Interspinous spacers are therapy devices put into your lower back to treat lumbar spinal stenosis. Lumbar spinal stenosis happens when the spinal cord in your lower back narrows, putting pressure on the spinal cord and the nerves that connect the spinal cord to your muscles, resulting in severe back pain. The narrowing can occur for various reasons, including arthritic and degenerative changes in your disc and facet joints. Doctors recommend interspinous spacers to create extra room in your back and relieve strain on your spinal nerves. That lessens the pain and discomfort and any weakness or numbness you could be experiencing in your legs.
Lumbar Spinal Stenosis
The spinal cord comprises many nerves that flow through the spinal cord, formed by the vertebrae. It is located at the base of your spine. Lumbar spinal stenosis occurs when the spinal cord narrows, putting pressure on the spinal cord. While spinal cord narrowing can occur in any portion of your spine, it most commonly occurs in your lower back, in the lumbar area.
When the constriction begins, you can suffer pain or difficulty walking, even short distances. If the discomfort worsens, you could feel compelled to bend forward as you walk to alleviate some of the pain or strain on your lower back. The pain can also worsen and transfer to your legs, affecting walking, sitting, and standing. Patients with the most severe lumbar spinal stenosis have difficulty managing their bladder and intestines. Although this ailment is not curable, you have numerous therapy options to alleviate the pain and other symptoms.
Osteoarthritis is the most prevalent cause of lumbar spinal stenosis. The wear and strain on the joints occur after some time. Spinal stenosis is a highly prevalent ailment, especially in adults over the age of 50, because osteoarthritis starts to affect many people's spines around that age. Most people start to have symptoms after the age of 50. Women are more affected than men. Other factors or conditions that can contribute to spinal stenosis include:
- Spinal tumor
- A narrower spinal canal
- Injuries to the spinal cord
- Rheumatoid arthritis
- Some types of bone diseases
- A complication after spinal surgery
Lumbar spinal stenosis does not exhibit any symptoms at its onset, but severe symptoms could develop over time. Some of the common symptoms include:
- Severe back pain
- A burning sensation on the back that goes into your buttocks and down your legs
- Tingling, numbness, weakness, and cramping in your legs
- Loss of feeling in your feet
- Weakness on your feet that cause your feet to slap down or drop when walking
- Loss of sexual capacity
Increased strain on your lumbar nerves can cause more severe symptoms and illnesses like cauda equina syndrome. As a result, if you experience any of the following symptoms, you should seek emergency medical attention:
- Loss of bladder or bowel control
- Increasing or severe numbness between the inner thighs, legs, and at the back of your legs
- Severe weakness or pain that spreads into your legs — Making it difficult to walk or rise from a sitting position
Treatment Using an Interspinous Spacer
Until recently, people diagnosed with spinal stenosis had few therapeutic options. The most popular approaches were conservative nonsurgical treatments and formal decompressive surgeries. Physical therapies, activity modification, and corticosteroid medications are today's most common nonsurgical treatments. Except in circumstances where conservative management has failed to produce the desired results, surgical procedures have never been frequently adopted. In these cases, clinicians have traditionally suggested decompressive laminectomy surgery, sometimes with or without fusion. This treatment also benefits people with a low quality of life due to walking constraints and pain.
When the two treatment choices are compared, those who received surgical treatment improved by 60% more than those who received nonsurgical treatment (30% improvement). Even with a higher success rate, decompressive surgery for lumbar spinal stenosis has drawbacks that patients should know before deciding on this treatment. Patients, for example, should be advised of potential consequences following surgery, like increased discomfort and the likelihood of developing a handicap. Other serious problems include brain impairments, wound healing troubles, surgical hematoma formation, and death.
Some risk factors and medical comorbidities also increase complications after decompressive surgery. Obesity, diabetes, obstructive lung disease, depression, rheumatic illness, smoking, heart disease, and a lengthy history of severe symptoms are among them. Furthermore, not all patients achieve the same level of success after treatment. While some experience tremendous success, others do not see a significant change in their symptoms. Over time, some problems appear after surgical therapy.
Introducing interspinous spacers to treat lumbar spinal stenosis is a massive relief for patients who have not obtained appropriate treatment from conservative management. It is an alternative treatment to the two long-established treatment alternatives. Patients can now immediately elect to have a spacer placed rather than attempt the hazardous or less-successful therapy alternative. The advantage of using an interspinous spacer is that the procedure for implanting it is easy and less invasive. While you are under local anesthesia, the doctor can implant the spacer. It also takes very little time to obtain the spacer.
Unless you are being treated for anything else or have more severe symptoms, you do not need to be admitted to a hospital to have an interspinous spacer. Otherwise, the spacer will be implanted in an outpatient environment on the same day you attend the hospital.
However, interspinous spacers do not help all patients with lumbar spinal stenosis. Because severe spinal stenosis commonly develops in people over 60, implantation of interspinous spacers can only benefit a few. It is because people over the age of 50 have risk factors and chronic comorbidities that could impair the spacer's performance. If the spacer is effective for you, it will assist in alleviating your symptoms by relieving pressure on your facet joints and improving your overall canal dimensions.
Who Can or Can Not Receive An Interspinous Spacer?
Your doctor can propose an interspinous spacer if you have lumbar spinal stenosis at the first or second level. Your medical history and a physical assessment using diagnostic confirmation determine your stenosis level. Doctors utilize computed tomography or magnetic resonance imaging to assess the stage of the disease. You must also have a medical history of experiencing pain that you have not successfully relieved using flexion.
Before ordering an interspinous spacer, your doctor will evaluate several variables. If you have one or more of the following symptoms, you could be denied surgery:
- You have two or more levels of moderate spinal stenosis
- Your spinal stenosis is severe at one or more levels
- You have advanced osteoporosis
- You are diagnosed with severe spondylolisthesis of higher grade than one
- You have a progressive deformity at the suggested area of implantation
- You have undergone a decompression surgery in the past at the suggested area of implantation
- You are allergic to metals
When you are diagnosed with spinal stenosis, your doctor will initially consider conservative nonsurgical therapy before recommending the insertion of an interspinous spacer. In some circumstances, they can advise activity modification, non-steroid anti-inflammatory medications, physical therapy, and corticosteroid injection. Your doctor can also send you to a specialist in pain management. They can go after a series of nonsurgical treatments if you have subtle symptoms. However, your doctor can propose surgical surgery if your symptoms are moderate and do not improve despite conservative treatments.
The decision to undergo surgery and the procedure's timing is at your doctor's discretion. They will assess your circumstances and the severity of your symptoms before recommending the best treatment option. It is important to remember that degenerative lumbar spinal stenosis is primarily a condition of older adults. In that instance, the treating surgeon will consider all possible risk factors before recommending surgery. Some medical issues, like cardiopulmonary disease, can preclude some individuals from undergoing surgery. Patients who cannot undergo surgery can be suitable candidates for implanting the less invasive interspinous spacer.
The Implantation Process
The interspinous spacer must function properly to reduce your discomfort. In that situation, the treating surgeon must understand your anatomy to determine how well the spacer will serve its role after implantation. The surgeon will make a small midline incision in your back to put the spacer between the adjacent posterior spinous processes. However, the implantation process varies from device to device. The location of the patient also varies depending on the gadget. Some devices require the patient to be positioned laterally, while others require the patient to be placed pronely.
Using biplanar fluoroscopy, the surgeon must take the time to visualize and comprehend your anatomy. The visualization occurs as the gadget is being implanted. If the surgeon fails to position the device properly, orientation can result in expulsion. The gadget can fracture your bone in the most severe circumstances, leading to even more serious consequences.
Inserting an interspinous spacer is often done through a small tube. After making a minor incision in your lower back, the surgeon will put the little tube through the insertion and between two vertebrae. The spacer has two arms that open around the spine's spinous process after insertion. It is held in place by two arms. The gadget provides and maintains appropriate space for the afflicted nerves in that fixed posture. This alleviates the pressure that is causing your back and leg pains.
This implant does not require the removal of any tissues or bones. The procedure is also reversible because it does not change your anatomy. That leaves the door open for future treatments if they are required. Furthermore, the procedure does not weaken the spine. The device is available in various sizes, selected based on the patient's anatomy. Because the implantation is carried out through a tiny tube, there is little blood loss or tissue injury. That makes it safe.
An interspinous spacer is implanted in a matter of minutes. You will be able to leave in less than two hours. Keep in mind that this is an outpatient implantation procedure. It means you could have your spacer the same day you go to the hospital.
If you are given pain medication, your doctor can also allow you to depart soon after implantation. After the treatment, you will continue to take your pain medication for the required number of days. Your doctor will also provide you with guidelines to follow for a few days following your treatment.
For example, you will be asked to rest two or three days after implantation. This permits your body to become acquainted with the new equipment. Do some mild stretching and modest physical activity during that period.
After a week of relaxation, you can gradually increase your physical activity by taking short walks. You will eventually be able to resume your normal daily activities. For a few months after implantation, avoiding excessive physical activity and/or heavy lifting is best. If your primary job is sedentary, you should be able to return to work after a week. You can begin physical therapy after a month. Because this type of treatment is usually less invasive, rehabilitation after obtaining an interspinous spacer is generally faster and easier. However, remember that not all patients' recovery times are the same. Some patients require more time than others.
Find a Reliable Neurointerventional Surgeon Near Me
Have you been diagnosed with lumbar spinal stenosis in Los Angeles?
You can pick from various treatments depending on your symptoms' severity and medical history. For patients with minor medical issues, an interspinous spacer is strongly recommended. However, your treating physician will prescribe surgical surgery if nonsurgical measures fail to relieve it. Interspinous spacer implantation is less intrusive, faster, and more efficient in reducing the pain and discomfort associated with lumbar stenosis. If you are a suitable candidate for a spacer, our LAMIS surgeons will first discuss your treatment choices and the implantation process. We will accompany you on your treatment journey until you get rid of all your symptoms. To learn more about interspinous spacers and their benefits, contact our team at 310-734-6088. We will guide you accordingly.