What Is the Newest Treatment for Spinal Stenosis?

Conventionally, cases of spinal stenosis that can’t be resolved with non-surgical therapies have been treated with laminectomy and spinal fusion. Laminectomy creates more space in the spinal canal, while spinal fusion stabilizes the spine. 

Regrettably, spinal fusion is a major surgery that comes with many significant risks and downsides. Along with a sizable percentage of patients who require reoperation, fusion diminishes patients’ spinal flexibility, which can limit their mobility. 

Considering these risks and drawbacks, many medical professionals have been seeking out fusion alternatives that can effectively treat spinal stenosis patients. Now, we have a greater range of treatment options available, the newest of which allows patients to avoid fusion altogether. 

Here, we’ll discuss the newest treatment for spinal stenosis and how it may benefit the spinal stenosis recovery process.  

Table of Contents

Can Spinal Stenosis Get Better Without Surgery?

First off, let’s consider non-surgical treatment options for spinal stenosis. Many patients with mild to moderate cases of spinal stenosis can improve their symptoms without going under the knife. This claim is supported by recent medical research. 

A 2022 paper published in the Journal of the American Medical Association evaluated patients with lumbar spinal stenosis and their condition after three years without operative intervention. About one-third of the patients’ conditions improved, about half of patients experienced no change in their symptoms, and 10% to 20% of patients’ symptoms worsened. 

With these results in mind, patients with moderate to severe cases of spinal stenosis often require surgery for lasting symptom improvement. 

Spinal Stenosis Severity Gradation and Corresponding Treatment Options for Every Grade

Physicians evaluate the severity of spinal stenosis using a grading system. There are three different grading systems that they may choose between the Lee system, the Schizas system, and the Miskin system. 

The Lee and Schizas systems are the most popular spinal stenosis grading systems. The Miskin system was more recently developed but has proven to reduce inconsistencies between neuroradiologists and musculoskeletal radiologists. 

Patients diagnosed with mild to moderate spinal stenosis based on one of the systems listed below can consider non-surgical treatment options. However, patients with moderate to severe and extreme stenosis will likely need to consider surgery to attain significant relief. 

The Lee Grading System

The Lee grading system is based on the amount of separation of the cauda equina using axial T2-weighted images. 

  • Grade 0 or No Stenosis: No obliteration of the anterior CSF (cerebrospinal fluid) space
  • Grade 1 or Mild Stenosis: Mild obliteration of the anterior CSF space, but the cauda equina are distinctly separated
  • Grade 2 or Moderate Stenosis: Moderate obliteration of the anterior CSF space, and some cauda equina can’t be visibly separated
  • Grade 3 or Severe Stenosis: Severe obliteration of the anterior CSF space, and no cauda equina can be visibly separated 

The Schizas Grading System

The Schizas grading system features seven grades based on the shape, size, and structure of the dural sac, as well as the proportion of rootlets to cerebrospinal fluid. Physicians use axial T2-weighted images to determine a grade using the Schizas system. 

  • Grade A (No Stenosis or Minor Stenosis): Evident CSF in the dural sac, but the CSF distribution is uneven
    • Grade A1: The rootlets are positioned dorsally and take up less than half of the dural sac region.
    • Grade A2: The rootlets are positioned dorsally in a horseshoe shape and are touching the dura.
    • Grade A3: The rootlets are positioned dorsally and take up over half of the dural sac region. 
    • Grade A4: The rootlets are positioned in the center of the dural sac region and take up over half of this area. 
  • Grade B (Moderate Stenosis): The rootlets take up the entire dural sac region but can be differentiated. The sac has a gritty appearance with some CSF. 
  • Grade C (Severe Stenosis): No rootlets can be identified and no CSF is apparent. The sac has an even, gray appearance with posterior epidural fat. 
  • Grade D (Extreme Stenosis): No rootlets can be identified and the posterior epidural fat has been destroyed.   

The Miskin Grading System

The Miskin grading system is an adapted version of the Schizas grading system. It was altered based on information from radiologists and non-radiologist spinal specialists. 

  • Normal Spine: The nerve roots are openly spread out, not crowded, and the thecal sac’s anterior margin is flat or convex
  • Mild Spinal Stenosis: The nerve roots are mildly crowded and the thecal sac’s anterior margin is flat or a little concave. The nerve roots can be differentiated from the CSF. 
  • Moderate Spinal Stenosis: The nerve roots are crowded, giving the CSF a grainy appearance. The thecal sac’s anterior margin is concave. 
  • Severe Spinal Stenosis: The nerve roots can’t be differentiated from the CSF. the thecal sac’s anterior margin is concave or indistinguishable.

What Is the Newest Treatment for Severe Lumbar Spinal Stenosis?

The newest lumbar spinal stenosis treatment has been referred to with many different names, including non-fusion implant and dynamic stabilization system, among others. These names all refer to devices that are used in place of spinal fusion to provide stability and symptom relief. Premia Spine TOPS System is the best one.

Non-fusion implants establish a controlled range of motion in the affected vertebrae. They replace the tissue removed during decompression surgery, ensuring that the spine remains stable after the procedure. 

In addition to spinal stenosis, many dynamic stabilization systems can effectively treat spondylolisthesis and degenerative disc disease. But, as the newest treatment option for spinal stenosis, dynamic stabilization systems aren’t yet being used throughout the U.S.

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One example, the TOPS System from Premia Spine, has received the breakthrough designation from the FDA, which allowed the start of an IDE investigation in 330 to 476 patients in the U.S. Patients with single-level spinal stenosis and spondylolisthesis may talk to their doctors about enrolling in this trial if they’re a good candidate for the TOPS System. In June 2023 it received FDA approval. The FDA granted TOPS approval for single-level spondylolisthesis between L3 and L5 with lumbar spinal stenosis. The system also earned a superiority-to-fusion claim for these spinal conditions, as it preserves motion in the lumbar spine.

Why Consider The Newest Spinal Stenosis Treatment?

Patients suffering from spinal stenosis symptoms have many factors to consider when choosing a treatment route. Although spinal fusion has been used since the early 1900s, it presents many notable downsides. Dynamic stabilization systems have a shorter history, but they were developed with the drawbacks of fusion in mind. Therefore, this route of treatment can help you avoid complications including:

  • Adjacent segment disease
  • Failed bone fusion (pseudoarthrosis)
  • Lost spinal mobility
  • Back muscle atrophy

Spinal stenosis patients should speak with an experienced spine specialist to find the right treatment option for their needs.