Lumbar stenosis is a big issue that can make it hard to stand upright. In the past, physicians often recommended invasive surgery as a treatment for lumbar stenosis. However, recently, experts developed a new device, an interspinous spacer, that resolves the issue with minimally invasive surgery. Spinal stenosis occurs if the area where the spinal cord or nerves travel becomes too small, causing nerve irritation. An interspinous spacer is a tiny implant that can help relieve spinal stenosis's painful symptoms. The implant sits between two interspinous processes in the lower spine. It increases the height between processes, thus reducing discomfort and other symptoms of spinal stenosis. If you need interspinous spacers in Los Angeles, contact LAMIS.
A significant percentage of yearly physician-related visits in the United States are attributed to lumbar spinal stenosis. Spinal stenosis is among the leading causes of lower back surgery, especially in patients over 50. As the population ages, symptomatic lumbar spinal stenosis becomes more prevalent with the increase in life expectancy. Spinal stenosis can be degenerative or congenital. The acquired type is more prevalent and usually results from spinal degeneration. It can also occur due to segmental instability, scoliosis, and neoplastic processes.
The common symptoms of lumbar spinal stenosis in patients older than fifty years include intermittent claudication with pain in your legs and back. The symptoms usually become worse when a patient stands or walks. Most people with classic lumbar stenosis have a flexed walking style. Usually, this position leads to a widened area of the spinal canal. This postural change is a compensatory action of the body trying to correct the decreased foraminal volume and central canal.
Before the discovery of interspinous spacers, people with lumbar stenosis only had two options:
- Conservative nonsurgical therapy or
- Formal decompressive surgery
Traditional treatments include physical therapy, activity modification, corticosteroid injections, and nonsteroidal anti-inflammatory medications.
A decompressive laminectomy was the go-to surgical treatment in patients where the conservative management of lumbar spinal stenosis failed. Surgery was also recommended for patients with limitations in walking tolerance or who presented a poor quality of life secondary to pain. However, decompressive lumbar surgery had some complications, including worsening pain and disability, neurologic deficits, postoperative hematoma formation, wound healing problems, and sometimes death.
Certain medical conditions increase the risk of decompressive surgery side effects. The conditions included obesity, diabetes, chronic obstructive pulmonary disease, cardiac disease, depression, rheumatoid disease, smoking, and depression.
The development of interspinous spacers provided an alternative treatment method for patients with spinal stenosis, especially for those where conservative management of the condition had failed. The main benefits of interspinous implantation include:
- The procedure can be performed under local anesthesia and sedation
- Has a relatively short operating period
- The procedure can be completed in an outpatient setting
What Causes Spinal Stenosis?
There is usually sufficient space in the spinal column opening for nerves to branch out from your spine, like the sciatic nerve, which connects the spine and the muscles in your buttocks, thighs, lower legs, and foot. However, nerve root compression can happen when the size of these spaces is reduced. Spinal stenosis can potentially harm the spinal cord by reducing the available room within the spinal canal and squeezing nerves.
Changes in the size or structure of the spinal canal are mainly caused by aging, but they can also be caused by an injury, hereditary illness, or other issue, like:
- Thickening and stiffening of the spinal ligaments
- The formation of bone spurs
- Herniated discs
- Vertebral slippage
Spinal stenosis can be caused by any of these disorders, resulting in significant discomfort and other symptoms that could interfere with your regular activities.
Interspinous Spacer Explained
The LF is located at the back of your spinal canal. As your spinal level degenerates and loses the disc height, this structure could become hypertrophied (larger) and buckle. This could irritate your descending nerves. This LF buckling improves with flexion, as do the symptoms, and worsens with extension, as do the symptoms.
Patients with central canal stenosis have trouble standing straight, resulting in significant lower back pain or weakness or numbness in your legs. Beyond physical therapy, the most typical treatment begins with pain management, including radiofrequency ablation (RFA) or epidural steroid injections. When this fails, the following process is a wide laminectomy or surgical decompression, which involves removing the structures that stress the nerves in your spinal canal. Since this is a major surgery with numerous potential significant side effects. Experts have been searching for alternatives to open surgery.
The interspinous spacers create space at the back of your spinal column to open additional room for your spinal nerves. Since surgeons and doctors insert the spacer through a minimally invasive procedure, you will unlikely face postoperative complications.
Interspinous spacers go by several names:
- Paradigm Spine – Coflex
- Globus Medical – SP-FIX, Aerial, P-FLEX, RENEGADE
- Medtronic – X-Stop, DIAM
- SpineFrontier – Inspan
- Nuvasive – Affix II Mini
- Zimmer Biomet – ASPEN, Wallis SYSTEM, InterBRIDGE
Acquiring an Interspinous Spacer
An interspinous spacer treats the symptoms of spinal stenosis and sometimes the painful condition caused by the narrowing of the spinal canal. The spacer implant keeps the space between the spinous process open to ensure that when you stand upright, the nerves between the bones in your back will not be pinched or cause pain. The spacer enlarges the space between the bones in your back, thus reducing pressure on the spinal nerves. This alleviates the symptoms of spinal stenosis, including cramping, leg pain, numbness, or tingling in the lower back, legs, and buttocks.
The interspinous spacer is designed so that it remains in place permanently. It does not need hardware or screws attached to the ligaments or bones in your back. A spacer preserves the natural anatomy of the spine because the bone or tissue removal required for traditional back surgery is not necessary with a spacer.
What to Expect During an Interspinous Spacer Placement
Your doctor will make a tiny incision in your back to place an interspinous spacer, usually under local anesthesia. The treatment procedure will likely take between 45 and 90 minutes. Once in place, the implant will keep the space between your spinous processes open so that you will not feel pain when you stand upright.
The process of implanting an interspinous space is minimally invasive. Therefore, you can travel and engage in light activity soon after treatment or whenever you feel ready. You can even resume your normal activities in less than two weeks, but this will depend on your individual situation.
An interspinous spacer lies between two bones, known as the spinous processes, positioned in the lower back. When implanted, a spacer is not placed close to the spinal cord or the nerves but behind the spinal cord between the spinous processes. You will undergo the procedure in the theater. Your doctor will place the spacer under X-ray guidance. The doctor can use local or general anesthesia, depending on the anatomy of your body and your specific medical condition.
Your doctor can recommend physiotherapy following your discharge from the hospital. Your doctor will likely schedule a follow-up appointment six weeks after the surgery. Even if you can travel or engage in light activities soon after the treatment, your doctor will likely limit certain activities. If you intend to undergo other treatments or diagnostic procedures, you should inform your doctor that you have had spinal surgery.
It is crucial to ensure that you follow your doctor's instructions following the treatment to fully recover from the surgery. The symptoms or discomfort can recur if you fail to follow your doctor's instructions. If you resume strenuous activity soon after the treatment, you could experience a stress fracture.
The Spacer Placement Process
During the surgical procedure, the doctor implants a titanium alloy to relieve numbness and back pain in your legs or buttocks caused by spinal stenosis. This non-fusion procedure is minimally invasive and a perfect alternative to laminectomy. Here is the process followed during the placement of an interspinous spacer:
The anesthesiologist administers anesthesia. The doctor positions the patient and makes a small incision in the lower back.
Accessing The Spine
The doctor creates an opening at the rear of the spine through the ligaments. Through this opening, the doctor can access the spinous process. These are the bony protrusions at the back of the spine.
Preparation of the Implant Site
Your doctor can remove some bony overgrowth on your spinous process to ensure the spacer fits perfectly. Your doctor might also need to resurface a small portion of one or more laminae.
Placing The Implant
The doctor uses fluoroscopic guidance to place the spacer through the incision. The spacer is placed between the spinous processes.
End Of The Procedure
In many cases, the patient can go back home the same day. In other instances, the patient can have an overnight stay in the hospital. Your doctor will determine the length of your hospital stay and guide you through the postoperative recovery.
An interspinous spacer can help alleviate nerve-related symptoms that include:
- Cramping or discomfort in your legs or buttocks
- Tingling or numbness in your lower back, buttocks, and legs
- Muscle weakness in your legs
Daily Living With an Interspinous Spacer
You should focus on recovery after the placement of an interspinous spacer. After you heal and resume normal activities, you will not feel or notice the spinal implant. You should talk to your dentist about how to resume a healthy lifestyle following back surgery. You should eat a healthy diet and exercise regularly. Your doctor could have some helpful additional tips for you.
Interspinous Spacers vs. Laminectomy
Interspinous spacers restore a more natural width to the spinal canal without significant trauma to the ligaments and muscles. In addition, the placement of interspinous spacers does not require bone removal. Therefore, you should expect less pain and a faster recovery with interspinous spacers compared to a conventional laminectomy. The other benefits of interspinous spacers compared to laminectomy include:
- A decreased risk of infection
- Less blood loss during the treatment procedure
- An increased preservation of the spinal motion
The nonsurgical, conservative treatment for symptomatic lumbar spinal stenosis includes activity modification, non-steroidal anti-inflammatory drugs, physical therapy, and, in certain situations, corticosteroid injections. A referral to a pain management specialist could be necessary. Patients with minor symptoms might discover that nonsurgical approaches provide adequate comfort. Those with moderate symptoms could fail to improve; thus, various surgical interventions might be necessary for this group of patients.
The decision to undergo surgery and the timing of the surgery should be left to the treating surgeon's discretion. Since degenerative spinal stenosis is a condition of the elderly, all relevant risk factors must be considered before surgery.
Several medical comorbidities, particularly cardiovascular disease, can hinder some patients from undergoing surgery. This same set of patients could benefit from a less invasive interspinous spacer.
Given the rationale for using an interspinous spacer, the surgeon must be thoroughly aware of the patient's anatomy. The device is typically inserted through a tiny midline incision between adjacent posterior spinous processes. Each device has its method of attachment. Depending on the device, patient placement ranges from lateral to prone. When implanting these devices, a doctor must be able to grasp and observe anatomy using bi-planar fluoroscopy. Failure to put the device in the proper anatomical position or orientation could result in device expulsion and, in certain situations, a bone fracture.
Find a Neurointerventional Surgeon Near Me
The interspinous spacer procedure includes implanting a titanium spacer through a thin tube through a tiny incision in the lower back. Once implanted between two vertebrae, the spacer's arms open around the lumbar spine's spinous process to secure the device. The implant provides and preserves room for damaged nerves, relieving the pressure that leads to lumbar spinal stenosis-related leg and back discomfort. The implant does not need the removal of any bone or tissue, and it is inserted in a reversible process that does not affect the patient's anatomy, allowing for future treatments if necessary. If you want to learn more about interspinous spacer treatment in Los Angeles, including whether you are a good candidate for the procedure, contact LAMIS. Call us at 310-734-6088 to speak to one of our experts.