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Pros of B12 Oral Sprays: Up to 90% absorption rate (comparable to injections) Completely painless and non-invasive No needles, no medical appointments Convenient daily use at home Travel-friendly and portable More affordable long-term Can use methylcobalamin (superior bioavailability) Pleasant taste (raspberry flavor) No risk of infection Cons of B12 Oral Sprays: Requires daily consistency Must hold under tongue for 30-60 seconds May not be suitable for extremely severe deficiency requiring immediate correction Absorption Comparison One of the biggest myths about B12 supplementation is that injections are the only way to achieve high absorption

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B12 supports hematologic and neurologic functions, and L-carnitine transports long-chain fatty acids into mitochondria

Abbreviations CDH: Cervical disc herniation ACDF: Anterior cervical decompression and fusion PPECD: Posterior percutaneous endoscopic cervical discectomy PELD: Percutaneous endoscopic lumbar disectomy VASs: Visual analog scores NDI: Neck disability index References Carette S, Fehlings MG

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Proposal Summary As noted previously, we proposed to revise 410.63(a)(2), Intermediate Risk Groups, by adding paragraph (a)(2)(iv) to include individuals who have not previously received a completed hepatitis B vaccination series or whose vaccination history is unknown