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What are the treatment options for spinal stenosis?
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 spinal 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 spinal 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.
The surgical procedure starts with an incision approximately two to five inches long (about 5-13 cm) made in the midline of the back. The left and right back muscles are then dissected off the lamina on both sides and at various levels. A laminectomy, or removal of the lamina, is then performed. This allows the nerve roots to be exposed. The final procedure in the laminectomy surgery consists of undercutting the facet joints. The facet joints are directly over the nerve roots, so trimming them gives the roots more room.
Following the operation, patients usually remain in the hospital for one to three days. How fast the patient recovers mobility is usually dependent on how old the patient is and his or her general health condition before the operation. Patients are encouraged to be mobile directly after the surgery, but are advised to refrain from any heavy lifting or exercise for at least six weeks. This is to avoid any pulling on the suture line before it heals properly.
Another treatment that can enhance the results of the decompression of spinal stenosis is to fuse the joint. Fusing the joint prevents stenosis from recurring and can eliminate pain from an unstable segment. If stenosis occurs at one level from an unstable joint, then decompression surgery combined with fusion is a more reliable option.
Laminectomy surgery has a very high success rate. Approximately 80% of patients feel improvement in their daily lives. Most also notice a significant reduction in their level of discomfort and pain. The success of a laminectomy is much higher if the sufferer feels more pain in their legs. It is not as successful for the treatment of lower back pain.
As with all surgery, a laminectomy has potential risks and complications. There is a 1 in 1000 chance of nerve root damage or bladder/bowel incontinence. Infections happen in about 1% of elective cases. If infection occurs, further surgery combined with antibiotics is necessary to rectify the situation. Although complications are very rare, laminectomy surgery is usually performed on elderly patients who are at an increased risk.
What What is IPD®? What is the X-STOP® Device?
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.
Patients can gain relief from chronic lower back pain, and may walk out of the hospital the same day, thanks to this innovative new surgical implant that recently was approved by the FDA.
The X-STOP® Interspinous Process Decompression System implant is inserted through a small incision in a patient's back. It separates the ligaments and bone, which prevents pressure on nerves and immediately relieves pain. The procedure takes less than one hour and typically requires a local anesthetic. Many patients are able to stand upright and walk the same day of the surgery.
[Please note: 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. It is also 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.
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Interspinous Process Decompression (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 or X-STOP® spinal stenosis 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. How is the X-STOP® procedure performed? Using local anesthesia and with the help of X-ray guidance,the X-STOP® Interspinous Process Decompression System implant is inserted through a small incision in a patient's back. Alternatively, your surgeon may elect to use general anesthesia. |
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It separates the ligaments and bone, which prevents pressure on nerves and immediately relieves pain.
The procedure takes less than one hour and typically requires a local anesthetic. Many patients are able to stand upright and walk the same day of the surgery.
Minimally invasive techniques should be performed whenever possible so that patients can benefit from smaller incisions, faster recovery and less post-operative pain.
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.
Patients may experience rapid relief from their symptoms and enjoy improvement of physical function. The unique design of the X-STOP® implant enables it to be inserted using a minimally invasive approach, resulting in very little tissue disruption. Also, the X-STOP® implant's unique design allows it to be implanted without fixation to bones or ligaments so to provide a reversible procedure that should not limit future treatment options. Due to its minimally invasive nature, the procedure can typically be performed in less than an hour, and as demonstrated during the clinical trial, with a low rate of procedural complications.
Am I a candidate for X-STOP® spinal surgery?You may be a candidate for the X-STOP® spinal surgery if you have primarily leg pain rather than mostly back pain and your pain is due to spinal stenosis/ foraminol stenosis. Your leg pain is worse with prolonged standing and bending backwards. You must get significant relief of your pain when you sit down and bend forward or stand and bend forward.
According to an independent market research organization, there are approximately 1.4 million individuals in the United States with a primary or secondary diagnosis of lumbar spinal stenosis. The X-STOP® device may be a treatment alternative for approximately 220,000 of these individuals who would have otherwise been treated with conservative non-operative therapies or with a surgical procedure called a laminectomy.
What are the benefits to being treated with the X-STOP® IPD®? IPD offers several benefits compared to traditional surgery for lumbar spinal stenosis, including:
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X-STOP® IPD®: Clinical Study Results
The X-STOP® IPD System was tested in a carefully controlled research study that took place in nine hospitals across the United States. In this study, 100 patients with lumbar spinal stenosis had x-stop spinal surgery with the X-STOP® device. These patients were compared to 91 patients who did not have surgery, but were treated by their doctors in other ways (for example, with medications, corsets, physical therapy, etc.).
Approximately half of the patients who received the X-STOP® device in this two-year research study experienced a degree of pain relief and ability to increase their activity levels that was sufficient to be considered a successful outcome at two years after the surgery. The clinical benefit beyond two years has not been measured.
The likelihood of needing an additional operation during the study was low. Overall, 90% of patients had significant improved clinical outcome.