NAME
PLEASE READ THE MARKED CHAPTERS WITH CAREFUL ATTENTION.
PLEASE DISCUSS ANY QUESTIONS THAT MIGHT ARISE WITH YOUR
SPECIALIST BEFORE SIGNING THE DECLARATION .
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Anatomy of the Spine
Back Pain
Osteoporosis
Lumbar Slipped Disc
Lumbar Spinal Stenosis
Spondylolisthesis
Kyphosis and Scoliosis
Tests and Scans
Back Pain and Emotional Distress
Going to Theatre
Anaesthesia
Your Back Operation
Lumbar Nerve Root Block
Caudal/Sacral Block
Lumbar Facet Block
Lumbar Radiofrequency Rhizotomy
Lumbar Nucleoplasty
Lumbar Microdiscectomy
Lumbar Decompression
Lumbar Fusion
Anterior Lumbar Interbody Fusion
Lumbar Total Disc Arthroplasty
Kyphoplasty and Vertebroplasty
Scoliosis Surgery
Everyday Life
Please see the website www.my-spine.com for further infor-
mation about the prosthesis involved as well as videos, forums
and blogs.
I, .............................................................................................
have read the chapters marked above. I believe that I understand the
pathology and the reason why the following procedure
................................................................................................
is being carried out to address my underlying pathology and I under-
stand the risks involved. I have had the opportunity prior to signing
this document to ask any further questions I may have had about the
procedure and the risks involved.
Signed:
Date: