I have a back problem and I have heard of a new device called the X-stop, am I a candidate for this procedure?

The X-stop is a new medical device which was improved by the FDA in the end of 2005. It may be used in the operative treatment in a very select group of patients with a particular type of back problem called neurogenic claudication or “nerve cramping”.

The nerves of the low back are contained in the spinal canal which is located behind the discs and in front of the joints of the low back. At each level of the low back some of the nerves exit the spinal canal through another opening called the neural foramen. Unfortunately, as part of the normal aging process of the spine, the discs and/or the joints may encroach upon the spinal canal and/or neural foramen and compress the nerves. This compression of the nerves is called spinal stenosis and results in neurogenic claudication.

The symptoms of neurogenic claudication are usually present in the legs and to some degree in the back. The leg symptoms are usually an achy pain, numbness, tingling, weakness or tiredness, and the back pain is usually a dull ache. The hallmark of neurogenic claudication is that all of the symptoms are worsened by standing and/or walking and are generally improved with sitting or lying down.

The diagnosis of neurogenic claudication is made based upon the history, physical exam, x-rays and the presence of spinal stenosis, usually identified on an MRI scan.

The nonoperative treatment of neurogenic claudication is a trial of anti-inflammatories and exercises. In some cases the use of epidural injections of anti-inflammatory medications and numbing medicines around the nerves may be indicated.

Patients who fail to get relief with non-surgical measures may be candidates for surgery. The goal of surgery for spinal stenosis is to remove the pressure on the nerves and relieve the symptoms of neurogenic claudication. This is accomplished through a procedure called a spinal decompression.

For many years spinal decompression was accomplished using a technique called a laminectomy. During a laminectomy the back of the spinal canal or lamina is exposed and removed to visualize the spinal nerves. The nerves are decompressed by removing the portions of the discs or joints that are compressing them. Laminectomies have a very long track record and the success rate is documented in the 70 to 90% range. While it traditionally had required a hospitalization of one or two days, it may now be performed as an outpatient procedure.

Recently the X-stop device was designed to replace the laminectomy in some patients by decompressing the spine without the removal of the lamina. During the X-STOP procedure the spine is exposed from behind, just as in a laminectomy, but instead of removing the lamina they are spread apart by insert this small spacer. This metallic spacer prevents eXtension (X-stop), indirectly opens the spinal canal and foramen and decompresses the nerves. The FDA approved the use of the X-STOP device after scientific studies documented its safety and demonstrated that the results of the X-STOP are equal to that of a laminectomy at two years. The postoperative hospitalization and recovery are essentially the same for the X-STOP and laminectomy.

Potential benefits of the X-stop over the laminectomy, however, include shorter operative time, the use of either local or general anesthesia, and the absence of exposure or manipulation of the nerves. In addition, in some patients the performance of a laminectomy may require a fusion; in these cases performance of the X-stop procedure does not require this additional surgery. Both the X-stop and the laminectomy have specific risks and benefits. The X-stop does, however, represent a new and innovative approach to the treatment of spinal stenosis. Its potential benefits must be weighed against its relatively short track record and all options should be discussed thoroughly with your physician prior to proceeding with any operative intervention.

If you have any questions about the X-stop procedure or any other questions regarding your spine problems, please contact Dr. Steven J. Rizzolo, Montana Orthopedics & Sports Medicine, PC.

Steven J. Rizzolo, MD/kdd