1. London Bridge Hospital Orientation
January 2011
COMPANY CONFIDENTIAL NOT FOR DISTRIBUTION

2. What Is SCS?
Spinal cord stimulation (SCS) is a reversible and minimally invasive therapy for reducing chronic leg pain
Typical indications include patients with :
Failed Back Surgery Syndrome (FBSS)
Intractable neuropathic leg pain
Complex Regional Pain Syndrome (CRPS)
SCS has been in use for more than 40 years to treat patients with chronic, neuropathic pain
Current players: Medtronic, St Jude Medical and Boston Scientific
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3. What Is SCS? SCS procedure involves:
percutaneous or surgical implantation of leads into the epidural space
leads are connected to an implantable pulse generator (IPG)
Electrical pulses delivered to the spinal cord alleviate pain
SCS trial to permanent implant process:
“Temporary trial”
Percutaneous lead insertion
Intra-operative testing & programming
Therapy at home for several days/weeks
“Permanent implant”
IPG implanted & connected to lead
If >50% pain relief
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4. Conventional SCS’s Unmet Needs
Paresthesia-dependent masking of pain
Paresthesia (an altered sensation) is felt as an electrical “buzzing” or tingling sensation in the extremities
The position of the leads and the electrical parameters programmed determine the location and intensity of the paresthesia
Paresthesia commonly induces a shocking sensation as body position changes
71% of SCS patients surveyed found paresthesia uncomfortable, sometimes worse than the pain itself
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5. Conventional SCS’s Unmet Needs
Failure to adequately treat low back pain
Attempted and failed to achieve consistent and durable back pain relief:
Medtronic
St. Jude
Boston Scientific
Leg pain relief commonly unmasks underlying back pain post-SCS
Attempts to relieve back pain commonly over-stimulate the legs
Unresolved back is a major opportunity—NANS 2010 survey respondents indicated that:
43% of their current SCS patients complained of unresolved back pain
SCS procedure volume would grow 110% if they had access to a device that allowed them to effectively treat low back pain
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6. Conventional SCS’s Unmet Needs
Inefficient use of theatre and physician time
Intra-operative testing involves an iterative approach with poor guidelines for lead placement and optimal parameter selection
Patient must be awakened in the operating room to provide feedback to the physician regarding coverage of painful regions with paresthesia
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7. Conventional SCS’s Unmet Needs
Continued need for opiates to provide relief for unaddressed (back) pain
65% of SCS study candidates were on opiates at baseline
Continued management of narcotic analgesics is an additional burden for physician and patient with significant concerns regarding addiction
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8. Nevro System Benefits Relief of leg and back pain
Intra-operative procedure simplicity
Anatomic versus physiologic lead placement
Reduced physician management burden
No paresthesia or shocking
Limited return office visits required
Reduced device complexity for patients
Reduced need for opiates and opiate management
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9. Nevro Clinical Trials US Feasibility Study
Evaluation during temporary trial considering:
Patient preference for Nevro versus Conventional SCS
Presence of paresthesia, jolting and shocking
Short-term pain relief
International Multi-center Trial
Evaluation of Nevro’s permanently implantable SCS system considering:
The long-term, sustainable relief of leg and back pain
Functional improvements reported by patients
Opiate use post-implant
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10. Nevro provides better pain relief (77% vs 56%)
US Feasibility Trial Results Pain Relief (10 point Visual Analog Score) 10
Nevro provides better pain relief (77% vs 56%)
Show only CRF data. Use Bar graph
Baseline, commercial, Day 4
P < 0.001
P < 0.001
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11. US Feasibility Trial Results Pain Relief
More positive screenings result in more implants
In terms of pain relief with Nevro, on average had 76% pain relief, and Commercial had on average 56% pain relief.
But this data needs to be explained too much. So using patient with > 50% pain reduction is more clear cut and implies trial to perm ratio.
14 out of 24
20 out of 24
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12. US Feasibility Trial Results Patient Preference12
88% of Patients Prefer Nevro Therapy
(N=24)
Prefer Nevro
21 out of 24 patients chose Nevro therapy over Conventional SCS
Nevro patients:
do not experience paresthesia
do not need to adjust therapy with changes in body position
are not shocked during body position changes
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13. International Multi-center Trial Results Long-term Data Comparison
Nevro versus PROCESS* Trial Results
3x better relief of back pain
Nearly 2x better leg pain relief
50% improvement in function
3x less opiate use
*most credible Conventional SCS study to date
(1)Pain relief is measured by difference in VAS.
(2)Functional Improvement is measured by reduction in Oswestry Disability Index score. 0 = no disability, 100= extreme disability. Higher reduction in score represents better functional improvement.
(3)Kumar, 2007, PAIN. Pain relief data are extrapolated from graphs in the article.
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14. International Multi-center Trial Results Nevro: Succeeding Where Conventional SCS Has Failed
87%
Success
Rate in SCS Failures!
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15. Other Results and Benefits
No reported paresthesia
Less programming for doctor and patient
No movement-dependent jolting/shocking
Fewer patient complaints and office visits
Improved sleep
At 6 months, sleep disturbance reduced by 82%
Eliminated (83%) or reduced opiate use at 6 months
Less narcotic management and concern over addiction
Shorter procedure time
More time to enjoy life or perform more procedures!
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16. Nevro Corp Profile Co-Founded by Mayo Clinic CE Mark received May 2010
Licensed technology and know how
$50M invested to date by leading healthcare investors
CE Mark received May 2010
International thought leader support
Jean-Pierre VanBuyten, MD-Belgium
Adnan Al-Kaisy, MD-UK
Jaimie Henderson, MD-Stanford University
Others
Plenary session presentations approved or planned at:
North American Neuromodulation Society Annual Meeting Dec 2010
American Academy of Pain Management Meeting March 2011
International Neuromodulation Society Meeting May 2011
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