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When
it is in place, the x-stop (image at right)
relieves narrowing in the spinal canal. |
Spine surgeons at Huntington Hospital are using
a new implant to relieve the symptoms of spinal
stenosis in certain patients. The device, known
as x-stop, has been shown in
studies to be superior to physical therapy in
managing sciatic pain in patients with stenosis.
Implanted in a minimally invasive surgical procedure,
the x-stop is one more option among a range of
techniques that spine surgeons can offer to patients
suffering from chronic pain.
Spinal stenosis is a narrowing in the spinal
canal that carries nerves to the legs. As the
space in the spinal canal shrinks, pressure is
exerted on the nerves causing pain in the legs,
buttocks, groin and sometimes back. Traditional
treatments range from physical therapy, medication,
and pain management techniques, to invasive surgery.
The
x-stop provides a mid-range option between these
traditional approaches.
“X-stop is an alternative to laminectomy
or laminectomy and fusion,” said attending
spine surgeon Laurence Mermelstein, MD. Laminectomy
involves the removal of all bony and
ligamentous tissue that is exerting pressure
on the nerves. In some cases surgeons also perform
a fusion, which stabilizes the area by fusing
one vertebral level to another.
Despite its potential benefits, surgeons caution
that the x-stop is not appropriate for all patients.
“The x-stop is a good procedure for the
correctly selected patient,” attested attending
spine surgeon Arnold Schwartz, MD.
“The patients who do best with the x-stop
are those whose sciatica is position dependent,”
Dr. Mermelstein explained. “Those who find
relief when they sit or lean forward, or lean
on a shopping cart are the best candidates for
the x-stop implant.”
The device is also best suited to patients whose
stenosis is not severe as well as those who do
not have osteoporosis. It is also inappropriate
for patients with congenital stenosis.
Resembling a metal cylinder with wings on either
side, the x-stop is a titanium device that is
wedged into the area of stenosis to keep the space
open and prevent pressure from being exerted on
the nerves. Insertion takes place during a 45
– 90 minute surgical procedure, often under
local anesthesia, through 1.5 inch incisions.
Patients may return home the following day, can
shower in three days and may resume their normal
activities when their incision heals, usually
within a week to ten days.
Because spinal stenosis is a chronic degenerative
condition of the discs and facet joints of the
spine, even those patients who find some relief
from the x-stop may ultimately require more invasive
surgery. However, both Dr. Mermelstein and Dr.
Schwartz agree that the x-stop may delay the need
for laminectomy and fusion.
“It can be a good option for a patient
who is not ready to undergo a bigger surgical
procedure,” Dr. Schwartz noted. “And
it doesn’t burn any bridges, so patients
who have had the x-stop are still candidates for
laminectomy and fusion in the future.”
“Many people who have been diagnosed
with stenosis and who have had multiple conservative
treatments such as medications, exercise, physical
therapy, and epidural
steroid injections, and who continue to have
symptoms, in the past have been told that
their only remaining options are to have a laminectomy
or live with the pain,” said Dr.
Mermelstein. “X-stop offers something in
between those options. Not everybody may be a
candidate for the procedure but they can be evaluated
for it.” //
Healthline December 2008 |
