Feb 10, 2015

Spinal stenosis is a narrowing of the space for the nerves and/or the spinal cord. It can occur developmentally and as part of the aging process of the spine. When it occurs in the lower (lumbar) part of the spine, the symptoms of spinal stenosis can include pain radiating to the legs (sciatica), a heavy feeling in the legs when walking, numbness, and tingling sensations. Patients often say that it becomes more difficult to walk longer distances. Sitting can help the symptoms temporarily, and leaning over slightly helps them to walk further.

We can establish a diagnosis of spinal stenosis if the patient has a history of these leg symptoms. Even if a physical examination appears totally normal, imaging such as x-rays, an MRI, or a CAT scan can help us confirm the diagnosis.

Sometimes non-surgical treatment options like modifying physical activity, taking anti-inflammatory medications such as Advil or Aleve, or spinal injections can help. Depending on the degree of stenosis (mild, moderate or severe), the success rates of these non-surgical options can vary.

In other words, if one has moderate to severe spinal stenosis and symptoms are progressing, then non-surgical options will likely only provide temporary relief.

When surgery is necessary, the standard operation is a laminectomy, where we remove the bone and the ligaments of the spine from the back. Recently, we’ve seen some new, less invasive options developed to address symptomatic spinal stenosis. These include the X-STOP and other competitive devices. The concept is to place a spacer in the back of the spinal column. The spacer indirectly wedges open the space between the vertebrae and makes more space for the nerves and the channels, helping to decrease or eliminate the symptoms of spinal stenosis.

A recent study comparing the success of the laminectomy as compared to the new surgical procedures showed mixed results. Patients with either procedure improved significantly and in a similar fashion, but more X-STOP procedure patients (26%) needed additional surgery when compared to the group that had the decompression alone (6%). The study also found that in 22% of the X-STOP patients, the symptoms did not improve. They required removal of the implant and conversion of the decompression.

The bottom line is that while the X-STOP procedure is less invasive, patients should be aware of the high probability of repeat surgery.