1. Emerging Technologies in Spinal Surgery Presenter/author date

2. Meet Dr. ____________ Brief overview of featured physician/practice, including – Education background – Years spent practicing – Specialties 2

3. The Dimensions of Back Pain Back pain statistics: Low back pain is the single leading cause of disability worldwide. 1 31 million Americans experience low-back pain at any given time. 2 One-half of all working Americans admit to having back pain symptoms each year. 3 Experts estimate that as many as 80% of the population will experience a back problem at some time in our lives. 4 Spine procedures performed annually 5 : Approx. 500,000 lumbar spinal decompressions Approx. 380,000 thoracolumbar procedures 1 Global Burden of Disease Study 2010. Published Dec 13, 2012. http://www.thelancet.com/themed/global-burden-of-disease.http://www.thelancet.com/themed/global-burden-of-disease 2 Jensen M, Brant-Zawadzki M, Obuchowski N, et al. Magnetic Resonance Imaging of the Lumbar Spine in People Without Back Pain. N Engl J Med 1994; 331: 69-116. 3 Vallfors B. Acute, Subacute and Chronic Low Back Pain: Clinical Symptoms, Absenteeism and Working Environment. Scan J Rehab Med Suppl 1985; 11: 1-98. 4 Vallfors B. Acute, Subacute and Chronic Low Back Pain: Clinical Symptoms, Absenteeism and Working Environment. Scan J Rehab Med Suppl 1985; 11: 1-98. 5 Orthopedic Network News, 2013 Spinal Surgery Update Vol. 24, Num. 4. Published October 2013. www.OrthopedicNetworkNews.com.www.OrthopedicNetworkNews.com 3

4. Sources of Back Pain 4

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8. Conservative Treatment Bed rest Muscle relaxants Physical therapy Prescription pain relievers Interventional pain procedures 8

9. Minimally-Invasive Surgery: A Breakthrough Innovation Potential advantages compared with “open” surgery – Smaller incisions and scars – Minimal scaring and destruction of soft tissue – Less blood loss during surgery – Shorter hospital stay – Less postoperative pain – Less need for postoperative pain medicine – Faster return to work and daily activities Posterior approach - TLIF Anterior/Lateral approach - XLIF 9

10. Mazor Robotics Renaissance® 10

11. Mazor Robotics Renaissance™ Only FDA-approved mechanical guidance system for spinal surgery Accuracy in screw placement < 1.5mm Over 45,000 screws placed & over 7,500 procedures performed Available at only 68 sites worldwide 11

12. Renaissance® Applications in Spine Surgery Posterior Surgical Approaches: Open MIS Percutaneous 12 Thoracic, Lumbar, Sacrum: Spinal fixation ‐Pedicle screws ‐Transfacet, translaminar- facet screws ‐Sacroiliac screws Spinal deformities ‐Scoliosis PSF, osteotomies Cement augmentations ‐Kyphoplasty and vertebroplasty Oncological applications ‐Biopsies, tumor resections Revisions

13. Freehand Spine Surgery Challenges 13 Patient Expectations Clinical Challenges Human Factor Occupational Risk - Safe - Successful - Definitive - 10% misplaced screws 1 - 0.8%-2% permanent nerve damage 2 - Anatomical challenges (eg, deformities, revisions) - Field-of-view (eg, MIS) -Increased cancer risk for spine surgeons 3 -Cancer incidence in orthopedic surgeons vs non- radiation exposed matched controls has Odds Ratio = 5.4 (CI 1.9-15.4) 4 References 1. Kosmopoulos V, Schizas C. Pedicle screw placement accuracy: a meta-analysis. Spine. 2007;32(3):E111-20. 2. Gertzbein SB, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine. 1990;15(1): 11-4. 3. Singer, Occupational radiation exposure to the surgeon, Am Acad Ortho Surg. 2005;13:69-76. 4. Mastrangelo G, Fedeli U, Fadda E, Giovanazzi A, Scoizzato L, Saia B. Increased cancer risk among surgeons in an orthopaedic hospital. Occup Med. 2005;55(6):498-500.Saia55(6

14. Mazor Robotics Renaissance® Spine Surgery 14 Goals: Improve accuracy with screw placement ‐Higher confidence and safety in difficult areas May reduce use of fluoroscopy/risk Maintain standard operative time ‐Improve screw insertion times, especially in cases of difficult anatomy Can use for all levels of difficulty: minimally-invasive, percutaneous and complex/deformity cases

15. How It Works – Step 1 15 Step 1: Preoperative Plan Step 4: Operate Step 2: Mount Step 3: 3D Sync Preoperative blueprint of the ideal surgery is created in a virtual 3D environment.

16. How It Works – Step 2 16 Step 1: Preoperative plan Step 4: Operate Step 2: Mount Step 3: 3D Sync Rigid attachment to the patient ensures maximum surgical accuracy throughout the procedure.

17. How It Works – Step 3 17 Step 4: Operate Step 2: Mount Step 3: 3D Sync Two fluoroscopy images are synchronized with the CT- based surgical blueprint (independent of anatomy). Step 1: Preoperative plan

18. How It Works – Step 4 18 Step 4: Operate Step 2: Mount Step 3: 3D Sync Step 1: Preoperative plan Tools and implants are guided to the planned trajectory with 1.5mm accuracy.

19. Contact info For More Information