Low back care is one of the largest unmet clinical needs in medicine, accounting for 50% of all missed work days and up to 30% of the opioid crisis. Over 1 million degenerative lumbar fusions are performed in the US each year, yet spinal fusion has the highest cost and worst outcomes of any hospital procedure. Our purpose is to totally change the paradigm, and bring a step change to the management of leg and back pain.

We've taken a radical approach to care, vertically integrating development, clinical research, and healthcare delivery like no other company. Our flagship technology has become a catalyst for the broader business model of restoring the doctor/patient relationship and aligning incentives across stakeholders.





It all started with a big idea, and big things tend to come in sets of three:


The BalancedBack procedure is based on the radical idea of a prosthesis passing through Kambin’s triangle, utilizing the entire length of the pedicle for postural correction and support.  The innovation works in much the same way a snowshoe distributes a load across soft snow.  This delicate, patented balance of features allows for aggressive deformity correction without compromising integration of the construct. 


Unlike an anterior disc, our procedure replaces the function of the disc and both facet joints: the first ever “total” joint replacement for the lumbar spine.  No other technology ever conceived allows the surgeon to more fully address both leg and back pain.  



With our powered osteotomy, the surgeon can correct over 20-degrees of segmental lordosis per level, using a simple, high-speed, navigated, revisable, posterior approach.  Put your head over your feet.  Keep it that way if you lose or gain weight.  And most importantly, maintain normal biomechanics when you transition from standing to sitting, or when you slump in a chair.  All from the back, and even better with the help of a spinal robot. No other technology can do this, and no other procedure comes close to our clinical outcomes.

Sound hard?  What if we told you this is all done on an outpatient basis, with hardware implantation time of about 15 minutes?  We welcome you to visit our clinic and see for yourself.  Total Joint Replacement for the lumbar spine is here. 



Marissa Koscielski


Marissa manages our clinical programs and keeps everyone moving in the same direction, across several continents and time zones.

Ron Yarbrough


Ron manages our regulatory and quality functions, and is the key operating leader for our supply chain.

Miguel Monteiro


Miguel manages inventory control, logistics, and additionally supports new product development.

Brady Riesgraf

Clinical Associate

Brady does the heavy lifting for inbound marketing, clinical qualification, protocol development, and EDM. 

Gregory Hunter


Greg leads the finance and tax team for our Special Economic Zone Company and management sub. 

Marc Peterman


Marc leads the strategic and new product development functions of the company.

Scott Hodges

Medical Director

Scott drives clinical decision making, study development, and ideation to advance patient care. 

Craig Humphreys


Craig executes the publication plan and is responsible for management of clinical activities at our African sites.

Nathan Schatzman


Nathan represents the company's investors and provides leadership to the Board of Directors.

Don Duff

Practice Manager

Don administers the Cayman practice, study data collection, and rehabilitation programs.

Marcus James


Marcus is the interface between our recruitment function and care delivery. 

Donna Duff

Patient Advocate

Donna helps patients achieve their individual goals at every step of their journey. 



The BalancedBack procedure is the first Total Joint Replacement for the lumbar spine, an alternative to spinal fusion for patients suffering from leg and back pain. This innovation is the result of $32 million in R&D and over 12 years of clinical research.


Unlike other lumbar motion technologies, the BalancedBack procedure is appropriate for the vast majority of degenerative indications, allowing the surgeon to replace the function of the entire joint. We restore up to 20 degrees of segmental sagittal balance per level, while maintaining a full 18-degree range of motion.  This allows the patient to comfortably balance in a standing posture, unwind their lumbar lordosis sitting, and obtain kyphotic lumbar postures on slumped sitting.  Recent literature indicates that this adaptive balancing is the key driver to adjacent segment breakdown and revision surgery. 


We have an integrated spine practice in the Cayman Islands, where we provide concierge access to the entire MotionSurgery technology continuum, at affordable prices. 


The practice is research based and built around an episode of care model, where the incentives of patients and providers are fully aligned. We offer unlimited surgeon consultations, one-on-one nursing care, and 100% outcomes data collection and reporting. 


This innovative delivery model provides exceptional quality, fixed cost, and transparent outcomes, often referred to as the “triple Aim.”

Why are fusions so common if the data are so bad? To answer this question you have to look at reimbursement dynamics influencing the surgeon, the hospital, and even certain insurance plans. Up and down the chain, everyone does well with fusion. Everyone except the patient.


If you remove reimbursement from the equation, a whole universe of under-utilized alternative procedures become available. We call these Motion Surgeries. Some are simple, others are complex. Most involve no implant hardware at all. Each are effective across a broad swath of indications, and each preserve options for the patient. In many cases, a simple endoscopic decompression is all somebody needs. At the end stages of the disease process, some people will require a cervical disc or lumbar total joint replacement.


Fusion isn't in the picture at all. In this new paradigm, fusion is a salvage procedure. And, as you might imagine, in this new paradigm there is no such thing as an MIS fusion.  

What if you built a new kind of clinic, a NovoClinic? Imagine that this clinic didn't take insurance, but instead charged very reasonable, published, flat fees. Every patient was entered into a registry and the outcomes were available publicly in real time.


Imagine that this clinic was sophisticated enough to reduce the regulatory friction associated with new technology, allowing the doctors to make medical decisions in the best interest of the patient, with the latest technology available worldwide, aligned with the pathology, risk tolerance, and goals of the patient.  


That's our model. At NovoClinic, patients are empowered to take control of their own healthcare.  At NovoClinic, incentives are aligned. We welcome you to visit us and see for yourself.



International Surgical SEZC

Cayman Enterprise City

Strathvale House


Grand Cayman KY1-9012

Cayman Islands


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