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Orthopaedic Surgery

X-Stop offers spinal stenosis patients a low-risk alternative to invasive surgery

01/01/2009

X-stop Spinal Stenosis Patient Approximately 2 million Americans suffer from lumbar spinal stenosis, a painful and sometimes crippling condition caused by a narrowing of the spinal canal. The traditional surgical remedy for lumber spinal stenosis is lumbar laminectomy, an invasive procedure involving the removal of a rim of bone from around the spinal canal.
Many people, particularly the old and infirm, are unable or unwilling to undergo laminectomy due to surgical risks and the extended recovery time. With no recourse other than conservative therapies that have failed them in the past, these patients often suffer cramping, pain and numbness in the back and legs, and can experience problems with bladder and bowel function.

Surgeons at UCLA are pioneering an effective, low-risk alternative to laminectomy. The X-Stop Interspinous Process Decompression Device (X-Stop) is a titanium implant that opens spaces in the lower spine to relieve pressure on nerves. The device is inserted through a small incision in the back during an outpatient procedure that is typically performed in less than one hour under local anesthesia and mild sedation. Patients usually return home the same day. Back soreness from the procedure can be treated with pain medication and generally disappears within a few days.

Since the Food and Drug Administration (FDA) approved the X-Stop in 2005, UCLA has implanted the device in more than 150 patients; the oldest was a 92-year-old man.
In an 18-month follow-up study, UCLA researchers found that 80 percent to 90 percent of patients experienced a six-point reduction of pain on a scale of one to 10, making the X-Stop as effective if not more so than laminectomy, with few of the associated risks.

Causes of spinal stenosis

Spinal stenosis is a normal part of the aging process and is the most common reason for back surgery in people age 50 years and older. The condition occurs as the discs between vertebrae degenerate due to age or injury and the spinal cord and nerves get pinched or compressed. Pain typically radiates from the lower back to the buttock and upper leg, and is most acute when the patient is standing or walking. Many spinal stenosis patients have difficulty with daily activities. Obesity, depression and general physical deterioration can result. Because the occurrence of spinal stenosis increases with age, the condition will become more common as baby boomers advance in years.

The X-Stop procedure

The X-Stop is an oval spacer that fits between the spinous processes with two wings that are designed to prevent the implant from moving. Unlike laminectomy, the X-Stop procedure does not involve removal of bone or soft tissue and no fusion is required.
The device replicates the effect of being in a seated or forward-leaning position. Patients who experience pain relief in these positions — approximately 85 percent of spinal stenosis patients — are candidates for the X-Stop procedure. The X-Stop procedure is completely reversible and can be used as a first-line approach without compromising future therapies.

An attractive alternative

Although laminectomy is the surgical standard of care for spinal stenosis and has a good record of success, physicians often do not refer patients for this invasive procedure due to age, health problems and the risk of surgical complications. Some patients who are good candidates for laminectomy exclude themselves for fear of complications, the invasiveness of the procedure and the extended recovery time.
Until the introduction of the X-Stop, non-surgical treatments such as medication, corsets and physical therapy were the only alternatives to laminectomy. A multicenter randomized trial compared X-Stop with these non-operative treatments. After two years, 73.1 percent of X-Stop patients reported satisfaction with their outcomes compared to 35.9 percent of patients who received nonsurgical treatment.


New outpatient treatment offered

"The X-Stop is a completely new way of treating spinal stenosis," states Arya "Nick" Shamie, M.D., associate clinical professor in the departments of neurosurgery and orthopaedic surgery.

The X-Stop is an oval spacer that relieves pressure on the spinal cord and nerves. The device carries far fewer of the risks associated with laminectomy, an invasive procedure that is the standard surgical treatment for lumbar spinal stenosis. Laminectomy risks include nerve damage, hematoma, blood clots, infection, spinal fluid leak and pulmonary problems.
The X-Stop is inserted through a small incision during an outpatient procedure performed under local anesthesia and mild sedation. The vast majority of patients report a significant reduction in pain following the procedure.
While widely available, the X-Stop is currently underutilized due to its newness. With baby boomers soon to be heading into their 70s - the prime decade for symptomatic spinal stenosis - Dr. Shamie encourages physicians to familiarize themselves with this minimally invasive alternative to laminectomy.

Participating Physicians

Larry T. Khoo, M.D.
Assistant Professor of Neurological
and Orthopaedic Surgery
Santa Monica-UCLA Medical Center and
Orthopaedic Hospital

Duncan Q. McBride, M.D.
Associate Professor of Clinical Surgery
Department of Neurosurgery

Langston Holly, M.D.
Assistant Professor
Co-Vice Chief of Clinical Affairs
Department of Neurosurgery
Department of Orthopaedic Surgery

Arya “Nick” Shamie, M.D.
Associate Clinical Professor
Department of Neurosurgery
Department of Orthopaedic Surgery
Director of Spinal Deformity Surgery
UCLA Medical Center, Santa Monica

Jeffrey C. Wang, M.D.
Professor Department of Neurosurgery
Department of Orthopaedic Surgery
Executive Director of the UCLA Comprehensive Spine Center

Contact Information

Patient referral: (310) 440-2999
http://spinecenter.ucla.edu/





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