Total Joint Replacement Common Questions

Do you have patient stories?

Yes! Take a look at one of our most recent patient stories below, and then click here to see what the path to recovery looked like for even more BalancedBack® patients.



How can I find out if I’m a candidate for BalancedBack®?

The first step is to reach out to us via our website. Our clinical coordinator will do an initial screening, with a few basic questions about your history and condition. A BalancedBack® surgeon will then review the data and request additional imaging, usually an MRI. Thereafter, you will discuss your condition and the procedure with your surgeon, and make a decision together if BalancedBack® is right for you. We also welcome involvement from your current spine surgeon, primary care physician, therapist, or chiropractor.

Note that most commonly we address single-level pathologies, but we are able to treat up to three levels at one time. The most common pathologies of BalancedBack® candidates include degenerative disc disease, facet joint arthritis, severe spinal stenosis, recurring herniated discs, and spondylolisthesis.

Can I see the results of previous BalancedBack® surgeries?

Yes. Before committing to any type of surgery you want to know what you can expect. The BalancedBack® total disc replacement procedure is still relatively new, but we’ve been consistently collecting data since the first surgery was performed ten years ago. 

By sharing the results of actual BalancedBack® patients, we hope you’ll be able to make a more informed decision about whether or not the procedure might be right for you. You can view the latest data here.

Why do I have to travel for surgery?

Every country has its own regulatory paradigm. Due to the pace of the Food and Drug Administration (FDA)’s approval process, anti-innovation efforts to control skyrocketing healthcare costs, and a politicized insurance system, the U.S. is often slow to adopt new medical technology.  

In contrast, the British territory of the Cayman Islands provides a first-class healthcare, financial, and tourism economy efficiently regulated by the Health Practice Commission (HPC). Each of our U.S.-based, fellowship-trained providers is licensed by HPC to practice in Cayman, as well as the U.S. The team travels with you to Cayman for surgery, where HPC regulates the safe clinical use of BalancedBack®. This arrangement gives you the opportunity to take advantage of the advanced technology ahead of a possible approval by the FDA.  

Destination healthcare is an emerging trend. More and more people are taking control of their own healthcare, seeking safe, effective, and affordable solutions to their medical conditions outside of the United States system.

How much does the BalancedBack® procedure cost?

Typical total cost is approximately $55,000 USD. That includes travel and accommodations, surgical care, and local ground concierge service. There is no cost for your initial consultation with our clinical team.

Does insurance cover a total joint replacement?

The BalancedBack® procedure is not covered by insurance. Certain self-insured plans may provide for reimbursement, but the procedure is private pay.

What is the recovery period?

Recovery from any surgical procedure will depend on your individual condition. Also, all patients have different lifestyles and therefore different expectations coming out of surgery. Our rehabilitation specialist will discuss your goals with you before surgery, and design a recovery program to help you reach them.

In general, BalancedBack® patients are ambulating the same afternoon or evening after surgery, and are discharged from the hospital the next day. Patients spend an average of five days recovering on Seven Mile Beach before traveling home, with daily physician visits and rehabilitation sessions. Most patients begin a more aggressive physical therapy program at week six, and return to unrestricted activity at about three months.

How long will I be in the Caymans?

Patients typically arrive in Grand Cayman one or two days ahead of their scheduled procedure, and travel home five to seven days after surgery. The length of stay can be shortened or extended based on your individual condition and preference, but 10 days total is typical. Please note that pricing is not influenced by length of stay. It is our goal to design the optimal destination healthcare experience based on your travel distance, time off work, travel preferences, and individual condition.

What is the experience like?

We work hard to provide the highest-quality care from the time you arrive on the island until you’re safely back home. It all starts with understanding your individual condition and determining if BalancedBack® is right for you. If the answer is yes, our team will customize travel arrangements to make your trip easy. We select routes, flights, and seats based upon our experience. When you land in Cayman, our airport concierge representative will meet you at your airplane and expedite you through customs. They will bring you to our local concierge curbside, who will take you to your hotel on Seven Mile Beach, manage your luggage, and remain available to help you with small requests throughout your stay, like groceries, dinner reservations, or other needs. At your hotel, you will receive a welcome bag telling you what to expect during your stay, the names and contact information of our team members, and other useful items and information.

After settling in, you will complete one last pre-operative visit at NovoClinic prior to your surgery that includes pain and disability scores, baseline pre-operative x-rays, and a neurologic exam. Our team will manage transport to and from CTMH (Chrissie Tomlinson Memorial Hospital) Doctors Hospital for you and your traveling companions during your surgery stay. Our goal is to get you out of the hospital and back to your room on Seven Mile Beach as quickly as possible, where our clinicians and rehab specialists will visit you several times daily to aid with your mobility and minimize any post-surgical discomfort.

A safe surgery is our number-one goal, but we also take pride in a superior vacation experience in the days before and following your surgery. We believe the postoperative experience is important for your long-term recovery, and have structured the entire program to maximize your chances of a successful outcome.

On the day of departure, our ground concierge will meet you at the hotel, manage your luggage, and bring you to the airport, expediting you through security and staying with you until you are comfortably seated on the airplane. From there, the airline will assist you with connections and luggage to your local ground transportation home. (For your comfort, we request special assistance from the airline on departure.)  

Even after you arrive home, you’ll interact with a dedicated NovoClinic team member to coordinate future care through your primary care physician, physical therapist, or other providers as needed. Our goal is to help you regain full, pain-free motion, and the outcome you expect.

Can I make my own travel arrangements?

We prefer to arrange travel, simply because we know what is easy and hard for people with your healthcare condition. If you are a savvy traveler and prefer to make your own arrangements, let us know and we’ll tailor a program to meet your needs. People often ask to use airline miles or other loyalty programs to reduce travel cost, which is fine, or elect private air travel over commercial flights in certain circumstances. Whatever your request, we have likely managed it before and will be happy to help meet your needs.

Can I bring someone, and will it increase the cost?

We strongly encourage you to bring a friend, spouse, or significant other. It makes the experience more pleasant for you, and it’s a good opportunity for both of you to enjoy the beauty of the Cayman Islands. When patients come to Cayman a day or two early with someone they trust, we see the natural anxiety of traveling for care melt away.

The cost of the procedure includes companion costs for accommodations, but not travel.

How would I know if this procedure is right for me?

Our clinical coordinator will do an initial screening, with a few basic questions about your history and condition. A BalancedBack® surgeon will then review the data and request additional imaging, usually an MRI. Thereafter, you will discuss your condition and the procedure with your surgeon, and make a decision together if BalancedBack® is right for you. We also welcome involvement from your current spine surgeon, primary care physician, therapist, or chiropractor.

Who are the BalancedBack® surgeons?

Dr. Scott Hodges and Dr. Craig Humphreys perform BalancedBack® procedures at CTMH in Grand Cayman, assisted by anesthesiologist Dr. Nathan Schatzman and their team. All our fellowship-trained, Board-certified specialists have 20+ years of clinical practice in the United States. Please visit our website to read their biographies. You can also visit Heathgrades or similar websites for more information.

Is my medical information confidential?

We value your privacy, which is why we use HIPAA compliant software to store all of your medical information. 

How can I get a BalancedBack® surgeon to review my condition?

Either visit the Learn More section of our website, or email our clinical staff directly. They’ll help you gather the information you need about the BalancedBack® procedure, and facilitate an evaluation by one of our surgeons. If you’re a good match for the procedure, it may be possible to schedule surgery in just a few weeks, depending on availability. In other cases, patients interface with our team for many months prior to care, try conservative therapies, or even travel to Cayman to tour the facilities before scheduling a procedure. Our goal is to provide whatever level of information you need. We do not charge for any consultations.

How is BalancedBack® different than an anterior (artificial) disc replacement?

An anterior (artificial) disc replacement addresses degenerative disc disease by replacing a damaged disc with a new, artificial disc. BalancedBack® also addresses degenerative disc disease, but there are differences in the implants, how the procedures are done, and things to consider regarding revision surgery. The main differences between artificial disc replacement and the BalancedBack® procedure are as follows:


Anterior Disc Replacement (ADR)

BalancedBack® Total Joint Replacement


ADR replaces the disc only. The facet joints are left intact.

BalancedBack® replaces the function of the entire joint—both the disc and facet joints—with a new motion device.

Why it’s important: Very often patients have facet joint degeneration at the same time as a degenerating disc, with or without spinal stenosis. Replacing the facet joints and the disc allows you address all pain generators while keeping everything moving.


ADR is performed using an anterior (from the front) approach, through the belly.

BalancedBack® uses a posterior (from the back) approach.

Why it’s important: The anterior approach used in ADR requires surgeons to work around vital internal structures to access the damaged disc, which makes the surgery more complicated, often requiring a vascular surgeon to assist. Additionally, a frontal approach does not allow the surgeon to address spinal stenosis (pinched nerves). BalancedBack® surgeons have much easier, safer access to all of the pain generators, including the disc, pinched nerves, and arthritic facet joints.

Future Surgery

An ADR implant will likely require revision surgery a second time through the belly when it wears out.

BalancedBack® may also require revision surgery, but likely from the back.

Why it’s important: A second surgery through the abdomen is always challenging even for the most experienced surgeons, because of scarring from the initial surgery around the vena cava, aorta, and other vital structures.


Only 2% to 5% of patients have the right indications for total disc replacement—that means they have facet joints in good condition and no other pathologies that need to be addressed to relieve pain, such as pinched nerves or spinal stenosis. A BalancedBack® Total Joint Replacement, in contrast, is a good option for more than 50% of potential patients.

Haven’t found the answer you’re looking for?

Contact us here. It’s important to us that every patient considering Total Joint Replacement surgery understands their condition, the alternatives, and how BalancedBack® can help. If you are not a candidate for BalancedBack® we will help you determine the right course of action.

Want to learn more about total disc replacement?

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