Transforming Care

Our Mission

Low back care is one of the largest unmet clinical needs in orthopaedics, accounting for nearly 50%1 of all missed work days and 19% of the opioid crisis in the United States.2 Over 1 million degenerative lumbar fusions are performed in the US each year, yet spinal fusion has one of the highest cost and worst outcomes of any hospital procedure.3 Our purpose is to reenvision 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.

Innovating Spine Motion

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

Cross 3 Columns

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 sagittal 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 in the market allows the surgeon to more fully address both leg and back pain in a single design.


With our 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.

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.

General Manager
Marissa Koscielski

Chief Operating Officer
Ron Yarbrough

Miguel Monteiro

Clinical Associate
Brady Riesgraf

Chief Financial Officer
Gregory Hunter

Chief Executive Officer
Marc Peterman

Medical Director
Scott Hodges

Craig Humphreys

Nathan Schatzman

Practice Manager
Don Duff

Marcus James

Patient Advocate
Donna Duff

Jeffery Goldstein, MD
Louis Nel, MBChB, MMed
Avanish Patwardhan, PhD

Our Portfolio

BalancedBack is available at CTMH Doctor’s Hospital in the Cayman Islands by a team of fellowship-trained US surgeons with over 15 years experience. Meet our team:

Stay Updated


1Guo HR, Tanaka S, Halperin WE, Cmeron LL. Back pain prevalence in US industry and estimates of lost workdays. Am J Public Health. 1999;89(7):1029-1035. doi:10.2105/ajph.89.7.1029

2Deyo RA, Smith DHM, Johnson ES, et al. Opioids for back pain patients: Primary care prescribing patterns and use of services. J Am Board Fam Med. Published online 2011. doi:10.3122/jabfm.2011.06.100232

3Irmola TM, Häkkinen A, Järvenpää S, Marttinen I, Vihtonen K, Neva M. Reoperation Rates Following Instrumented lumber spine fusion. Spine (Phila Pa 1976). Published online 2018. doi:10.1097/BRS.0000000000002291