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

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

London Bridge Hospital Orientation

January 2011COMPANY CONFIDENTIALNOT FOR DISTRIBUTION

Page 2: London Bridge Hospital Orientation January 2011 COMPANY CONFIDENTIAL NOT FOR DISTRIBUTION.

What Is SCS?

Nevro Confidential

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

Page 3: London Bridge Hospital Orientation January 2011 COMPANY CONFIDENTIAL NOT FOR DISTRIBUTION.

What Is SCS?

Nevro Confidential

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

Page 4: London Bridge Hospital Orientation January 2011 COMPANY CONFIDENTIAL NOT FOR DISTRIBUTION.

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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Nevro Confidential

Page 5: London Bridge Hospital Orientation January 2011 COMPANY CONFIDENTIAL NOT FOR DISTRIBUTION.

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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Nevro Confidential

Page 6: London Bridge Hospital Orientation January 2011 COMPANY CONFIDENTIAL NOT FOR DISTRIBUTION.

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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Nevro Confidential

Page 7: London Bridge Hospital Orientation January 2011 COMPANY CONFIDENTIAL NOT FOR DISTRIBUTION.

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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Nevro Confidential

Page 8: London Bridge Hospital Orientation January 2011 COMPANY CONFIDENTIAL NOT FOR DISTRIBUTION.

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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Nevro Confidential

Page 9: London Bridge Hospital Orientation January 2011 COMPANY CONFIDENTIAL NOT FOR DISTRIBUTION.

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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Nevro Confidential

Page 10: London Bridge Hospital Orientation January 2011 COMPANY CONFIDENTIAL NOT FOR DISTRIBUTION.

US Feasibility Trial ResultsPain Relief (10 point Visual Analog Score)

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P < 0.001P < 0.001

Nevro Confidential

Nevro provides better pain relief (77% vs 56%)

Page 11: London Bridge Hospital Orientation January 2011 COMPANY CONFIDENTIAL NOT FOR DISTRIBUTION.

US Feasibility Trial ResultsPain Relief

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20 out of 2414 out of 24

Nevro Confidential

More positive

screenings result in

more implants

Page 12: London Bridge Hospital Orientation January 2011 COMPANY CONFIDENTIAL NOT FOR DISTRIBUTION.

US Feasibility Trial ResultsPatient Preference

21 out of 24 patients chose Nevro therapy over Conventional SCS

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Nevro patients:

do not experience paresthesia

do not need to adjust therapy with changes in body position

are not shocked during body position changes

Prefer Nevro

88% of Patients Prefer Nevro Therapy

(N=24)

Nevro Confidential

Page 13: London Bridge Hospital Orientation January 2011 COMPANY CONFIDENTIAL NOT FOR DISTRIBUTION.

International Multi-center Trial ResultsLong-term Data Comparison

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Nevro versus PROCESS* Trial Results

(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.Nevro Confidential

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

Page 14: London Bridge Hospital Orientation January 2011 COMPANY CONFIDENTIAL NOT FOR DISTRIBUTION.

International Multi-center Trial ResultsNevro: Succeeding Where Conventional SCS Has Failed

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87%Success

Rate in SCS Failures!

Nevro Confidential

Page 15: London Bridge Hospital Orientation January 2011 COMPANY CONFIDENTIAL NOT FOR DISTRIBUTION.

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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Nevro Confidential

Page 16: London Bridge Hospital Orientation January 2011 COMPANY CONFIDENTIAL NOT FOR DISTRIBUTION.

Nevro Corp Profile

Co-Founded by Mayo Clinic 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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Nevro Confidential


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