The 1st 5 spine surgery cases with coflex in a NY ASC: Q&A with Dr. Nicholas Renaldo

Nicholas Renaldo, MD, recently became the first surgeon in New York to perform five procedures in an ASC using Paradigm Spine's coflex device.

Dr. Renaldo practices with Poughkeepsie, N.Y.-based Orthopedic Associates of Dutchess County and performs cases at the Surgery Center at Orthopedic Associates. He also serves as the medical director of spine surgery at Vassar Brothers Medical Center in Poughkeepsie.

Q: Why did you decide to incorporate the coflex procedure into your outpatient practice?

Dr. Nicholas Renaldo: The coflex procedure has filled a major gap in my practice in providing options to spinal stenosis patients. Often our only options are laminectomy alone or laminectomy with fusion/instrumentation. Coflex provides a motion-sparing option that protects the soft tissues from aggressive exposure and provides slight foraminal distraction while allowing for controlled motion through a standard laminectomy incision. I am hoping that these effects will prevent recurrent stenosis at the index level and shield other levels from adjacent segment degeneration. The procedure is much less invasive than a traditional fusion and can easily be done on an outpatient basis in the right patients.

Q: What steps did you take to bring the procedure into the ASC?

NR: I have been doing laminectomies and microdiscectomies in the ASC for several years. It was not a big leap to bring the coflex to the ASC. The coflex instrumentation is simple and efficient. An in-service was done with the staff and we were ready to start. Price can be a challenge, and not all insurance companies cover the device. But Medicare does reimburse for the procedure, allowing many affected patients access to the coflex technology.

Q: How did the ASC procedure go? Do you plan to perform more coflex procedures in the ASC?

NR: I have done five cases and they have all done excellent. Leg pain relief is early and there is mild expected incision discomfort. On larger patients, I will leave a drain and have the drain pulled the next day in the office. I will continue to do these cases at the ASC when appropriate, as I feel their overall experience is superior to the hospital.

Q: What quality and economic advantage does the coflex procedure in the ASC setting have for the patient and healthcare system?

NR: The ASC is much more efficient and economically advantageous than the inpatient hospital setting. The center excels at doing smaller, predictable elective cases on healthier individuals and getting them on their feet and back to the comfort of their homes as quickly as possible. The nurses have access to the full services of our adjacent orthopedic office to facilitate patients' needs including PT, OT and bracing. We are also developing an overnight hotel suite which will be staffed by a nurse for select patients that may benefit from further observation.

Q: Where do you see the biggest opportunities for outpatient spine surgery in the future?

NR: New York has been a difficult state to get outpatient spine surgery through. The insurance carriers have been slow to negotiate carve-out payments for implants and to approve new technologies. Surgeries like coflex allow us to provide patients with effective less invasive options that can be successfully performed in the ASC. As we demonstrate efficacy over time, I predict that more spinal procedures will fit nicely into the ASC model, including ACDF and minimally invasive lumbar fusion procedures.

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