 |
 |
Introduction
Procedure
Risks
Alternative Treatments
The lumbar spine is comprised of vertebral bodies (also known as vertebrae) that are separated by soft intervertebral discs, which act to cushion the spine, allow mobility, and provide stability.
A lumbar interspinous process decompression device is an apparatus that can lead to relief of sympotms in certain patients with lumbar stenosis, a condition characterized by narrowing of a portion of the spinal canal, as indicated by the midline side-view image of the lumbar spine that appears below.
The symptoms associated with this condition are usually the result of crowding and compression of nerve roots within the spinal canal by overgrowth of tissue within this space. In patients who are considered good candidates for this surgery, the placement of this device leads to stretching and thinning of the overgrown tissue, thereby creating more space within the spinal canal for the nerve roots.
After induction of general anesthesia, an incision is made in the lower back over the region of spinal narrowing.
The back muscles and other tissue are dissected down to the level of the vertebrae.
At this point a set of instruments are used to open the space between the involved vertebrae.
The interspinous process decompression (also known as the X-STOP) device is then inserted into the opened space as shown in the image below on the left. The X-STOP device is depicted in the image below on the right, with the disassembled version (to allow for insertion) shown in the inset.
After insertion, the device is reassembled and locked in place.
The final position of the device is shon in the figures below.
The incision is then closed prior to completion of the operation.
Due to advances in medicine and technology, surgical procedures are generally considered to be safe, and a great majority of patients who undergo surgery will not experience any complications. However, there are certain risks involved in any procedure which are important to be aware of in order to make an informed treatment decision.
Risks Specific to this Procedure: The risks associated with this surgery include, but are not limited to, damage to spinal cord or nerve roots leading to increased pain or other neurologic problems and need for further surgery.
Infection: Invasion of tissue by bacteria or other germs occurs to some degree whenever a cut, incision or puncture is made. In most instances, through the natural defense mechanisms of the body, healing of the affected area occurs without difficulty. In some instances antibiotic medicines are prescribed and at times additional surgical measures may be necessary to combat infection.
Hemorrhage: The cutting of blood vessels causes bleeding and this occurs in every surgical incision. This bleeding is usually controlled without difficulty. At times, blood transfusions are required to replace blood loss. If blood transfusions are given, there are additional risks of liver inflammation, hepatitis, and the possibility of receiving Acquired Immune Deficiency Syndrome (AIDS). There is no absolutely reliable way to predict these unwanted reactions, some of which may be quite serious and even lead to death.
Drug Reactions: Unexpected allergies, lack of proper response to medications or illness caused by the prescribed drugs are possibilities. It is important for you to inform your physician and your anesthesiologist or certified registered nurse anesthetist of any problem you or your family have had with reactions to drugs and which medications you have taken in the past six months, including over-the-counter drugs, especially aspirin.
Anesthesia Reactions: There may be unusual or unexpected responses to the gases, drugs or methods used to anesthetize you which can lead to difficulties with lung, heart or nerve function. Eating or drinking before anesthesia increases the risks of vomiting which may cause significant complications. Inform your anesthesiologist or certified registered nurse anesthetist of problems you and your family have had with anesthesia.
Blood Vessel Inflammation and Clotting: It is impossible to predict the occurrence of blood vessel inflammation and clotting problems. If blood clots form, they can move from where they formed to other areas of the body and cause injury.
Injury to Other Organs: Because of the closeness of other organs to the area being operated on, there may be injury to other organs. The stress of surgery or the procedure may also harm other organ systems of the body.
The alternative management modalities for this procedure are physical therapy, pain management using medications or injections, certain alternative medicine therapies (acupuncture), possibly other surgical procedures (such as traditional lumbar laminectomy), and expectant management with no treatment at all. If the decision is made to not have this procedure, there may be associated risks which need to be discussed with a physician.
