What is Spinal Stenosis?

spinal stenosis

“What is spinal stenosis?” is one of the most frequently asked questions in any spinal physician’s office. Spinal stenosis is a common back problem, but many affected patients have never heard of it before they are given the diagnosis. Symptoms of spinal stenosis can include intense pain inside the back of the legs and numbing or cramping in various regions of the body. The loss of sensation that spinal stenosis patients experience can be extreme.

Here at Premia Spine we focus on advanced surgical treatments for spinal stenosis and related spinal disorders, including bone spurs, or facet arthrosis, and slipped disc, or spondylolisthesis. We’re excited to share information about these conditions – conditions that affect up to 70 percent of all people at some point in their lives – through our blog. An explanation of spinal stenosis is a good place to start.

“Stenosis” means “narrowing,” and spinal stenosis signifies an unnatural narrowing of the spinal canal, the space at the center of the vertebrae that houses the spinal nerves. This narrowing puts pressure on the nerves, and on nerves that emanate from the affected vertebrae to other parts of the body. The most commonly affected area is the lower, or lumbar, region of the spine. The neck, or cervical region of the spine, can also exhibit a narrowing; these conditions are called lumbar spinal stenosis and cervical spinal stenosis respectively.

Spinal stenosis can be caused by a variety of factors, including heredity, chronic inflammatory and arthritic conditions, and the normal aging process. In fact, it is most often seen in adults above the ages of 45 years; women are affected by spinal stenosis more frequently than men. The severity is related to the extent of the narrowing and of any attendant spinal problems, such as bone spurs, slipped discs, pinched nerves, spondylolisthesis, or sciatica. A neurosurgeon, orthopedic surgeon or any physician specializing in spinal disorders can diagnose spinal stenosis based on radiographs and X-rays.

Many treatments for spinal stenosis are available, including medications and physical therapy, including exercises for stretching the spine. For patients with moderate to severe spinal stenosis who do not respond to conservative spinal stenosis therapy, spinal decompression surgery may be an option. In spinal decompression procedures the back surgeon reestablishes the proper diameter of the spinal canal at the affected area by removing bony elements that have grown towards the spinal canal and are impinging on the nerves. Typically, spinal fusion back surgery is performed in conjunction with the decompression procedure. Spinal fusion involves connecting two or more adjacent vertebrae with screws and rigid rods. Fusion restores stability but eliminates the natural mobility between the vertebrae.

Today a new implantable device allows the surgeon to decompress and stabilize the spine while preserving the spine’s range of motion: the TOPS™ System, developed here at Premia Spine. Clinical studies show the TOPS System provides better outcomes than spinal fusion. We encourage patients to consult with a physician who specializes in spinal medicine, and to educate themselves about treatment options.

What is Spondylolysis?

spondylolysis

It’s not as common as spinal stenosis or a herniated disc, but when it comes to the conditions that can cause lower back pain, spondylolysis deserves a place near the top of the list. Spondylolysis is a defect in a vertebra – a bone in the spinal column – at the point where it connects to the vertebra above it. The defect can lead to small stress fractures that allow a vertebra to move out of position and press against, or compress the spinal cord. This condition is called spondylolisthesis, or slipped discA slipped disc can cause several symptoms, with lower back pain being the most common. The good news is that many people with spondylolysis remain asymptomatic – they have no symptoms and are usually unaware they even have the condition. When the spondylolysis does cause lower back pain, it usually spreads across the lower back and feels like a muscle strain, and is generally exacerbated by exercise or vigorous activities.The weakness at the root of spondylolysis occurs in the pars interarticularis, the thin piece of bone that connects the upper and lower segments of the facet joints, which link the vertebrae and allow the movement of the spine. The cause of the weakness in the vertebrae that characterizes spondylolysis is unknown. Genetics is believed to play a role, and repetitive trauma to the lower back may also be a causal factor. The condition is not rare, affecting an estimated three to seven percent of Americans, many of them younger than traditional spinal patients. In fact, spondylolysisis the primary cause of low back pain in people under 25 years of age.

Simple over-the-counter non-steroidal anti-inflammatory drugs (NSAID) such as ibuprofen can often relieve mild symptoms of spondylolysis. In moderate to severe cases that don’t respond to conservative treatments, spinal decompression surgery to remove the portion of the defective vertebra compressing the spinal nerve may be recommended. Typically, spinal fusion surgery is performed following the decompression procedure in order to stabilize the spine. Recently an advanced alternative to spinal fusion, the TOPS Posterior Arthroplasty procedure, has been proven to provide better clinical outcomes than fusion, while preserving the patient’s full range of back motion.

Back pain is one of the world’s most common and debilitating medical conditions. As pioneers of advanced surgical treatments for spinal disorders, we at Premia Spine encourage anyone suffering from back pain to learn about all the treatment options available today.

What is Laminoplasty?

Laminoplasty

Laminoplasty is a surgical procedure for treating spinal stenosis, an unnatural narrowing of the spinal canal and a common cause of mild to severe lower back pain and restricted mobility. A variety of conservative methods of therapy for spinal stenosis are available, including spinal stenosis exercises, medications and injections. These therapies are often successful in relieving the symptoms of spinal stenosis, but if they prove ineffective, spinal surgery may be recommended. Numerous surgical procedures are available. Tools and therapies have undergone great advances in recent years, providing better outcomes and fewer complications. Laminoplasty is one example of these advances in treatments for spinal stenosis.

Laminoplasty is a surgical procedure performed through a small incision. The spinal surgeon makes two cuts almost opposite each other through the lamina, or outer sheath of the vertebra affected by spinal stenosis. One cut is made completely through the lamina, and the second cut is simply a groove that acts as a hinge, allowing the lamina to swing open like a door. In fact, this procedure is often referred to as an “open door laminoplasty.“ The tips of the spinous processes may be removed to create room for the bone to pull open. This spinal stenosis surgery procedure immediately relieves pressure on the spinal cord. The lamina is then closed, using small pieces of bones as wedges to ensure the spinal cord is no longer compressed at that level. Spinal fusion back surgery may be performed in conjunction with laminoplasty to stabilize the vertebra. But spinal fusion eliminates the natural flexion and rotation on the individual vertebra. Today there’s a new option, the TOPS System, which stabilizes the vertebrae while permitting natural flexion and rotation of the individual vertebra. It’s proven to provide superior clinical outcomes to spinal fusion surgery.

Spinal problems and back pain are among the most common and debilitating medical ailments. If you suffer from the symptoms of spinal problems, you have a variety of treatment options. Make sure you’re familiar with all the medical procedures available to you.

What is the X-Stop procedure?

X-stop

X-Stop is a minimally invasive spinal surgery procedure that may be performed to treat cases of lumbar spinal stenosis that don’t respond to more conservative treatments, such as physical therapy and medication. X-Stop is also the name of the titanium implant used in the procedure, a device in a category termed “Interspinous Process Decompression Systems.” This lumbar spinal surgery procedure was approved as safe and effective by the FDA in 2005.

Lumbar spinal stenosis is an unnatural narrowing of the spinal column in the lower, or lumbar portion of the spine. The constricted spinal canal that characterizes spinal stenosis puts pressure on the spinal cord and the nerves emanating from it at the affected vertebrae, which can cause pain and restrict mobility. In the X-Stop procedure, the titanium implant is inserted into the spine through a small incision made between two spinal “processes” of the vertebra affected by stenosis. Spinous processes are the protrusions of the individual vertebra visible along the back. The X-Stop device distracts two vertebral segments and relieves the pressure on the nerve roots caused by the stenosis, which in turn often relieves leg and back pain. The X-Stop, a recent advance in spinal stenosis surgery, is not an alternative to spinal fusion back surgery, a procedure that eliminates the natural flexion and rotation of the fused vertebrae. The X-Stop is ideal for patients with very mild spinal stenosis. For more advanced disease, the X-Stop is not applicable because the implant cannot be used when decompression surgery is necessary to remove the bony elements pressing on nerve roots. In such situations, where decompression surgery is performed in conjunction with spine stabilization, the TOPS System may be a more relevant solution for maintaining the spine’s native motion.

As developers of treatments for advanced spinal stenosis and associated conditions, we at Premia Spinerecommend that patients learn about all their treatment options. If you have a back condition that’s causing pain or is affecting your mobility, be certain to learn about all the choices available to you.

What is Interspinous Process Fusion?

Interspinous Process Fusion

As we noted in our last blog, X-Stop, an implant deployed in the surgical treatment of mild spinal stenosis, was approved by the FDA in 2005 as a safe and effective treatment for symptoms of lumbar spinal stenosis. This procedure illustrates the advances that make spinal medicine such an exciting field. Today, there are devices similar to the X-Stop in design but that do allow motion at the operative segment. These devices are used to create a spinal fusion between the adjacent vertebral segments. This procedure is more commonly referred to as an interspinous process fusion. As with the X-Stop, a device is inserted in a small incision made between adjacent spinous processes, which are the bony protrusions of the vertebrae that can be seen and felt along the back of the spine. Interspinous process fusion is another form of spinal fusion back surgery that eliminates the natural flexion and rotational ability of the individual vertebrae.

Interspinous process fusion is typically performed in about one hour, either under general anesthesia or using intravenous sedation with local anesthesia, and can be performed as an outpatient procedure. The procedure is relevant for patients who have mild spinal stenosis and require only a minimal removal of bone and soft tissue to achieve pain relief. This represents an advance in spinal care, but any spinal surgery has the risk of complications, and not every technique is right for every patient. Before considering surgical intervention including interspinous process fusion, patients should try more conservative treatments such as exercises, physical therapy, epidural injections, and pain medications. When surgery is recommended, interspinous process fusion is most appropriate for people over 50 years of age with mild spinal stenosisconfined to one or two levels of the spine, and who experience relief from symptoms when bending forward at the waist or when sitting. With more advanced spinal stenosis disease, patients should consider the option of avoiding fusion surgery and opting for a solution, such as TOPS Posterior Arthroplasty, that preserves motion of the spine at the operative level while stabilizing the segment after decompression surgery. Here at Premia Spine, developers of advanced surgical treatments for spinal stenosis and related spinal problems, we think it’s important for anyone suffering from ongoing back pain or restricted mobility to know all their treatment options.

Can You Get Blood Clots From Spinal Surgery?

Spine Surgery

Spinal surgery has made significant advances in terms of both its safety and efficacy in correcting a multitude of back problems, from traumatic spinal cord injury to degenerative diseases like spinal stenosisspondylosis and slipped disc. Many of these advances in spinal surgery have come in recent years as a result of minimally invasive microsurgical tools and techniques. Nonetheless, back surgery is a serious operation, and surgical candidates need to be aware of all facets of the operation they’re considering – not only the benefits of the surgery, but the potential risks. One of the risks of spinal surgery is that of developing blood clots.

Any injury to the body increases the risk of a blood clot, as the injury stimulates the clotting process. Surgery constitutes an injury or trauma, and the body responds accordingly. In fact, spinal surgery – which the body interprets as an injury to the spinal cord – can lead to the formation of blood clots within the veins. Should such clots become dislodged, they can clog a blood vessel as it narrows, causing a stroke or heart attack, possibly resulting in paralysis or death. Proper postoperative care, medications, and the patient’s active role in the recovery process can minimize the risks of blood clots.

Anyone considering back surgery should also be aware that some procedures for treating a spinal problem may present lower risks or provide better outcomes than others. For example, the TOPS™ (Total Posterior Solution) procedure, which may be performed after spinal decompression surgery in order to stabilize the spine, provides better clinical outcomes than spinal fusion surgery, which was the traditional choice for spine stabilization before the introduction of the TOPS system. The TOPS solution has the added benefit of preserving the spine’s full range of motion, unlike spinal fusion, which permanently fuses adjacent vertebrae. If you’re a candidate for back surgery, make sure you understand not only the upsides and downsides, but also all the alternative surgical solutions that can help you minimize the already low risks associated with advanced spinal procedures.

How much physical therapy do I need after spinal surgery?

Physical Therapy

Whether a patient is having open back surgery for a spinal cord injury or a minimally invasive procedure for a condition such as a slipped disc or spinal stenosis, the operation itself is only the first part of a successful outcome. The post-surgical recovery period is critically important for long-term success, and the proper physical therapy program plays a large role in this process.

Patients for both open and minimally invasive back surgery will require physical therapy. Physical therapy strengthens the muscles in the back and helps heal the tissues in the area where the surgery was performed. In fact, back problems are often caused in part by muscle weakness. Even in otherwise well conditioned individuals, the back muscles around areas exhibiting spinal problems have been shown to be weaker than surrounding muscles, and weak muscles also contribute to poor spine and spinal joint functioning. Thus, one of the goals of post-operative therapy is to strengthen muscles that support the spine. Some of these muscles are in the back, but specific abdominal muscle groups also provide back support. Biofeedback devices can help patients learn how to activate, control and exercise these abdominal muscles, thereby strengthening them.

The amount of physical therapy required will vary based on the procedure performed, and this is one area where surgical options are important to consider. For example, patients undergoing spinal decompression surgery typically have a secondary procedure performed in conjunction in order to stabilize the vertebral segments where the spinal decompression was performed. This secondary operation following the spinal decompression procedure may be spinal fusion or the TOPS™ (Total Posterior Solution) implant. The TOPS Solution preserves the full range of motion of individual vertebra whereas spinal fusion surgery eliminates this independent movement. More important from a recovery perspective, The TOPS solution places no restrictions on patients.  You can do whatever you feel like pursuing.

The amount of physical therapy required after spinal surgery will vary from patient to patient, and from procedure to procedure. Make sure you’re aware of the physical therapy associated with the procedure you’re considering.

Can Acupuncture Relieve Back Pain?

Spine Acupuncture

Not all advances in treating spinal disorders are necessarily new. Acupuncture has been practiced for thousands of years, and researchers and medical experts have now established that this ancient healing art can relieve chronic back pain. One recent study funded by the National Institutes of Health found that acupuncture can be more effective than standard treatments such as medication or physical therapy for relieving back pain – even for conditions such as very mild incidents of spinal stenosis and slipped disc. In the study, patients were divided into four groups. In one group patients received customized acupuncture treatments. Another group received acupuncture treatments generally recommended by practitioners for chronic lower back pain. A third group received only a treatment that mimicked acupuncture, using a toothpick that never actually penetrated the skin. The fourth group simply continued the course of therapy they were already pursuing, without acupuncture.

Researchers found that all three of the acupuncture groups – even the simulated acupuncture group – reported more “meaningful” improvement in their ability to engage in everyday activities than did the group that continued their usual back pain therapy without acupuncture. Moreover, the study authors found that the superior improvements in pain reduction reported by the acupuncture group participants persisted after a year.

This study certainly doesn’t suggest everyone with spinal problems should stop their current treatment regimens in favor of acupuncture. After all, not all participants in the study benefited from acupuncture. But the study concluded that acupuncture is a reasonable option to be considered when selecting therapy for back pain. This is one more example of new thinking about treatments for chronic back pain, which has witnessed major advances in recent years. For example, spinal decompression surgery, which can dramatically reduce back pain by relieving pressure on pinched nerves emanating from the spinal column, was traditionally followed by spine fusion surgery, to stabilize the vertebral segments where the decompression procedure was performed. Today the TOPS™ (Total Posterior Solution) System can be implanted as an alternative to spinal fusion. Unlike spinal fusion, the TOPS solution allows the individual vertebrae to maintain their full range of independent motion.

If you have chronic back pain, make sure you know all the treatment options available – from acupuncture to spinal decompression surgery. And always work with qualified physicians specializing in spinal problems to find an appropriate treatment protocol.

What is XLIF?

XLIF Procedure

Thanks to advances in spinal medicine, patients today can benefit from treatment regimens and procedures tailored to their individual needs and specific conditions. Among these recent advances on the surgical front is eXtreme Lateral Interbody Fusion, or XLIF. XLIF is a form of spine fusion surgery in which the surgeon accesses the intervertebral disc space approaching from the side (lateral) rather than from the front (anterior) or the back (posterior) of the spine.

XLIF is one of the endoscopic spine surgery procedures performed with microsurgery tools and techniques. The procedure utilizes electromyography, or EMG, a form of neuromonitoring, allowing the surgeon to test the nerves emanating from the spine during surgery to ensure they are not harmed or irritated. Nerves from the spinal column lie in close proximity to the psoas muscle surrounding the spine, which can be compromised during surgery. Requiring only small incisions, XLIF minimizes tissue damage, blood loss and scarring, and has a relatively quick recovery time. XLIF falls in a category of back surgery in which the disc in the front of the spine is removed and replaced with an implant containing a bone graft. The bone graft enables the two vertebrae to fuse through the disc space. XLIF offers a spinal fusion option for treating various types of lower back disorders including lumbar degenerative disc disease,spondylolisthesis, scoliosis and types of spinal stenosis.

A drawback of the procedure is that it involves fusing vertebrae, eliminating independent movement between adjacent levels. Today, thanks to another advance in spinal medicine – the TOPS™ System – in some cases a TOPS implant can be used in place of traditional spine fusion surgery. Unlike fusion, the TOPS System preserves the full range of motion of individual vertebrae, and the TOPS System has been proven to provide better outcomes than spinal fusion in clinical studies conducted around the world. This adds up to two breakthroughs in the treatment of spinal conditions, promising effective relief for many patients with back problems requiring a surgical solution.

Why are some spinal surgeons more successful than others?

Surgeons

It’s a fact that some spine surgeonshave higher success rates for the operations they perform than their colleagues. What accounts for these differences in surgical outcomes of spinal procedures? A number of factors influence surgical success rates and should be considered when interpreting what the rates say about a particular spinal surgeon’s abilities.

Spine surgery is a highly complex endeavor requiring years of training and experience to perfect. Surgeons with more experience tend to have more successful outcomes than less experienced surgeons. The success rates of board certified or board eligible spine surgeons are also typically higher than those of non-board certified or eligible surgeons. Another factor to consider: some surgeons specialize in specific areas of the spine – such as lumbar spinal surgery – and some specialize in treating particular conditions – such as slipped disc or spondylolisthesis – while other back surgeons do not specialize in any one type of treatment. Specialists have higher success rates than those of their colleagues who do not focus on the type of surgeries they perform.

Beyond the skill of the surgeon, success rates are also linked to the type of procedure chosen to treat a particular problem. The decision to utilize one procedure – perhaps because the surgeon is more familiar with it – rather than an alternative treatment, can also affect a surgeon’s success rate. For example, there is a choice in surgical stabilization procedures to employ following decompression spinal surgery, which is performed to treat conditions including spinal stenosisspondylosis, and spinal cord injuries. In the past, spinal fusion back surgery has been virtually the only surgical stabilization option, but today an alternative procedure, the TOPS™ (Total Posterior Solution) System has been proven in clinical trials around the world to provide better success rates that spinal fusion. Thus, a back surgeon might have a better than average success rate performing spinal fusion procedures, but still not reach the success rates achieved with a new procedure. That’s why it’s important to be familiar with the full range of available treatment options when evaluating the success rates of any spine surgeon.