relieve the axial
`
`back pain and align the lumbar spine. Additionally, an
`indirect decompression of the nerves at the foramina
`could be performed by improving the alignment of the
`scoliosis.
`
`Surgical Procedure
`
`to address these three goals, we
`In an effort
`elected to proceed with the direct
`lateral anterior
`interbody fusion of the lumbar spine. This minimally
`invasive
`retroperitoneal
`approach
`allowed
`for
`significant
`improvement
`in the patient’s scoliosis
`deformity
`and
`indirect
`decompression of
`the
`foramina, as well as the canal, during realignment.
`
`It
`also
`required
`significantly
`less
`posterior
`surgery than would have been required if the
`full
`decompression
`had
`been
`done
`directly.
`
`Journal of The Spinal Research Foundation 55
`
`
`
`Fig. 1 -Direct Lateral Interbody Fusion procedure
`(Image courtesy Medtronic http:l/wwwlessinvasivespinecom/sextant-
`systemhtml)
`
`SPRING 2010 VOL 5 N01
`
`CONFIDENTIAL
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`Page 3
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`MNUV5059289
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`Page 3
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`Fig. 3 -Lateral x-ray of the lumbar spine prior to surgery (left)
`and after surgery (right), showing curve correction and lordosis
`restoration
`
`between the muscle fibers of the psoas muscles to
`enter the disc space. This facilitates the use of
`smaller skin incisions while maintaining the benefits
`of the retroperitoneal approach. The direct lateral
`interbody techniques appear to offer a significant
`improvement
`in the treatment of some patient’s
`conditions. This approach is a useful tool for a well
`rounded surgeon to have};-
`
`Fig 2. -Anterior-PosteriorX-ray of the lumbar spine priorto surgery
`(left) and after surgery (right),
`showing scoliosis correction
`
`Results
`
`This procedure allowed the patient to be mobilized
`
`sooner than traditionally would have been an option
`
`for her. This can help decrease the risk of postoperative
`
`morbidities associated with prolonged bed rest and
`decreased activities. Preoperative versus postoperative
`radiographs demonstrated significant improvement in
`the lumbar scoliosis. Her clinical report demonstrated
`significant improvement of both axial back pain as
`
`well as her lower extremity symptoms.
`
`Discussion
`
`Direct lateral interbody fusion is an innovative
`
`surgical procedure. This surgical procedure expands
`
`upon the advantage of a retroperitoneal approach to
`
`the anterior lumbar spine.
`
`It
`
`involves using a
`
`technique of entering the disc, preparing the disc,
`and placing an implant for interbody fusion through
`a more lateral approach. This is directed through and
`
`Michael W. Hasz, MD
`
`is Board certified by
`Dr. Hasz
`The American Board
`of Spine
`Surgery.
`He is a fellow in the
`American Academy of Orthopaedic
`Surgeons and a member of both
`the
`American Association
`of
`
`
`
`Orthopaedic Surgeons and the North American Spine Society.
`He was Chairman of the Department of Orthopaedic Surgery
`and Director of Spinal Surgery at the Andrews Air Force Base
`I Malcolm Grow Medical Center in Maryland. He currently holds
`an appointment as Clinical Instructor ofOrthopaedic Surgery and
`Assistant Professor of Surgery at the Uniformed Services Health
`Science University in Bethesda, Maryland.
`
`SPRING 2010 VOL 5 N01
`
`CONFIDENTIAL
`
`Journal of The Spinal Research Foundation 56
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`MNUV5059290
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`Page 4
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`Page 4
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