Finding effective pain relief can be an uphill task if you are experiencing incapacitating back or leg pain, particularly if you suffer from spinal stenosis. The condition develops when your spinal cord narrows in specific lower back areas, compressing the nerves linking your spine to the muscles. Spinal stenosis causes back pain, weakness, tingling, and numbness in the legs.
Luckily, spinal stenosis symptoms will be history with the new and innovative pain management solution. At LAMIS, we recommend Interspinous devices (ISDs) or spacers to relieve your pain and numbness in Los Angeles. The advanced pain management and relief solution is minimally invasive and eases pain by creating space in the lower spine, stopping the strain on the spine nerves.
Spinal Stenosis Overview
Your spine comprises multiple nerves flowing through the backbone, which comprises the vertebral column. Spinal stenosis happens when the space where the spinal nerves flow narrows and compresses the nerves, causing symptoms. It is possible to be born with the condition, although adults fifty or older are more susceptible to the illness because of osteoarthritis. Spine narrowing can happen in any spine section; otherwise, it is prevalent in the lower back or the lumbar part.
When lower back spinal stenosis begins, you begin experiencing pain or trouble walking. At its worst, the pain compels you to lean forward when walking to alleviate the discomfort or reduce the lumbar area strain. If you do not address the symptoms early, the pain spreads to the legs, affecting your sitting, standing, or walking. In extreme cases, the disorder can lead to problems controlling bladder or bowel movements. Spinal stenosis has no cure, but treatments are available to arrest the symptoms and ease the pain.
If you experience these symptoms, you probably wonder what the cause could be. Most spinal stenosis stems from osteoarthritis, which causes joint wear and tension. The disease begins to affect adults of all genders at age 50, explaining the prevalence of the disorder among these individuals. Apart from osteoarthritis, other aspects that can lead to the narrowing of the lumbar zone of the backbone are:
- Herniated discs.
- Spinal tumors.
- Spinal surgery complications.
- Rheumatoid arthritis.
- Spine injuries or trauma.
- Thickened ligaments.
- Bone overgrowth.
- Narrow spinal canal.
In the early stages, spinal stenosis has no detectable symptoms. Nevertheless, over time, the condition starts to exhibit symptoms like:
- Debilitating back pain or discomfort.
- A burning feeling in the lumbar area that spreads to the buttocks, hips, and legs.
- Sexual incapacitation.
- Feet weakness that causes slapdown when walking.
- Loss of sensation in the feet.
- Cramping, tingling, and numbness.
Increased lumbar nerve compression can lead to severe conditions like cauda equina syndrome. Therefore, if you suffer from these symptoms, you should contact a neurointerventional surgeon for emergency medical care:
- Bladder or intestine control difficulties.
- Elevated numbness in legs, inner thighs, and back of the legs.
- Problems walking due to severe discomfort or weakness that spreads to the legs.
Several interventional treatments, like selective nerve root blocks and epidural steroid injections, are available to address spinal stenosis symptoms. Nevertheless, when these treatments fail, we at LAMIS recommend interspinous devices or spacers.
Treating Lumbar Spinal Stenosis with Interspinous Devices
Spinal stenosis patients have relied on conservative nonsurgical therapies and proper decompressive surgeries to address the symptoms. Other noninvasive therapeutic options patients have relied on are:
- Physical therapies.
- Corticosteroid drugs.
- Activity modification.
Except in exceptional situations where conservative therapies are not producing results, medical professionals have adopted surgical procedures like decompressive laminectomy surgery with or without fusion. Low-income patients with pain and walking difficulties also benefit from the treatment.
Surgical treatments provided better pain relief than nonsurgical therapeutic options. Even with surgery proving to be more successful in addressing spinal stenosis in the lumbar area, it has its downsides that you must be aware of before opting for the treatment. The consequences of the surgery are:
- Brain impairments.
- Increased pain.
- Heightened risk of an emergent handicap.
- Slow healing of the surgical wound.
- Formation of surgical hematoma.
The medication your neurointerventional surgeon administers after the decompressive surgery can also elevate the risk of complications. The factors that promote the risk of post-surgery complications are:
- Heart disease.
- Tobacco use or smoking.
- Lung disease.
- A prolonged, severe symptom history.
- Obstructive lung illness.
Even after the decompressive surgery, all patients' results are different. Some experience tremendous success, while others experience a slight or no improvement in the symptoms. The symptoms tend to reappear after the surgery.
The recent introduction of dynamic ISDs as therapy for spinal stenosis has been revolutionary for patients who had not witnessed any success with conservative treatments. ISDs have come as an alternative to decompressive surgery and nonsurgical therapy. Instead of undergoing dangerous and inefficient conventional treatments, you can have an interspinous device implanted between spinous processes to distract adjacent spinous processes, reducing nerve decompression and alleviating the symptoms.
ISDs provide several benefits to our spinal stenosis patients. The devices are easy to implant as the process is less invasive and does not involve any hardware. Our neurointerventional surgeons administer anesthesia to make the placement process virtually painless. Besides, the spacer’s innovative design allows for permanent placement without support. That way, ISD alleviates your pain and, at the same time, preserves the spine and its surroundings. Again, the removal process is easy if you want the device removed in the future.
Unless you have severe symptoms or have another condition, an ISD implantation does not need an inpatient setting, we perform the procedure in a casualty setting, and you will be free to return home in no more than two hours.
Nevertheless, not all individuals with spinal stenosis are candidates for interspinous spacers. As the condition is prevalent among patients 60 or older, ISDs’ impact can be minimal. The low success rate among individuals 50 or older is due to chronic comorbidities. However, for the few patients whose procedure is successful, ISDs create room for spinal nerves to relieve the pressure, which alleviates your symptoms.
Candidacy for Interspinous Devices
At LAMIS, we will recommend an interspinous device if your spinal stenosis is in the first or second degree. Our doctors determine stenosis levels by analyzing your medical and physical history with diagnostic determination. We employ computer tomography (CT) and magnetic resonance imaging (MRI) to evaluate the disorder’s stage. A history of pain that does not go away even with flexion can also help us determine your stenosis level.
Before an interspinous device or spacer procedure, your surgeon looks for particular symptoms. If they exist, they rule you out of therapy. The symptoms that make you ineligible for ISDs are:
- At least two moderate stenosis levels.
- At least one degree of severe spinal stenosis.
- Advanced osteoporosis.
- Allergic reactions to metals.
- You had decompressive surgery before in the area recommended for ISD.
- Progressive deformity in the suggested implantation area.
- Severe spondylolisthesis with a grade higher than one.
Your neurointervention surgeon will not suggest ISD directly, even after a spinal stenosis diagnosis. We will first consider conservative, nonsurgical treatment. If it is ineffective, we will opt for interspinous devices. Also, our neurointervention experts can recommend activity change, physical therapy, corticosteroid injections, and non-steroid anti-inflammatory drugs. Alternatively, your physician can refer you to a pain management professional for nonsurgical treatments to help manage pain. Surgery will be the last option when you have moderate symptoms that are not improving after conservative therapies.
Your neurointerventional surgeon will assess you to determine the best time for surgery. Their decision is informed by your symptoms and the likely post-surgery complications. Health conditions like cardiopulmonary illness will disqualify you from the surgery. Furthermore, if you are a senior citizen, there are many risk factors for undergoing surgery. Our doctors will rule out the operation and recommend less intrusive interspinous devices. Therefore, if you are ineligible for surgery and conservative nonsurgical therapies have been ineffective, you are a candidate for interspinous device implantation.
The Implantation Procedure
For the ISD to reduce pain caused by spinal stenosis, it must function optimally. Also, the interspinous space has several anatomic variations. So, your neurointervention surgeon should comprehend your body structure, specifically the space’s shape and whether it matches the device’s shape, to know the functionality of the implants.
During surgery, your surgeon will make a little incision in the lumbar area where the ISD will be implanted. The neurointervention surgeon will attach the implant to the neighboring posterior spinous processes. The surgical technique to be adapted by your surgeon depends on the type of ISD applied. Besides, your location depends on the device, with some gadgets requiring you to position yourself literally while others can be attached pronely.
Visualizing is critical during implantation for the surgeon to understand your anatomy. If the placement is wrong, it could lead to expulsion. The ISD can rupture your bone, resulting in severe health complications.
At LAMIS, we insert the ISD with a minor tube. Once your surgeon makes an incision in the implantation area, the tube is inserted through the cut into the space between two vertebrae. After insertion, the device's two arms open around the spinous process. The role of the arms is to hold the spacer in place. Once the surgeon effectively implants the device creates and maintains room for the compressed nerves. The decompression relieves the nerves of the pressure, which is the primary cause of spinal stenosis symptoms like back pain.
The surgeon will not extract tissue or bone from your spine during implantation. And because the therapy does not charge your anatomy or structure, it is reversible. If you need further treatment, the ISD will not hinder it. ISDs do not weaken the spine. If anything, it strengthens it. Also, spacers come in numerous sizes and shapes, giving you an array of options based on your anatomic variation. Lastly, ISD treatment is less invasive as it only involves a small incision with less blood loss. Therefore, interspinous devices are the way to go if you seek a safe treatment with minimal infection risk and one that preserves spinal motion.
The implantation procedure only takes approximately fifteen to forty-five minutes. Within an hour or two, you will be free to go home. At LAMIS, we perform the treatment on an outpatient basis, meaning you will return home a few hours after the implantation.
After surgery, our physicians will administer painkillers, which you must take for a few days. Also, we will equip you with post-operative instructions that you will adhere to for several days to ensure the implantation is successful.
For instance, we recommend resting the first forty-eight to seventy-two hours after the surgery to give the body time to acquaint itself with the foreign device. During this resting period, you should engage in minimal physical activity.
After resting for a few days, you can gradually increase your physical activity. It will enable you to resume your routines. However, avoid heavy lifting or intensive physical exercise in the first few months after the implantation, as the implantation could fail. Individuals with sedentary jobs can resume work after the first week of treatment.
Furthermore, after your treatment, we will encourage you to go for physical therapy (PT) to enhance your flexibility and strength of the muscles. Implantation of ISDs is less invasive, so PT should be quick and easy. Nevertheless, recovery time differs from one patient to another. Some take a shorter time to heal, while others take longer.
Interspinous Device Implantation Complications
When your surgeon implants the wrong size of ISD, the spinous process could rupture, leading to severe consequences.
Similarly, the ISD can dislocate into the spinal canal, causing debilitating pain to recur. The problem is common in these procedures. If you suffer this complication, the surgeon must replace the displaced spacer with another one.
Other complications associated with ISDs are:
- Injury of the nerve root.
- Neurological impairment.
- Late radicular intermittent pain.
- Chronic lumbar area pain.
You can minimize the risk of these complications by finding an experienced ISD to perform the procedure.
Find an Experienced Neurointervention Surgeon Near Me
Are you suffering from back and leg pain in Los Angeles and have unsuccessfully tried conservative treatment and surgery?
Call LAMIS today at 310-734-6088 to arrange a face-to-face or online meeting. Our experienced neurointerventional surgeons will conduct a thorough examination using MRI and CT scans. If we confirm that your symptoms are due to spinal stenosis, we will discuss your treatment options, including interspinous devices.