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  "documentTitle": "Nevro Corp. (NVRO)",
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  "authorName": "Kir Kahlon",
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  "notes": "Uses expert testimony (KOL and Medtronic regional manager) to undermine the company's core product value proposition.",
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      "text": "If Nevro continues to do sloppy lead placement and try to switch to classic low frequency stimulation, they're going to run into all sorts of problems and unintended consequences.",
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      "text": "A KOL explained why Omnia’s “all frequencies and waveforms” shtick is absurd and haphazard. Aside from differences in lead location by frequency, different waveforms which Omnia claims to offer, like burst, also require placement at different vertebrae than Nevro’s one-size-fits-all insertion at T8/9.",
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      "text": "A regional manager in one of Medtronic’s largest territories stated that Nevro’s no-paresthesia method causes doctors to be sloppy with lead insertion, causing “all sorts of problems and unintended consequences” if trying to use Omnia for low-frequency stimulation.",
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      "text": "KOL’s explained why Omnia’s “One System, All Frequencies” positioning is clinically illogical and risky, as different frequencies and waveforms require different surgical lead placements. We believe this explains the CEO's admission that Omnia is used almost exclusively as a high frequency device, and it leads us to find alternate explanations for why Omnia is rarely used for lower frequencies as misleading.",
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      "text": "I’ve seen some cases where Medtronic was implanted after a Nevro device was in there, I think their docs get a little sloppy with their lead placement because there is no paresthesia. They just kind of put the leads up, pretty much midline, and it’s good enough. That’s why docs early on were interested - I don’t have to wake up the patient during the procedure. If Nevro continues to do sloppy lead placement and try to switch to classic low frequency stimulation, they’re going to run into all sorts of problems and unintended consequences.",
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      "text": "If you look at true burst, they want you to be about a level up T8/9 which is the sweet spot for burst. So if your electrodes aren’t covering that and you try to do burst, you’re not going to hit it. For different frequencies, you need to be at the right place on the spinal cord to get that stimulation. If you’re at T9/10 where you put your Nevro, you might get it depending on where the affected problem is. You might get the upper thigh but for lower leg, probably not. And you may get other paresthesias that you don’t want. You try to do a tonic, but you’re to get all rib simulation. The idea that you put it in at T9/10 and get the other frequencies to work is very 50/50.",
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      "text": "\"If you look at true burst, they want you to be about a level up T8/9 which is the sweet spot for burst. So if your electrodes aren't covering that and you try to do burst, you're not going to hit it. For different frequencies, you need to be at the right place on the spinal cord to get that stimulation. If you're at T9/10 where you put your Nevro, you might get it depending on where the affected problem is. You might get the upper thigh but for lower leg, probably not. And you may get other paresthesias that you don't want. You try to do a tonic, but you're to get all rib simulation. The idea that you put it in at T9/10 and get the other frequencies to work is very 50/50.\" — KOL and former high volume Nevro implanter; \"I've seen some cases where Medtronic was implanted after a Nevro device was in there, I think their docs get a little sloppy with their lead placement because there is no paresthesia. They just kind of put the leads up, pretty much midline, and it's good enough. That was why docs early on were interested - I don't have to wake up the patient during the procedure. If Nevro continues to do sloppy lead placement and try to switch to classic low frequency stimulation, they're going to run into all sorts of problems and unintended consequences.\" — Medtronic SCS regional manager",
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      "text": "Source: Consultation calls with experts",
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      "text": "10. The new Omnia stimulator, the centerpiece of Nevro’s turnaround hopes, is a Hail Mary and colossal flop",
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      "text": "Scorpion Capital | Nevro (NYSE: NVRO)",
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