Through the use of minimally invasive indirect decompression surgery, Dr. Constant has been able to help reverse the effects of the debilitating degenerative condition. He is one of less than 250 of the 4,000 interventional pain management physicians nationwide who is trained on this type of therapy.
“There’s a certain skill set required to perform this procedure,” says Dr. Constant, who is one of three Coastal Orthopedics physicians trained on the procedure.
Since May 2018, Dr. Constant and fellow Coastal Orthopedics pain management specialists Dr. Gennady Gekht and Dr. Justin Sirianni have performed nearly 25 minimally invasive indirect decompression surgeries using a Superion Interspinous Spacer, a minimally invasive lumbar decompression device designed to relieve chronic pain caused by spinal stenosis, without complication.
“The outcomes have exceeded my own expectations,” says Dr. Constant. “When we began, I was excited about what the future might hold for patients facing a limited quality of life due to spinal stenosis.”
Characterized by the narrowing of the spine, spinal stenosis is a degenerative condition that frequently affects the elderly population. Spinal stenosis is often caused by changes to the spine related to osteoarthritis, resulting in significant lower back and leg pain when standing and walking.
Spinal stenosis plagues a number of people; and while there are a number of resources available, such as physical therapy, anti-inflammatories, injections and traditional surgery, there are limitations to how far they can take a patient.
Eventually the choices become limited, but now those patients who either don’t want a traditional surgery or are unable to undergo surgery for health reasons are finding alternative pain relief through the use of minimally invasive indirect decompression surgery.
But not every patient is a candidate for this type of procedure. That’s why it’s important for Dr. Constant to sit down and evaluate each of his patients as if they were a member of his own family and make sure they are fully informed, so they can manage their pathology to the best of their ability with the best knowledge available.
Dr. Constant performed his first case of minimally invasive indirect decompression surgery on a retired police officer and former marine who couldn’t stand for 15 minutes without experiencing significant pain due to compression of the L4-L5 spinal segment. Following the procedure, the patient was doing two miles on an elliptical and recently got back from a cruise — both of which wouldn’t have been possible without intervention.
Dr. Constant also has treated patients who were unable to walk to the mailbox without experiencing pain and are now 99 percent pain free after undergoing minimally invasive indirect decompression surgery.
“The relief is quick and within a few days patients notice a tremendous change in their quality of life,” said Dr. Constant. “It’s a real reward to hear these stories and to be able to share patients’ stories. It makes you excited to come to work.”
During the procedure, Dr. Constant makes a small incision in the patient’s back and implants a Superior Interspinous Spacer between the spinous process of the vertebra.
Once in place between the bones, the Superion Interspinous Spacer is opened up, gradually holding the two backbones apart and allowing for decompression of the spinal canal by acting as a support column.
The spacer serves as a spinal extension blocker, preventing the repeated compression of the spine during back extension, which is the most common source of lumbar spinal stenosis symptoms.
“Nerve impingement from spinal stenosis is like having your finger stuck in a car door, says Nick Villarreal, West Florida territory manager for Vertiflex, the company that created the Superion Interspinous Spacer. “The Superion procedure opens the channels that are crowding the nerves, allowing them to breathe and relieving the patient’s symptoms.”
The outpatient procedure itself takes roughly 20 to 30 minutes for a single level and less than an hour for two levels.
While Coastal Orthopedics has only been performing the procedure for the past seven months, the Superion Interspinous Spacer, which was commercialized in July 2016, has more than five years of clinical data with positive outcomes behind it.
The most recent data shows the device’s ability to play a key role in the fight to reduce opioid use in the U.S., which coincides with Dr. Constant’s patients who were on low-dose or no-dose opioids initially and also saw a reduction in medication usage following the procedure.
“Eighty-five percent of the proportion of patients who were on opioids prior to treatment no longer were,” says Villarreal. “This is incredibly powerful and potentially life-changing information.”
In addition to costing a fraction of a traditional lumbar surgery, minimally invasive indirect decompression surgery doesn’t alter the anatomy in any way, so in the event that symptoms represent themselves, the device can be removed down the road.
“In this case, it’s unique and exciting that we are able to offer a procedure that is not only less invasive but non-destructive because we’re not removing bone,” says Dr. Constant. “This does not replace the role of a surgeon because that’s still an important role. This is just a specific therapy that has been well-placed in the market for treating spinal stenosis.”