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 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.

How Long Does it Take to Recover From Spinal Surgery?

Spine Surgery Recovery

For people with moderate to severe spinal problems that do not respond to conventional conservative therapy, spinal surgery can provide dramatic relief. For example, spinal decompression can remove pressure on nerves, relieve pain and restore mobility in many such patients. If you’re a candidate for spinal surgery, it’s important to understand all aspects of the procedure and its aftermath. One of the most important questions these patients should have answers to is the length of time required to recover from spinal surgery.

Recovery time from back surgery depends on the form of surgery. Broadly speaking, there are two forms of back surgery: procedures where vertebrae are fused together versus procedures that do not immobilize the spine. Recovery from fusion surgery can take longer than the recovery time from back surgeries that only involve a decompression or a surgery that preserves motion. Your physician can tell you more about the recovery time required for a particular procedure. But it’s important for patients to consider outcomes as well as recovery time. For example, spinal decompression surgery has traditionally been performed in conjunction with spinal fusion back surgery. As part of the recovery process, restrictions on motions and activities are placed on the patient to allow the previously independent vertebral bodies to biologically fuse together and become one long rigid segment devoid of motion. In contrast, with the TOPS™ (Total Posterior Solution) System, an alternative to spinal fusion following a spinal decompression procedure, there are no restrictions placed on the patient.  You maintain full range of independent vertebral motion after surgery, and the speed of recovry from this back surgery is dictated by the patient.   You can increase you activity level as quickly as you want.

Back surgery treatment does not end when the surgeon completes his or her operative work. The recovery period is of critical importance in restoring spinal health. Whatever the recovery period required, make sure you carefully follow your physician’s instructions. And be aware of all your options for spinal surgery, so you’ll not only have as short a recovery time as possible, but also the best possible outcome to your back surgery.

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.

Are some spinal surgeries more successful than others?

Spine Surgery

Are some spinal surgeries more successful than others? The short answer is yes, but that doesn’t tell the entire story. Any spinal surgeon will tell you that every patient’s case is unique, and that post-operative recoveries and long-term outcomes also vary from patient to patient.  In addition, every operation is different, whether dealing with a traumatic spinal cord injury of a degenerative condition like spinal stenosis. For that reason alone some spinal surgeries are more successful than others. Some patients may work harder at their recovery, while others may benefit from an extremely skilled surgeon. Patients don’t always define success in the same terms, and thus rate clinically identical outcomes differently. But beyond these differences in individual cases is the undeniable fact that some surgeries carry more risk or have a lower rate of clinical success than other procedures, and that some are proven to provide superior outcomes than others for treating the same condition. Spinal decompression surgery, a relatively common procedure, is an excellent example of differences in the success rates of spinal surgeries.

Spinal decompression is performed to relieve pressure on a nerve within or emanating from the spinal column, the cause of common back problems such as sciatica. The spinal decompression procedure, which involves cutting away portions of a vertebra impinging on a nerve, can dramatically reduce pain and restore mobility in many cases. However, the procedure leaves the vertebral segment weakened and in need of stabilization. Traditionally, spinal fusion surgery was performed in conjunction with spinal decompression therapy to stabilize the spine at the segment where the decompression was performed. Today the TOPS™ (Total Posterior Solution) System is available as an alternative to spinal fusion back surgery. In clinical studies around the world, the TOPS Solution has been found to deliver superior clinical outcomes than spinal fusion surgery. And that’s a definition of success in just about every patient’s and doctor’s book.

What is Degenerative Joint Disease?

Degenerative Joint Pain

“What is degenerative joint disease, and what did I do to come down with it?” That’s a common reaction from spinal patients after receiving a diagnosis of osteoarthritis, also known as degenerative joint disease. The degeneration usually results from the normal process of aging, typically beginning in middle age with the breakdown of cartilage, the rubbery tissue that serves as a cushion between bones and around joints. Degenerative joint disease is the most common joint disorder, and is frequently seen in the joints of the spinal column due to the many stresses and strains put on these joints. Occupations that involve physically demanding kneeling or squatting can also predispose one to degenerative joint disease, and injury or disease can also contribute to degenerative changes in the affected area later in life. Excessive weight, lack of exercise, smoking and a poor diet can also exacerbate the degeneration.

Degeneration in the spine is characterized by a breakdown of the cushioning spinal discs. This leads to bones rubbing against each other, resulting in pain, stiffness, swelling, reduced motion of the joint and other associated symptoms.

A number of treatment options are available for degenerative joint disease of the spine, including physical therapy, medications and injections. For patients with moderate to severe osteoarthritis not improved by conservative approaches, spinal decompression surgery may provide relief by reducing pressure on pinched nerves resulting from the reduction in cushioning the degenerative joint disease causes. The decompression procedure has historically been performed in tandem with spinal fusion surgery, to stabilize the spine by fusing two vertebrae together at the point where the decompression procedure was performed. Today the TOPS™ System provides a clinically proven superior alternative to spinal fusion, enabling patients to maintain the full range of motion of each individual vertebra. You may not be able to stop natural degenerative changes, but a range of effective medical options are available to treat them. A qualified specialist can help you choose the one that’s right for you.

What is Endoscopic Spine Surgery?

Endoscopic Spine Surgery

The last several years have seen great strides in developing advanced surgical solutions for spinal problems. Many of these advances involve minimally invasive procedures that leave surrounding tissue undisturbed, allowing faster recovery times and eliminating many of the complications associated with invasive back surgery operations.

Minimally invasive spine surgery is taken one step further by state-of-the-art miniaturized medical equipment, such as fiber optic cameras and microscopes. These procedures, often referred to asendoscopic spine surgery, lend themselves to treating a variety of spinal conditions and disorders including slipped disc and pinched nerves. These minimally invasive spine surgery procedures can remove tissue exerting pressure on nerve roots emanating from the spine, providing dramatics relief for back pain and restricted mobility. However, like any form of surgery, endoscopic spine surgery should be performed only if non-surgical treatment options have been exhausted and these restricted access techniques can adequately address the patients’ diseases. Conservative treatments include physical therapy, epidural injections, and medication to control pain and discomfort. If you and your physician conclude that an endoscopic back surgery may be appropriate, the decision on which procedure is best should be made only after thorough evaluation of all aspects of your case. In some situations where bone must be removed from a vertebra as part of the surgical procedure (as in a laminectomy or spinal decompression surgery procedure), the endoscopic procedure does not provide adequate access or visualization to perform a proper decompression. Suboptimal removal of pain generators, especially when followed by he fusion of adjacent vertebrae, can have adverse outcomes. Moreover it is irreversible as spine fusion surgery eliminates the independent flexion and rotation of the fused vertebrae. But another advance of recent years, the TOPS™ System, has proven to provide a better clinical outcome than spinal fusion. An implant device, the TOPS, or Total Posterior Solution System, preserves the independent motion of the individual vertebrae.

If you suffer from back pain or other symptoms of spinal problems, don’t let outdated ideas about back surgery keep you from seeking treatment. Today a host of conservative treatments such as medication and physical therapy can often provide relief, and when surgery is called for, it can often be performed without complications.

Causes of Back Pain in Adolescents vs. Adults

Back pain

Though the majority of spinal problems appear between the ages of 35 and 55, wrought by natural processes associated with aging, you don’t have to be an adult to have back problems. Back pain can also affect adolescents and even children. As many as half of all young people will have experienced back pain by age 20. It may be a sharp and shooting pain, or a burning or aching. It may be felt anywhere in the back. These are the same symptoms adults experience, but the causes of adolescent back pain are usually different than those that afflict their elders. That said, benign musculoskeletal diseases and trauma are responsible for most cases of back pain in adolescents just as they are for adults. Any strenuous or straining activity – sports or play, carrying a heavy backpack, or falling – can sprain muscles in the back and cause pain. Such strains and trauma account for around 50 percent of the younger patients seen in hospital emergency rooms suffering from back pain.

Fortunately, most cases of adolescent back pain resolve on their own. In fact, the exact cause of the back pain is never identified in at least half the adolescents seeking treatment. However, adolescents can exhibit serious spinal conditions capable of causing long term problems. These include stress fracture of the spine, known as spondylolysis, spondylolisthesiswhich is forward slippage of one vertebra on another, and lumbar disc herniations. Infections, inflammatory diseases, and tumors can also cause back pain in children and adolescents, as can other congenital or acquired conditions. As in adults, spinal decompression surgery can relieve pressure on pinched nerves and the concomitant pain and restricted mobility these conditions can cause. A TOPS™ System implant can be used following decompression spine surgery, rather than the spinal fusion procedure typically performed. Whereas spine fusion surgery eliminates the independent movement of fused vertebrae, the TOPS System preserves the full range of flexion and rotational motion of each individual vertebra. And that’s welcome news for spine decompression patients.

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.