American Society of Interventional Pain PhysiciansTHE VOICE OF INTERVENTIONAL PAIN MANAGEMENT

LUMBAR ENDOSCOPIC SPINAL DECOMPRESSIONREVIEW COURSE AND CADAVER WORKSHOPDesignated for 15.5 AMA PRA Category 1 Credits™

JULY 12-13, 2019 | HILTON MEMPHIS

ASIPP® Educational Services | Excellence in the education of Interventional Pain Physicians

COURSE VENUEHILTON MEMPHIS 939 Ridge Lake Blvd, Memphis, TN 38120Phone: 901-684-6664

WORKSHOP VENUEMEDICAL EDUCATION & RESEARCH INSTITUTE44 South Cleveland, Memphis, TN 38104901-722-8001 | 800-360-6374http://www.meri.org

THIS COURSE IS OPEN TO PHYSICIANS ONLY

American Society of Interventional Pain Physicians2

LUMBAR ENDOSCOPIC SPINAL DECOMPRESSION REVIEW COURSE AND CADAVER WORKSHOPJULY 12-13, 2019 | HILTON MEMPHIS

YOU’RE INVITED On behalf of the Board of the American Society of Interventional Pain Physicians (ASIPP®),

it is our privilege and pleasure to invite you to attend this Lumbar Endoscopic Spinal

Decompression Comprehensive Review Course and Hands-On Cadaver Workshop. The 1/2

day didactic course is July 12 at the Hilton Memphis and the 1 1/2 day Cadaver Workshop is

July 12-13 at the Medical Education Research Institute facility. This course meets the needs of

interventionalists based on input and needs assessment.

EDUCATIONAL OBJECTIVES/TARGET AUDIENCEThis comprehensive review course and cadaver workshop for Lumbar Endoscopic Spinal Decompression are targeted to interventional pain physicians seeking CME credit hours and an introduction or review of proven interventional techniques, as well as skills improvement.

EDUCATIONAL OBJECTIVES • Provide high-quality, competent, safe, accessible, and cost-efficient services to your patients• Improve existing skills and/or develop new skills in the delivery of Lumbar Endoscopic Spinal Decompression• Incorporate interventional techniques in treating your patients so that patients have better outcomes and reduced side effects

AMERICANS WITH DISABILITIES ACT AND SPECIAL SERVICESOrganizers fully comply with the legal requirements of the Americans with Disabilities Act and the rules and regulations thereof. If any participant in this educational activity is in need of accommodations, please contact the organizers at (270) 554-9412 at least 10 days prior to the conference.

ACCREDITATION STATEMENTThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of The Institute for Medical Studies and the American Society of Interventional Pain Physicians (ASIPP®). The Institute for Medical Studies is accredited by the ACCME to provide continuing medical education for physicians.

CATEGORY I CREDITThe Institute for Medical Studies designates the Lumbar Endoscopic Spinal Decompression Review Course and Cadaver Workshop live activity for a maximum of 15.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ASIPP® is now an ABA Registered CME Provider.

Duplication or distribution of materials or recording of lectures without express written permission from ASIPP® is prohibited. There is NO commercial support for this course.

Laxmaiah Manchikanti, MDChairman of the Board and Chief Executive Officer, ASIPP®

Jason Capra, MD, PhDEditorial Board, Pain Physician

Sukdeb Datta, MDVice President - Strategic Alliances, ASIPP®

INVITEDFACULTY

Jason Capra, MD Hurlburt Field, FL

Sukdeb Datta, MD New York, NY

Craig Flinder, MD Clarkson, WA

George Rappard, MD Los Angeles, CA

Baher Yanni, MD East Windsor, NJ

ACCOMMODATIONS

HILTON MEMPHIS939 Ridge Lake BoulevardMemphis, TN 38120TEL: +1-901-684-6664 FAX: +1-901-762-7496

Enjoy rooms with luxurious bedding, 49-inch

flat-screen TVs, WiFi and large work desks. A

true gem among hotels in Memphis, TN, the

Hilton Memphis hotel is in the heart of the East

Memphis business district, a short distance

from top attractions. This hotel is located just

a few miles from the upscale shops, cinemas

and restaurants on Poplar Avenue. Downtown

Memphis is just a 20-minute drive and the

airport is just 15 minutes away.

COURSEDIRECTORS

American Society of Interventional Pain Physicians 3

LUMBAR ENDOSCOPIC SPINAL DECOMPRESSION REVIEW COURSE AND CADAVER WORKSHOP

JULY 12-13, 2019 | HILTON MEMPHIS

FRIDAY | JULY 12, 2019

REVIEW COURSE FOR LUMBAR ENDOSCOPIC SPINAL DECOMPRESSION

6:30am– 7:30am Registration and Breakfast

7:30am – 11:00am Session Chair – Jason Capra, MD

7:30am – 7:40am Introduction to Session – Jason Capra, MD

7:40am – 8:00am Patient selection in Endoscopic Spinal Decompression – George Rappard, MD

8:00am – 8:20am Identifying and Managing Complications of Lumbar Endoscopic Surgery – George Rappard, MD

8:20am – 9:00am Technical Consideration of Needle and Endoscope Placement and Manipulation – Sukdeb Datta, MD

9:00am – 9:30am BREAK

9:30am – 10:00am Patient Selection and Technical Considerations of Transforaminal Endoscopic Surgery Inside Out and Outside In – Jason Capra, MD

10:00am – 10:30am Technical Considerations of Disc Protrusion versus Extrusion

Gabriel Jasper, MD

10:30am – 11:00am Technical Considerations of Disc and Spine Decompression for Spondylolisthesis and Stenosis – Baher Yanni, MD

11:00am – 12:00am LUNCH

WORKSHOP FOR LUMBAR ENDOSCOPIC SPINAL DECOMPRESSION

12:15pm Buses Depart from Hotel to MERI

12:45pm – 1:45pm Introduction Lecture – Laxmaiah Manchikanti, MD

2:00pm – 5:00pm HANDS-ON CADAVER WORKSHOP

5:15pm Buses Leave

6:00pm-8:00pm DINNER AND COCKTAIL RECEPTION (non-cme lecture sponsored by Legally Mine, Inc.)

American Society of Interventional Pain Physicians4

LUMBAR ENDOSCOPIC SPINAL DECOMPRESSION REVIEW COURSE AND CADAVER WORKSHOPJULY 12-13, 2019 | HILTON MEMPHIS

SATURDAY | JULY 13, 2019

WORKSHOP FOR LUMBAR ENDOSCOPIC SPINAL DECOMPRESSION

7:00am Buses Depart Hotel to MERI

7:30am – 7:45am REGISTRATION AND BREAKFAST

7:45am – 8:45am Introduction and Discussion – Laxmaiah Manchikanti, MD

9:00am – 12:00pm HANDS-ON CADAVER WORKSHOP

12:00pm – 1:00pm LUNCH

1:00pm – 5:00pm HANDS-ON CADAVER WORKSHOP

5:15pm Buses Depart to Hotel

CADAVER LAB COURSE LEVELS FORLUMBAR ENDOSCOPIC

SPINAL DECOMPRESSION

1. Discography

2. Needle Placement for endoscopy

3. Scope manipulation and equipment use

4. Endoscopic decompression L4/5: prone

5. Endoscopic decompression L5/S1: prone and lateral

6. Endoscopic decompression annular tear: prone

7. Free form practice

American Society of Interventional Pain Physicians 5

LUMBAR ENDOSCOPIC SPINAL DECOMPRESSION REVIEW COURSE AND CADAVER WORKSHOP

JULY 12-13, 2019 | HILTON MEMPHIS

REGISTRANT INFORMATIONIMPORTANT. Please answer all the questions:

MEDICAL DEGREE:

m MD m DO m PhDm List other: ____________________________

PRIMARY SPECIALTY CERTIFICATION:

m Anesthesiology m Physiatrym Neurosurgery m Other: _______________________________

PAIN MEDICINE SUBSPECIALTY CERTIFICATION:

mAmerican Board of Anesthesiology m American Board of Pain Medicinem American Board of Interventional Pain Physiciansm Fellow of Interventional Pain Practice (FIPP)m Competency in Interventional Pain Management m Competency in Regenerative Medicine

SPECIALTY DESIGNATION:

m 09 - Interventional Pain Managementm 72 - Pain Managementm Other: ______________________________________

FELLOWSHIP TRAINING:

mPain Medicine m Spine Surgery m Sports Medicinem Other: ______________________________________

YEARS IN INTERVENTIONAL PAIN MANAGEMENT PRACTICE:m 0 m 1-5 m 6-10 m > 10

NUMBER OF YEARS EXPERIENCE IN LUMBAR SPINAL ENDOSCOPIC DECOMPRESSION:m 0 m 1-5 m 6-10 m > 10

TOTAL NUMBER OF PROCEDURES PERFORMED DURING PAST YEAR:

PROCEDURE TOTAL

Lumbar Discography * _________

Percutaneous Disc Decompression * _________

Lumbar Transforaminal Epidural * _________

Lumbar Interlaminar Epidural Injections * _________

Endoscopic Lumbar Disc Decompression * _________

Endoscopic Lumbar Spinal Decompression for Spinal Stenosis * _________

Endoscopic Decompression for Spondylolisthesis * _________

Endoscopic Spinal Decompression for Disc Extrusion * _________

CHOOSE YOUR CADAVER WORKSHOP LEVEL:

m Endoscopic Spinal Decompression*

m Advanced

* To participate at the Advanced Cadaver Workshop level you must have attended 2 previous ASIPP® Lumbar Endoscopic Spinal Decompression courses and performed at least 20 basic edoscopic cases. Please provide proof.

Please indicate the number of Lumbar Endoscopic Spinal Decompression courses you have attended with ASIPP and at which level; two are required for the advanced level of this course:

NUMBER OF ASIPP® LUMBAR SPINAL ENDOSCOPIC DECOMPRESSION COURSES BY LEVEL:

Basic m 0 m 1 m 2 m 3 m Other ____

Intermediate m 0 m 1 m 2 m 3 m Other ____

Advanced m 0 m 1 m 2 m 3 m Other ____

REGISTRATION PLEASE PRINT EXACTLY AS YOU WISH YOUR NAME TO APPEAR:

___________________________________________________________________________________________________NAME (FIRST) (MIDDLE INITIAL) (LAST)

_________________________________________________________________________________________ORGANIZATION

_________________________________________________________________________________________ADDRESS

_________________________________________________________________________________________CITY STATE ZIP

_________________________________________________________________________________________PHONE CELL FAX

_________________________________________________________________________________________E-MAIL

PAYMENT METHOD (Please check one):m MASTERCARD m VISA m AMERICAN EXPRESS m DISCOVER

________________________________________________________________________________________CREDIT CARD NUMBER SECURITY CODE (Back of Card) EXP. DATE

________________________________________________________________________________________NAME ON CARD

________________________________________________________________________________________AUTHORIZED SIGNATURE (required on all credit card orders)

(Your application will not be processed if payment does not accompany registration form)

RETURN COMPLETED FORM TO:ASIPP®, 81 Lakeview Drive, Paducah, KY 42001 or Fax to 270-554-5394

CANCELLATION POLICY:ASIPP reserves the right to cancel this course upon reasonable notice and will assume no financial obligation to registrants for cancellation for reasons beyond its control. Registration fees will be refunded, however, costs incurred by the registrants, such as airline or hotel fees or penalties, are the responsibility of the registrants. ASIPP requires a 30-day notice of cancellation. Cancellations must be submitted in writing by June 12, 2019. Cancellations after June 12, 2019 but prior to June 26, 2019 will forfeit 50% of their registration fee. No refunds can be made after June 26, 2019.

REGISTER ONLINE AT http://www.asipp.org/ASIPP-National-Meetings.html

LUMBAR ENDOSCOPIC DECOMPRESSION REVIEW COURSE AND CADAVER WORKSHOPPhysicians only- All registrations must be approved

* To participate at the Advanced Cadaver Workshop level you must have attended 2 previous ASIPP® Lumbar Endoscopic Spinal Decompression courses and performed at least 20 basic edoscopic cases. Please provide proof by submitting below.

Review Course and Cadaver Workshop

m $4,650 Member m $4,950 Non-Member

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