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Victor Hugo, when talking about the Hunchback of Notre Dame, tells us about how Quasimodo always stooped because of his back. Neurosurgeons have always suspected that this may have been a case of lumbar stenosis.
Lumbar stenosis is a debilitating problem that affects many people as they get older and costs the U.S. economy several billion dollars. At present, there are 400,000 people over the age of 50 that have symptoms of lumbar stenosis.
Lumbar stenosis is a form of tightness that occurs with arthritis and causes compression of the spine and the nerve roots. This leads to difficulty walking with back pain radiating down the legs, persistent, progressive low back pain with or without radiation, or numbness or weakness in the buttocks and legs. These symptoms do improve with rest and lying down.
Most times, lumbar stenosis can improve with just physical therapy and conservative management, however, if it persists, surgical options become necessary.
A new procedure that has been recently approved is called X-Stop, and is a prosthetic titanium device that is placed between the spinous processes. It is placed in the spine, with the patient under local anesthesia and is an outpatient procedure.
A study appearing in the Journal of Neurosurgery in June showed a greater clinical outcome two years after surgery compared to traditional non-operative methods. This study show that with the X-Stop, after two years, 63.4 percent of patients did better compared to traditional non-operative therapies like steroid injections and physical therapy which had a success rate of 12.9 percent.
In this procedure, the patient is laid on his side and is given some local anesthesia and sedation. A small opening is made in the back and the titanium device is placed inside. The procedure takes about 30 minutes and allows it to increase the space between the spinal bodies and thus gives more room to the nerve roots and spinal canal. This alleviates the symptoms fairly dramatically and patients do well.
In our experience with 24 X-stops put in at LSUHSC-Shreveport, we have had close to a 90 percent success rate and are very pleased with this procedure. Initially, we intended to use it for patients that would not tolerate open back surgery such as those with heart disease, who are on blood thinners, or where the medical risk is very high. Now we are including other patients over the age of 60 and this may be a simple procedure to try with good long term results.
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