Interspinous Spacers

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Interspinous Spacers for Spinal Stenosis Treatment

Increasing life expectancy and the related demand for quality of life among the elderly has contributed to neurogenic claudication becoming one of the most common diagnoses of all degenerative spine diseases. Back and leg pain along with decreasing walking tolerance limit quality of life and can result in social isolation. Non-operative spinal stenosis treatment is well recognized for the treatment of early-stage disease and mild symptoms, generally yielding satisfactory results within the first 3 months. In cases of severe complaints or a failure of conservative management, surgical treatment is usually offered to the patient.

What are Interspinous Spacers?

Interspinous spacers are devices that are inserted into the spine to help treat patients who have narrowing or stenosis, of the spinal canal in the lower back (lumbar area). This condition is called lumbar canal stenosis. It causes leg pain and in some cases, back pain when standing or walking. This condition typically develops late in life, usually in people who are in their late 60’s or older.

Lumbar interspinous spacers have recently become popular as an alternative spinal stenosis treatment and lumbar degenerative disease. Patients with lumbar spinal stenosis can experience intermittent neurogenic claudication, pain, and numbness in the legs.  Implantation of an interspinous spacer can increase the cross-sectional area of the spinal canal. Many interspinous spacers have been designed for clinical use and an increasing number of studies have reported their use for lumbar spinal stenosis treatment. Forward bending tends to relieve patients’ symptoms of neurogenic claudication. Interspinous spacers capitalize on this effect by inducing segmental kyphosis and limiting spine extension. Interspinous spacer devices are used in lumbar spine from L1 to L5 for spinal stenosis treatment with neurogenic claudication, foraminal stenosis, facet joint disease, and the dorsal disc unloading in extension.

Benefits of Getting Interspinous Spacers

Use of these devices significantly increases canal area and foraminal width radiographically. Implantation of an interspinous spacer is a rapid and uncomplicated procedure. Several studies have reported good short to mid-term results after spacer implantation, with less pain, claudication symptoms, and disability. The main indication for interspinous spacer implantation is the presence of discoligamentous lumbar spinal stenosis that results in tightening of the posterior longitudinal ligament and the ligamentum flavum. In cases of bony stenosis or reduced segmental flexibility, expansion of the spinal canal with the placement of an interspinous spacer is unlikely, and thus, this spinal stenosis treatment should not be selected. Evidence for the treatment of discogenic back pain with interspinous spacers is minimal.
It was reported that the biomechanical studies with all the devices showed that interspinous spacer devices have a beneficial effect on the kinematics of the degenerative spine. The Lumbar interspinous spacer devices may have a potential beneficial effect in the selected group of patients with degenerative disease of the lumbar spine.

Risks of Interspinous Spacers for Spinal Stenosis Treatment

In approximately one out of every seven cases, the spinal stenosis treatment does not adequately separate the vertebrae, so the pain is not relieved. A second surgery may need to be considered in this case.

There is also a low risk of infection. If the bones are very fragile and give way easily, it may not be possible to proceed with the operation.

Pre-Operative Advice

On the day you are scheduled for spinal stenosis treatment, it is important that you have nothing to eat. Do not eat anything after midnight on the night before your operation. Doctors and hospitals vary on how long before spinal stenosis treatment you need to stop drinking water. You will be given instructions that explain this. If you don’t understand something, be sure to ask your doctor.

  • Do not smoke on the day of your spinal stenosis treatment.
  • On the morning of your surgery, take a bath or a shower and don’t use any lotions or makeup. Be sure to remove any nail polish.
  • Be sure to take any scans or tests with you to the hospital.

How Interspinous Spacers are Inserted

This procedure typically does not require general anesthesia. You will be sedated and local anesthesia will be used to make sure you are comfortable. The sedative will be given to you through a vein in your arm or your hand, and you will sleep throughout the operation. The spinal stenosis treatment typically takes less than 30 minutes.

A small incision is made over the part of the spine that is affected. The tissues are then moved so the surgeon can see to insert the spacer between the vertebrae. This removes pressure from the nerves. The incision is then closed and bandaged.

Post-Operative Advice

Following the procedure, you will stay in the recovery room for a short time. Then you will be transferred back to the outpatient surgery area or your room and be given something to eat and drink. You will stay at the hospital for a few hours to make sure your condition is stable.

After you have been sedated or given a light anesthetic, you will not be able to drive, so you will need someone to pick you up and take you home. It is also recommended that someone stay with you during the first 24 hours following your procedure. Be sure to drink plenty of liquids and eat lightly.

Other instructions after a spinal stenosis treatment:

Do not drive or operate heavy equipment

  • Do not drink any alcohol
  • Avoid making any significant decisions. Your thinking and logic skills may continue to be affected by the sedative you were given for 24 hours.
  • Do not take any sleeping pills or medicine that makes you sleepy. For example, Benadryl.
  • The nurses at the hospital will provide you with instructions related to the care of your incision. If you have any questions or concerns about this, contact your surgeon.

It is normal to have discomfort and pain around your incision for one to two weeks after spinal stenosis treatment. If your surgeon doesn’t provide you with a prescription for pain medication, ask what over-the-counter analgesics you can use.

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