Interspinous Spacers for Lumbar Spinal Stenosis

Living with chronic lower back and leg pain can make daily activities challenging. If you’re experiencing these symptoms, your doctor may have discussed various treatment options, including an interspinous spacer, particularly if your pain is associated with a condition known as lumbar spinal stenosis (LSS).

This guide aims to provide you with clear, comprehensive information about interspinous spacers. It will help you understand this minimally invasive treatment approach and enable you to have informed discussions with your healthcare provider about your path to relief.

In This Article:

Key Takeaways

• Purpose: Interspinous spacers are small, implantable devices designed to relieve chronic lower back and leg pain caused by lumbar spinal stenosis (LSS), a condition in which the spinal canal in the lower back narrows, compressing the nerves.
• Mechanism of Action: These devices function by using “indirect decompression.” They are positioned between the spinous processes, the bony projections on your vertebrae, to gently widen the spinal canal and relieve pressure on the nerves, often without the need for extensive bone removal. Additionally, they help limit painful backward bending (extension) while generally preserving the natural motion of the spine.
• Candidacy: Ideal candidates usually experience moderate lumbar spinal stenosis (LSS) with neurogenic claudication, which is characterized by pain in the legs and buttocks that worsens with standing or walking but is relieved by sitting or leaning forward. These candidates should have not received sufficient relief from conservative treatments after at least six months. Careful selection of patients is essential for achieving successful outcomes.
• Minimally Invasive Procedure: Implantation is a minimally invasive surgery typically performed through a small incision. This approach results in less tissue damage, reduced blood loss, and a faster initial recovery compared to traditional open spine surgeries. Most patients are able to go home the same day.
• Primary Benefits: The primary objectives are to provide significant relief from neurogenic claudication and to enhance mobility, enabling patients to stand for longer periods and walk greater distances. Additionally, many spacers maintain a certain degree of spinal motion, unlike fusion procedures.
• Potential Risks: Like any surgical procedure, there are risks involved, such as infection, bleeding, and reactions to anesthesia. Specifically related to spacers, potential complications include device movement or loosening, spinous process fractures, and in some cases, the necessity for revision surgery.
• Recovery and Rehabilitation: Recovery typically requires avoiding strenuous activities for approximately six weeks, followed by a gradual return to normal function over the course of weeks to months. Physical therapy often plays a crucial role in rehabilitation, and strictly adhering to post-operative instructions is essential for optimal healing.
• Informed Decision-Making: Interspinous spacers are one of several treatment options for lumbar spinal stenosis (LSS). It’s important to have a detailed discussion with your doctor to evaluate the potential benefits and risks based on your specific condition, symptoms, and overall health.

Understanding Your Pain: Could It Be Lumbar Spinal Stenosis (LSS)?

To understand how an interspinous spacer can be beneficial, it’s essential to first grasp the concept of lumbar spinal stenosis (LSS), a common condition that these devices aim to treat. LSS occurs when the spinal canal (the hollow space within your vertebrae through which the spinal cord and nerve roots pass) narrows in the lower back. This narrowing can put pressure on the delicate neural structures, resulting in characteristic symptoms.

What is Lumbar Spinal Stenosis (LSS)?

Lumbar spinal stenosis (LSS) is a condition marked by the narrowing of the spinal canal in the lower back, specifically in the lumbar region. This narrowing often occurs due to the natural aging process and degenerative changes in the spine. Such changes may include osteoarthritis (commonly known as “wear and tear” arthritis), degenerative disc disease (which involves the breakdown of discs between the vertebrae), and the thickening of spinal ligaments.

LSS is a common condition, affecting many individuals, particularly older adults. In the United States, LSS was reported to affect more than 200,000 individuals. In adults over the age of 60, the most prevalent cause of LSS is spondylosis, a term that refers to age-related wear and tear affecting the spinal discs and facet joints.

Common Symptoms of LSS: Recognizing the Signs

The pressure on the spinal nerves caused by lumbar spinal stenosis (LSS) can lead to a specific set of symptoms. These symptoms may include pain, numbness, tingling sensations, or weakness in the lower back, which often radiates into the buttocks and down the legs.

A hallmark symptom of LSS is known as “neurogenic claudication.” This condition refers to pain, cramping, or a feeling of heaviness or discomfort in the legs and buttocks that typically worsens with activities such as standing or walking for extended periods. Claudication is a common indicator of LSS.

Many individuals experience relief from these symptoms when sitting down, leaning forward, or bending at the waist; this postural relief is a key characteristic of the condition. As a result, those affected often find it challenging to walk for more than a short distance or stand for prolonged periods without needing to rest or change position.

The “Shopping Cart Sign” and Positional Relief Explained

Many individuals with lumbar spinal stenosis (LSS) notice that their symptoms improve when they lean forward, such as when pushing a shopping cart or bending over a counter. This phenomenon, known as the “shopping cart sign,” occurs because bending forward (flexing the lumbar spine) temporarily increases the space within the spinal canal.

The added space reduces pressure on the compressed nerves. Recognizing this everyday observation can help individuals determine whether their experiences align with the typical patterns of LSS, as it connects a common behavior to the underlying mechanics of the condition.

How LSS is Diagnosed by Your Doctor

The diagnosis of lumbar spinal stenosis (LSS) begins with a comprehensive evaluation by your pain doctor or spine specialist. This evaluation includes a detailed review of your medical history, an assessment of your specific symptoms, and a thorough physical examination. Additionally, imaging tests are typically conducted to identify the levels and degree of stenosis, clearly understand your spine, and plan any potential surgery. These tests may include X-rays, Magnetic Resonance Imaging (MRI), and/or Computed Tomography (CT) scans.

What Are Interspinous Spacers? A Modern Approach to LSS Relief

For individuals whose lumbar spinal stenosis (LSS) symptoms significantly impact their quality of life and have not improved with conservative treatments, interspinous spacers offer a modern, minimally invasive surgical option.

These small, implantable devices are specifically designed to relieve the symptoms of lumbar spinal stenosis. They are carefully positioned between the spinous processes, which are the bony projections you can feel as bumps running down the middle of your back.

Defining Interspinous Spacers: Small Devices, Big Impact

Interspinous spacers are small implantable medical devices designed to relieve the symptoms of lumbar spinal stenosis. These devices are strategically placed between the spinous processes, which are the bony projections that can be felt as bumps along the midline of the lower back.

How Do Interspinous Spacers Work? The Science of Indirect Decompression

The primary function of an interspinous spacer is to relieve pressure on the spinal nerves that become compressed by a narrowed spinal canal in lumbar spinal stenosis (LSS). It operates through a clever mechanical action, similar to using a car jack to lift a vehicle. By being inserted between two adjacent spinous processes, the spacer gently separates them or “propping them open.”

This action has several beneficial effects: it increases the vertical height between the vertebrae at the level where the spacer is implanted, helping to open up the narrowed spinal canal and the neural foramina (the small tunnels through which nerves exit the spinal canal).

Crucially, the spacer limits how much the spine can extend (bend backward) at that specific segment, especially when standing upright or walking. This limitation is important because backward extension often worsens nerve compression in LSS.

This method of creating space and relieving nerve pressure is commonly referred to as “indirect decompression,” as it accomplishes this without extensively removing the spine’s natural structures.

Materials Used: Biocompatible and Durable

Spacers are usually made from medical-grade materials known for their strength, durability, and biocompatibility, which means they are well-tolerated by the body. Common materials include titanium and a specialized medical-grade synthetic polymer called PEEK (polyetheretherketone). Additionally, some PEEK spacers may include tantalum or titanium alloy components to improve visibility on X-rays or for other structural purposes.

Different Types of Interspinous Spacers

It’s important to understand that there are various designs and brands of spacers available, and your doctor will select the one best suited for your specific anatomy and condition. Some commonly known options include Vertiflex™ (which utilizes the Superion™ Indirect Decompression System), Coflex®, and the Minuteman® device. While the details of each device may vary, they all share the same fundamental principle of creating space to relieve nerve compression.

A distinction is often made between “interspinous spacers” and “interlaminar spacers.” Most of the devices discussed are interspinous, meaning they are primarily placed between the spinous processes. In contrast, some devices, such as Coflex®, are classified as interlaminar spacers because they are positioned between the laminae (the flat bony plates on the back of each vertebra) and also engage the spinous processes for stabilization.

Dynamic Stabilization: Preserving Motion Unlike Fusion

A key feature of many interspinous spacers that sets them apart from spinal fusion surgery is their role as “dynamic stabilizers.” While spinal fusion aims to completely eliminate movement at a treated spinal segment by permanently fusing vertebrae together, interspinous spacers are designed to limit harmful backward extension that can cause pain in lumbar spinal stenosis (LSS).

However, they still allow for a certain degree of natural spinal motion, such as forward bending (flexion), side bending (lateral bending), and twisting. This ability to preserve some movement can be a significant advantage for individuals who want to maintain flexibility and avoid the stiffness often associated with fusion surgery.

The Interspinous Spacer Procedure: What to Expect Step-by-Step

Understanding the journey from consultation to recovery can help ease anxieties surrounding the interspinous spacer procedure. This process is meticulously planned and carried out, prioritizing the reduction of discomfort and facilitating a quick return to daily activities. Typically, it includes comprehensive pre-operative planning, a minimally invasive surgical technique, and a structured recovery phase after the operation.

Before the Procedure: Consultation and Preparation

The process for an interspinous spacer procedure starts long before the actual surgery date.

Initial Diagnosis and Confirming Candidacy

The process starts with a thorough evaluation by your pain doctor or spine specialist. This evaluation includes a detailed review of your medical history, symptoms, and a comprehensive physical examination. The doctor will confirm the diagnosis of lumbar spinal stenosis (LSS) and determine whether an interspinous spacer is a suitable treatment option for you.

Essential Imaging Studies (MRI, X-ray, CT)

To obtain a clear view of your spine, identify the specific levels affected by stenosis, and plan the surgery, imaging tests such as X-rays, Magnetic Resonance Imaging (MRI), and/or Computed Tomography (CT) scans will be conducted. These images are essential for the surgeon to understand your unique anatomy.

The Role of Conservative Treatments First

Interspinous spacers are generally considered for patients who have not experienced sufficient relief from their symptoms after a period of conservative (non-surgical) treatments. This trial period typically lasts at least six months and may involve various therapies, including physical therapy, anti-inflammatory medications, pain relievers, and epidural steroid injections.

Pre-operative Instructions

Once the decision for surgery is made, your doctor will give you specific instructions to prepare for the procedure. These instructions may include temporarily stopping certain medications, particularly blood thinners, quitting smoking (since smoking can hinder healing), and fasting from food and drinks for a specified time before the surgery. Additionally, you may receive guidance on hygiene practices to follow on the day of the surgery.

During the Procedure: A Minimally Invasive Approach

The interspinous spacer procedure is considered minimally invasive.

Anesthesia Options: Local with Sedation or General

The surgery can be conducted using either local anesthesia with sedation (where you remain awake but feel drowsy and comfortable) or general anesthesia, in which you are completely asleep. The choice of anesthesia depends on your overall health, the specific type of spacer being used, and the preferences of both you and your surgeon.

Surgical Technique: Small Incision, Precise Placement

During the surgery, you are typically positioned lying face down on a specialized operating table. The surgeon utilizes real-time X-ray imaging, known as fluoroscopy, to guide the instruments and ensure the precise placement of the spacer between the targeted spinous processes. The incision made in the lower back is very small, usually one to two inches long or even smaller for certain devices like the Vertiflex™ spacer, which can be inserted through an incision about the size of a dime.

How the Spacer is Inserted

The surgeon begins by making a small incision to carefully create a pathway to the spinous processes. This is typically achieved by gently separating or spreading the muscles and ligaments, rather than making extensive cuts, which enhances the minimally invasive nature of the procedure.

Next, a spacer is inserted into the space between the designated spinous processes. Some devices, like Vertiflex, are introduced in a compressed state through a small tube and then expanded once in position, with “wings” or arms that open up to secure the device. Other devices, such as the Minuteman, are inserted through an incision made on the side of the body, using a lateral approach.

Duration of the Surgery

The procedure is generally brief, lasting anywhere from 30 minutes to 1-2 hours. The exact duration depends on factors such as the number of spinal levels being treated and the specific type of spacer being utilized. Once the spacer is properly positioned and secured, the small incision is closed with sutures or surgical glue, and a sterile bandage is applied.

Immediately After the Procedure: Recovery and Going Home

The minimally invasive nature of the surgery typically enables a faster initial recovery.

Post-Anesthesia Care

After the surgery, you will be taken to a recovery area for a brief observation period as the anesthesia effects diminish. Nursing staff will monitor your vital signs and comfort levels closely.

Typically an Outpatient Procedure

Interspinous spacer surgery is usually performed on an outpatient basis, allowing patients to return home on the same day as their procedure. However, in certain situations or if there are immediate post-operative concerns, an overnight hospital stay may be recommended.

Initial Pain Management and Mobility

It is normal to experience some soreness or discomfort at the incision site. This discomfort is typically well-managed with pain medications that your doctor prescribes. Most people can get up and walk a few hours after the surgery.

Key Benefits: Why Your Doctor Might Recommend an Interspinous Spacer

Interspinous spacers provide several potential advantages for patients with lumbar spinal stenosis (LSS), making them an appealing option when conservative treatments have not offered enough relief. These benefits include substantial pain reduction and a quicker return to daily activities, all resulting from the device’s unique design and its minimally invasive implantation method. The aim is not only to alleviate discomfort but also to enhance overall function and improve quality of life.

Significant Pain Relief for Back and Legs (Neurogenic Claudication Focus)

The main objective of interspinous spacers is to relieve chronic lower back pain and, specifically, the severe symptoms of neurogenic claudication. These symptoms can include pain, numbness, tingling, or cramping in the legs and buttocks.

Clinical studies on specific devices, such as the Vertiflex™ (Superion™) spacer, have shown significant and lasting improvements in both back and leg pain. For example, some studies indicate that, on average, patients experienced a 66% reduction in back pain and a 75% reduction in leg pain five years after the procedure.

Improved Mobility and Quality of Life

Interspinous spacers can help alleviate pressure on the spinal nerves, allowing patients to stand upright for longer periods, walk greater distances without severe pain, and engage more fully in their daily activities and hobbies. This often leads to a considerable improvement in overall quality of life. The ability to carry out simple tasks that were once painful can significantly enhance a person’s independence and well-being.

Minimally Invasive: Smaller Incisions, Less Tissue Damage

The minimally invasive nature of this surgery is a significant advantage. It involves smaller incisions, which cause less damage to surrounding muscles and soft tissues, resulting in reduced blood loss during the operation. These factors often lead to less post-operative pain and a potentially lower risk of complications, such as infection, compared to more extensive open spinal surgeries.

Quicker Recovery Times Compared to Traditional Surgery

Compared to traditional spinal surgeries such as spinal fusion or extensive laminectomy, the recovery period after an interspinous spacer procedure is typically quicker. Many patients are able to return to light activities within a few weeks following the surgery. This quicker return to normal activities is a significant advantage for many individuals.

Preserving Natural Spinal Motion

One major advantage of interspinous spacers compared to spinal fusion is that they are designed to maintain a more natural range of motion in the affected segment of the spine. While these spacers restrict painful backward bending, they generally allow for forward bending and some side-to-side flexibility. This capability can lead to a more natural feeling of movement and may help reduce stress on the adjacent levels of the spine.

Reduced Need for Opioid Medications

Effective pain relief from the spacer procedure can reduce the reliance on pain medications, including opioids. Clinical studies, particularly those focused on the Vertiflex™ device, have shown a significant decrease in opioid use among patients after the procedure. For instance, one dataset reported an 85% reduction in opioid use five years after the procedure.

Preservation of Natural Anatomy and Reversibility

The procedure generally does not involve removing large amounts of bone or ligament, which helps maintain the natural structure of the spine. Additionally, interspinous spacers can often be removed if needed. This reversibility allows for the possibility of exploring other treatment options, including more extensive surgeries, if the spacer does not deliver the expected relief or if the patient’s condition changes.

Long-Term Effectiveness: What Studies Show

While the immediate and short-term benefits of interspinous spacers can be impressive, it is important to consider the durability of these benefits over the long term. Clinical evidence on this issue varies. For example, devices like the Vertiflex™ (Superion™) spacer have demonstrated positive results in studies that tracked patients for five years, with many reporting significant pain relief and satisfaction. However, other research indicates that some individuals may experience a recurrence of symptoms or require reoperation, suggesting that long-term outcomes are not consistently positive across all spacer devices or patient groups.

Understanding Potential Risks and Complications

The implantation of an interspinous spacer, like any surgical procedure, involves potential risks and complications. Although the minimally invasive approach typically lowers some of these risks compared to open surgery, it is essential for patients to be aware of them. Your surgeon will discuss these potential issues in detail to help you make an informed decision about your treatment.

General Surgical Risks to Be Aware Of

These are the risks that apply to most surgical procedures.

• Infection: There is a risk of infection at the surgical incision site or, less commonly, deeper within the spine. Most infections are superficial and can be treated effectively with antibiotics; however, severe infections may require additional treatment or even surgery.
• Bleeding/Hematoma: Although significant bleeding is rare, some bleeding may occur, possibly resulting in a collection of blood (hematoma) that could require drainage.
• Anesthesia Reactions: Any procedure involving anesthesia carries a small risk of adverse reactions.
• Blood Clots (Deep Vein Thrombosis/Pulmonary Embolism): Blood clots, although rare, can develop in the legs (DVT) and may travel to the lungs (PE), which poses a serious risk.
• Nerve Damage: There is a slight risk of injury to nearby nerves or the spinal cord, which could result in new or worsening pain, numbness, or weakness.
• Dural Tear (Spinal Fluid Leak): If the dura mater surrounding the spinal cord is accidentally nicked, cerebrospinal fluid (CSF) may leak, often resulting in a positional headache that worsens when the person is upright. This condition typically heals with rest, but sometimes requires medical intervention.

Spacer-Specific Considerations and Complications

There are also specific risks associated with the interspinous spacer device itself.

Spacer Movement (Displacement, Migration, Loosening)

One of the most commonly discussed complications related to these devices is the potential for the spacer to move from its original intended position over time. It may shift, tilt, or become loose. If this happens, it can lead to a recurrence of pain or the development of new symptoms. In such cases, revision surgery may be necessary to reposition or remove the spacer.

Spinous Process Fracture

The spinous processes are the parts of the vertebrae that support the spacer, and they can sometimes fracture. This may occur during the implantation of the device or later on. The risk of fracture is higher if the bone is weak, such as in cases of osteoporosis, or if there is excessive stress on the area.

Implant Failure or Breakage (Rare)

Although the spacer device is designed to be durable, there are rare instances where it may break, wear out, or malfunction. Analysis of adverse event databases indicates that different types of spacers can experience varying predominant modes of malfunction.

Persistent Pain or Inadequate Relief

There is a possibility that the procedure may not achieve the expected level of pain relief. Pain could persist or return after an initial period of improvement, and not all patients respond to the treatment similarly.

The Possibility of Needing Revision Surgery

If significant complications arise, if the spacer shifts or fails, or if pain relief is insufficient or not long-lasting, further surgery may be necessary. This could involve removing, repositioning, or replacing the spacer, or it may require converting to a different type of surgical procedure, such as a traditional laminectomy or even spinal fusion.

Allergic Reaction to Implant Materials (Rare)

Though rare, patients may experience allergic or sensitivity reactions to materials used in the spacer, including titanium or PEEK. Those with known metal allergies should thoroughly discuss this with their doctor.

Your Recovery Journey: Healing and Returning to Activities

The recovery period following an interspinous spacer procedure is typically shorter and less intensive than that after traditional open spine surgery. However, it still requires careful attention and adherence to medical advice. Your active involvement in the recovery process is essential for achieving the best possible outcome. By following your surgeon’s instructions closely, you can help ensure proper healing and reduce the risk of complications.

The First Few Days and Weeks: What to Expect at Home

Your initial recovery will concentrate on managing discomfort and allowing your body the time it needs to heal.

Wound Care and Incision Site Management

It is essential to keep the small incision clean and dry, following your surgeon’s instructions to prevent infection. Stitches or surgical staples may need to be removed during a follow-up visit, typically scheduled for one to two weeks after the procedure. You will receive guidance on how to care for the bandage and when it can be safely removed.

Managing Post-Operative Discomfort

Pain medication will be prescribed to help manage any discomfort after your surgery. Be sure to take it as directed by your doctor. It’s normal to experience some soreness at the incision site. Since this procedure is often done on an outpatient basis, you will typically be discharged to go home on the same day.

Activity Levels and Restrictions: A Gradual Return

Resuming activities should be a gradual process that follows your doctor’s recommendations.

Importance of Avoiding Heavy Lifting and Strenuous Activities

Engaging in light activity, especially walking, is generally recommended shortly after surgery. This can be gradually increased based on your comfort level and your doctor’s advice.

For about the first six weeks, or as specifically instructed by your doctor, it is essential to avoid heavy lifting, typically defined as anything over 10 pounds. During this initial healing phase, you should also refrain from strenuous exercises and any activities that involve excessive bending, twisting, or straining of your back. Many people can return to light-duty work or office jobs within a few days to a week; however, jobs requiring more physical effort may need a longer recovery time.

The Role of Physical Therapy in Rehabilitation

Physical therapy plays a crucial role in the rehabilitation process following interspinous spacer surgery. A qualified physical therapist will create a personalized exercise program designed to restore strength in your back and core muscles. This program will emphasize improving flexibility and enhancing overall mobility and function. The focus will typically be on gentle exercises, core stabilization, and teaching proper body mechanics to protect the spine during daily activities.

Timeline for Full Recovery: Patience is Key

Many patients experience a relatively quick initial recovery and notice improvements in their symptoms within a few weeks. However, the timeline for full recovery can vary. Typically, full recovery takes anywhere from a few weeks to a few months. Several factors can influence the speed and success of recovery, including your age, overall health, the specific spacer implanted, and, importantly, your adherence to post-operative instructions and the physical therapy regimen.

Follow-Up Appointments: Monitoring Your Progress

Regular follow-up appointments with your surgeon are crucial. These visits enable your doctor to monitor your healing progress, ensure that the spacer is functioning properly, and evaluate your pain relief and functional improvement. Additionally, they provide a chance for you to raise any questions or concerns you may have. Typically, a follow-up visit is scheduled about six weeks after the surgery.

Long-Term Back Health: Maintaining Your Results

To ensure long-term back health and to maximize the benefits of your procedure, it’s essential to maintain a healthy lifestyle. This includes engaging in regular exercise as recommended by your doctor or physical therapist, managing your weight, and practicing good posture and body mechanics. Additionally, if you are undergoing any other medical or diagnostic procedures in the future, be sure to inform your healthcare providers about your spinal implant.

Importance of Adhering to Post-Operative Instructions

A successful recovery is an active process that requires your full participation. It is essential to diligently follow your surgeon’s post-operative instructions, consistently attend and engage in physical therapy sessions, and strictly adhere to activity restrictions, especially during the early stages of recovery.

These steps are critical for optimal healing. If you do not comply with these recommendations, you may increase the risk of complications, such as a stress fracture of the spinous process from resuming strenuous activity too soon, or you might experience a recurrence of symptoms.

Is an Interspinous Spacer the Right Choice for You?

Determining whether an interspinous spacer is the appropriate treatment requires a careful evaluation by a qualified physician, along with a thorough discussion between you and your doctor.

Several factors are considered to assess if this minimally invasive procedure aligns with your specific condition, symptoms, and overall health goals. It’s important to understand who typically benefits from this treatment and who may not be suitable candidates, as this is a crucial part of the decision-making process.

Who is Generally a Good Candidate for an Interspinous Spacer?

Patients considered suitable candidates for an interspinous spacer procedure typically have the following characteristics:

• A confirmed diagnosis of moderate lumbar spinal stenosis (LSS).
• Predominant symptoms of neurogenic claudication, meaning they experience pain, numbness, cramping, or weakness in the legs, buttocks, or groin that characteristically worsens with standing or walking and is relieved by activities that involve flexing the lumbar spine, such as sitting down or leaning forward (a “flexion-responsive” pattern).
• Failure to achieve adequate symptom relief after at least six months of dedicated conservative (non-surgical) treatments, which may include physical therapy, anti-inflammatory medications, pain relievers, and/or epidural steroid injections.
• Being skeletally mature (meaning their bones have stopped growing).
• They may have a stable Grade 1 spondylolisthesis (a condition where one vertebra has slipped slightly forward over the one below it) in conjunction with their spinal stenosis.
• Patients who wish to avoid more invasive surgical options like a traditional laminectomy or spinal fusion, or those who may not be ideal candidates for such larger surgeries due to their age, other coexisting medical conditions, or personal preference.

Who Might Not Be a Suitable Candidate? Understanding Contraindications

There are specific situations, known as contraindications, where an interspinous spacer procedure may not be recommended or could even be harmful. These include:

• Allergies: A known allergy or hypersensitivity to the materials used in the spacer implant, such as titanium or PEEK, is a contraindication.
• Spinal Instability: Significant spinal instability, such as spondylolisthesis greater than Grade 1 or specific types like isthmic spondylolisthesis, can prevent the procedure.
• Severe Osteoporosis: This condition, characterized by weakened and brittle bones, may not provide adequate support for the implant and could increase the risk of fractures.
• Infections: An active infection anywhere in the body, or one localized to the area of the planned surgery, prohibits implantation.
• Cauda Equina Syndrome: This rare but serious condition involves severe compression of the nerve roots and can lead to symptoms such as bowel or bladder dysfunction, or severe leg weakness. It requires immediate and more extensive surgical decompression instead of a spacer.
• Other Contraindications: Additional factors can include significant scoliosis, a previous spinal fusion or extensive laminectomy at the same spinal level(s), morbid obesity, pain that is primarily axial back pain without significant neurogenic claudication, or a fracture of the spinous process or nearby structures at the intended level.

The Critical Role of Patient Selection for Successful Outcomes

The extensive lists of indications and contraindications provided by regulatory bodies for these devices are based on clinical evidence aimed at maximizing benefits while minimizing risks. Careful and precise selection of patients is crucial for the success of interspinous spacer surgery and for avoiding potential complications.

Studies and clinical experience have demonstrated that poor patient selection (such as placing a spacer in an unstable spine, in bone significantly weakened by osteoporosis, or for symptoms not primarily caused by flexion-responsive stenosis) can lead to complications such as device migration, spinous process fractures, and overall treatment failure.

Why a Detailed Discussion With Your Doctor is Essential

This guide offers general information but should not be seen as a substitute for a personalized consultation with a qualified pain doctor or spine specialist. Deciding to proceed with an interspinous spacer is an important choice that should be made collaboratively between you and your doctor.

Your doctor will consider your specific symptoms, the results of imaging studies, your overall health, lifestyle factors, and your personal treatment goals to determine whether this procedure is the best option for you.

How Do Interspinous Spacers Compare to Other LSS Treatments?

Interspinous spacers are one of several options available for managing lumbar spinal stenosis. Understanding how they fit into the overall landscape of treatment can be helpful. The choice of treatment depends on various factors, including the severity of your symptoms, your overall health, and your personal preferences. The goal is always to find the safest and most effective path to relief. Each treatment option, ranging from conservative care to more invasive surgeries, has its own benefits, risks, and recovery expectations. Your doctor will discuss these with you to help determine the best approach for your situation.

Conservative (Non-Surgical) Treatments Revisited

These methods are generally considered the first line of defense against LSS (lumbar spinal stenosis) symptoms and are typically tried for at least six months before considering surgery. They include physical therapy and exercise specifically designed to strengthen the core and back muscles, improve flexibility, balance, and posture.

Medications such as non-steroidal anti-inflammatory drugs (NSAIDs), other pain relievers, and occasionally muscle relaxants may be used. Epidural steroid injections involve administering corticosteroid medication into the epidural space to reduce inflammation and alleviate pain, although the relief is often temporary. Lifestyle modifications, such as weight management and avoiding activities that worsen symptoms, along with, in some cases, the use of braces, can also be part of conservative care.

Traditional Decompressive Laminectomy/Laminotomy (Direct vs. Indirect Decompression)

Laminectomy is a common surgical procedure used to treat lumbar spinal stenosis (LSS). In this surgery, the surgeon removes the lamina (the bony part of the vertebra) and/or thickened ligaments that are pressing on the spinal nerves. Compared to “indirect” decompression methods, such as using spacers, laminectomy is a more invasive form of direct decompression.

While laminectomy can be very effective, it may involve more blood loss, a longer recovery time, and the possibility of spinal instability in the future, which could require a subsequent spinal fusion surgery.

Related: Direct and Indirect Spinal Decompression

Spinal Fusion (When Is It Considered?)

Spinal fusion is a more extensive surgical procedure in which two or more vertebrae are permanently joined, or “fused,” together. This is typically achieved using bone grafts and medical hardware such as screws and rods. Compared to interspinous spacer surgery, spinal fusion is significantly more invasive and usually requires a longer hospital stay and an extended recovery period. The main goal of this procedure is to eliminate motion at the treated level(s).

In contrast, interspinous spacers are less invasive and are designed to preserve some degree of motion. Fusion surgery is generally reserved for cases of severe lumbar spinal stenosis (LSS) that are accompanied by significant spinal instability or deformity. These conditions often make standalone spacer procedures inappropriate.

Other Minimally Invasive Options (e.g., MILD procedure)

The Minimally Invasive Lumbar Decompression (MILD) procedure is an option where the surgeon removes small portions of the lamina bone and/or the thickened ligamentum flavum through very small incisions, utilizing specialized instruments and imaging guidance. Both MILD and interspinous spacers are considered minimally invasive alternatives to traditional open surgery.

Research indicates that MILD may provide excellent long-term durability, potentially resulting in lower reoperation rates and fewer spinous process fractures compared to interspinous spacers. This is particularly true for carefully selected patients whose stenosis is primarily due to a thickened ligamentum flavum.

On the other hand, some studies have found that patients receiving interspinous spacers (without simultaneous direct decompression) had a lower risk of needing further spinal interventions compared to those undergoing MILD, while maintaining similar overall safety profiles.

Quick Comparison Table of LSS Treatments

To help illustrate the differences between treatment options, consider the following comparisons:

• Conservative Care: This is a non-surgical approach that focuses on managing symptoms.
• Interspinous Spacers: These are considered minimally invasive surgical options.
• Laminectomy: This procedure is invasive and involves removing part of the bone over the nerve.
• Spinal Fusion: This is a more invasive surgery that fuses two or more vertebrae together.

In terms of recovery times:

• Conservative Care: The recovery process is ongoing and may not have a definitive end.
• Interspinous Spacers and Laminectomy: Recovery typically takes several weeks to months.
• Spinal Fusion: Recovery can take from months to a year.

FAQs

Conclusion

Interspinous spacers offer a minimally invasive surgical option for individuals experiencing the often debilitating symptoms of lumbar spinal stenosis (LSS). These devices are particularly beneficial for those who find that their pain (especially leg pain, numbness, or cramping) worsens with standing or walking but improves when they bend forward or sit down.

Interspinous spacers work by gently increasing the space within the spinal canal, which alleviates pressure on compressed nerves and aims to enhance both pain relief and physical function.

Novus Spine & Pain Center

Novus Spine & Pain Center is in Lakeland, Florida, and treats patients with chronic pain with numerous therapies, including interspinous spacers. By using a comprehensive approach and cutting-edge therapies, we work together with patients to restore function and regain an active lifestyle while minimizing the need for opiates.

For your convenience, you may schedule an appointment online, request a call back, or call our office at 863-583-4445.