New Minimally Invasive Treatment for Spinal Stenosis
We want to inform you of a new minimally invasive, non-fusion technique for patients with spinal stenosis. Neurosurgeons in my group are now using a new FDA approved device called the “X-STOP” which is placed under local anesthesia in patients who have failed conservative therapy, have radiological confirmation of lumbar spinal stenosis and symptoms that significantly interfere with the quality of life.
Typical symptoms include low back pain, which intensify on standing and walking and subside when sitting, lying down or leaning forward.
A brochure for your review that illustrates what we believe to be a very significant minimally invasive advance for the treatment of this disorder as an outpatient is available by calling our office at 1-888-234-4357.
Topics:
· Diagnosing Lumbar Spinal Stenosis
· Are you a candidate for the X STOP® procedure?
Your spine consists of a column of 24 bones called vertebrae that extend from your skull down to your hips. Between the vertebrae are discs of soft tissue. The vertebrae join together like links in a chain, providing support for your head and body while the discs act as cushions, or “shock absorbers.” In addition to providing support, the spine encloses and protects a cylinder of nerve tissues called the spinal cord. The spinal cord is surrounded by a bony channel called the spinal canal.
Normally there is space between the spinal cord and the borders of the spinal canal so that the nerves are free and are not pinched.
As we age the ligaments and bone that surround the spinal canal can thicken. This thickening results in narrowing of the spinal canal, which is called “spinal stenosis.” The spinal cord and nerve fibers that exit the spinal canal (nerve roots) become crowded and pinched due to this narrowing. This results in pain and numbness in the back and legs.
If you suffer from lumbar spinal stenosis you may feel various symptoms, including:
• dull or aching back pain spreading to your legs
• numbness and “pins and needles” in your legs, calves or buttocks
• weakness, or a loss of balance, and
• a decreased endurance for physical activities
Symptoms increase after walking a certain distance or standing for a time. Symptoms can improve when you:
· • sit
· • bend or lean forward (see Figure below)
· • lie down, or
· • put your foot on a raised rest
Diagnosing Lumbar Spinal Stenosis
Before confirming a diagnosis of stenosis, it is important for your doctor to rule out other conditions that may produce similar symptoms. In order to do this, most doctors use a combination of techniques, including:
• History - Your doctor will begin by asking you to describe any symptoms you have and how the symptoms have changed over time. Your doctor will also need to know how you have been treating these symptoms, including medications you have tried.
• Physical Examination - Your doctor will then examine you and check for any limitations of movement in your spine, problems with balance, and signs of pain. Your doctor will also look for any loss of reflexes, muscle weakness, sensory loss, or abnormal reflexes.
• Tests - After examining you, your doctor may use a variety of tests to confirm the diagnosis. Examples of these tests include:
X-ray - shows the structure of the vertebrae and the outlines of joints.
MRI (Magnetic Resonance Imaging) - provides a three-dimensional view of our back and can show the spinal cord, nerve roots, and surrounding spaces, as well as signs of degeneration, tumors or infection.
CAT Scan (Computerized Axial Tomography) - depicts the three-dimensional shape and size of your spinal canal and bony structures surrounding it.
Myelogram - highlights the spinal cord and nerves after a dye is injected into your spinal column, which appears white on an X-ray film
Precaution: Radiological evidence of stenosis must be correlated with your symptoms before the diagnosis can be confirmed.
Once a diagnosis of spinal stenosis is confirmed, the process of treating the condition usually begins with a regimen of non-invasive, “conservative” therapy.
Non-surgical Treatment of Stenosis
There are a number of ways a doctor can treat stenosis without surgery, including:
• Medications, such as non-steroidal anti-inflammatory drugs (NSAIDs) to reduce swelling and pain, and analgesics to relieve pain.
• Corticosteroid injections (epidural steroids) to reduce swelling and treat acute pain that radiates to the hips or down the leg. Pain relief from an epidural injection may be temporary and patients are usually advised to get no more than 3 injections per 6-month period.
• Rest or restricted activity.
• Physical therapy and/or exercises to help stabilize the spine, build endurance and increase flexibility.
While some patients obtain relief from symptoms with these treatments, others do not.
Surgical Treatment of Stenosis
Decompression
Non-surgical treatments may temporarily relieve pain. More severe cases of stenosis may require surgery.
The most common surgical procedure for stenosis is a decompressive laminectomy sometimes accompanied by fusion. Often referred to as “unroofing” the spine, this procedure involves the removal of various parts of the vertebrae, including:
• the lamina, as well as the attached ligaments, that cause compression of the spinal cord and nerve roots, and/or
• enlarged facets, osteophytes and bulging disc material
The goal of the surgery is to relieve pressure on the spinal cord and nerves by increasing the area of the spinal canal and neural foramen.
Other types of surgery to treat stenosis include:
• Laminotomy - only a small portion of the lamina is removed to relieve local pressure on the spinal cord and nerve roots.
• Foraminotomy - the foramen (the opening through which the nerve roots exit the spinal canal) is enlarged to increase space for the nerves. This surgery can be done alone or with a laminotomy.
• Facetectomy - part of the facet joint is removed to increase space for the nerves.
The X STOP is a
titanium metal implant designed to fit between the spinous processes of the
vertebrae in your lower back. It is designed to remain safely and permanently
in place without attaching to the bone or ligaments in your back.
The oval spacer fits between the spinous processes and the wings are designed to prevent the implant from moving.
Warning: The X STOP implant is manufactured from a titanium alloy of metal. Please inform your doctor if you think you are allergic to titanium or titanium alloy.
Caution: The X STOP is manufactured from a titanium alloy which is known to produce artifacts if you undergo an MRI exam. If you have an MRI exam, after you have had X STOP surgery, inform your doctor that you have the X STOP. Failure to inform your doctor may affect the quality of diagnostic information obtained from these scans. The X STOP is MRI safe.
What is IPD®?
Interspinous Process Decompression (IPD)
IPD is a surgical procedure in which an implant, called the X STOP®, is placed between two bones called spinous processes in the back of your spine.
With IPD surgery there is no removal of bone or soft tissue. The X STOP implant is not positioned close to nerves or the spinal cord, but rather behind the spinal cord between the bony spinous process.
The procedure may be performed in either the operating room or special procedures room at the hospital. Using local anesthesia and with the help of X-ray guidance, the X STOP implant is inserted through a small incision in the skin of your back. Alternatively, your surgeon may elect to use general anesthesia.
You will be placed on your side during the procedure so that you can bend your spine when the X STOP is inserted. The surgery to implant the X STOP typically lasts 45 minutes to an hour-and-a-half. During this time you may be awake and able to communicate with your doctor.
Why may X STOP® IPD work?
The X STOP implant is designed to keep the space between your spinous processes open, so that when you stand upright the nerves in your back will not be pinched or cause pain. With the X STOP implant in place, you should not need to bend forward to relive your symptoms.
IPD offers several benefits compared to traditional surgery for lumbar spinal stenosis, including:
• the option of local anesthesia
• the potential to be an outpatient procedure
• usually no removal of bone or soft tissue allowing for potentially quicker recovery
• fully reversible procedure that does not limit any future non-surgical and surgical treatment options
Are you a candidate for the X STOP® procedure?
Preoperative Considerations
The X STOP is indicated
for patients aged 50 or older who have lumbar spinal stenosis. A diagnosis of
lumbar spinal stenosis should be confirmed by a doctor with X-ray, MRI or CT
scans. The X STOP is indicated for patients with moderately impaired ability to
function, who experience relief from their pain symptoms when bending forward.
Patients receiving the X STOP should have already been under a doctor’s care
and getting non-surgical treatment for their symptoms for at least 6 months.
The
X STOP may be implanted at one or two levels of the lumbar spine.
Who should not receive it?
The X STOP should not be used if you have:
• an allergy to titanium or titanium alloy
• spinal anatomy that would prevent implantation of the device or cause the device to be unstable in your body
• cauda equina syndrome, which is a spinal nerve compression that causes bowel or bladder dysfunction
• bone fractures or a diagnosis of severe Osteoporosis
• an infection in your blood or anywhere near your lower back where the surgery is planned.
Preparing for Surgery
If you and your surgeon elect to go ahead with X STOP IPD, there are several things you can do to help you achieve the best possible outcome for your surgery. You can increase the likelihood of a successful outcome by eating well-balanced nutritional meals as far in advance of your procedure as possible. Poor nutrition can reduce the body’s ability to heal itself.
For more information contact:
Tri-State Neurosurgical Associates-UPMC
Office Address:
Administrative Oakland Office
Presbyterian University Hospital
Department of Neurosurgery
Suite 5C
200 Lothrop Street
Pittsburgh, PA 15213
Phone: 1-888-234-4357
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© 2006 Tri-State Neurosurgical Associates - UPMC
Last Updated: March 13, 2006