DR. SCOTT KATZMAN

It’s possible to relieve pinched spinal nerves with a spacer

By Alfredo Arango
Medical Editor

A new surgical procedure for relieving painful pinched spinal nerves is now facilitating this delicate and frequent operation for both surgeons and patients.

This new surgery corrects spinal stenosis in a less invasive manner. This condition consists of a pinching of the nerves of the spinal cord or the roots of the nerves that exit through the spinal column, as a result of degenerative processes in the tissues, caused either by disease or aging. Prior methods of treatment require larger incisions, more blood loss and are more painful.

“The new way to correct stenosis is by means of a procedure that does not require going in as deep as conventional surgery. It takes less than an hour, and it is performed through a small incision through which a spacer is inserted,” says Dr. Scott Katzman, an orthopedic surgeon affiliated with Columbia Hospital, who subspecializes in minimally invasive techniques for the spinal column.

The new technique is known as ExtenSure. NuVasive, the manufacturer of this technology, explains that it is “an interspinous dynamic stabilization and fusion system allowing decompression through a more natural restoration of the spinal anatomy. ExtenSure’s primary indication is for lumbar spinal stenosis.” The word lumbar refers to the lower back.

According to technical descriptions of this technology, the ExtenSure device is a cylindrically fashioned piece of allograft bone intended to effect distraction, restore and maintain the space between two adjacent spinous processes and indirectly decompress a stenotic spinal canal. The procedure promotes fusion of the allograft to the spinous process above, while allowing motion between the allograft and the spinous process below. It is thought that this will provide a long-term biological solution to implant stability while retaining segmental motion. It may also be used to facilitate fusion between two or more adjacent spinous processes. This is similar to the action of the X-stop device.

In other words, a piece of poly-ether material, approximately ½” by 1” is placed between the spinous process (the bone that you can feel sticking out in the center of your back), which opens the space for the nerves to “breathe.” This relieves the pressure and thus the pain and associated symptoms. The procedure is performed through a small incision, and there is no danger because the spinal canal is not entered. “This procedure is a safe, minimally invasive option for patients with symptoms of lumbar spine stenosis”, assures Dr. Katzman.

Generally, ExtenSure patients are seen again in the physician’s office about one week after surgery. If during that first week after surgery the patient has any questions or problems, he/she should call the surgeon immediately. The patient then returns for follow-up appointments at various intervals.

The conventional way of correcting stenosis has been to perform laminotomy (removal of the lamina) and facetectomy (removal of the facet). The lamina and the facet are structures of the bone of the spinal column. These procedures are also known as “open decompression.” They are carried out by means of very invasive surgery, in which a long incision is made along the back, and fragments of the bone that covers the root of the pinched nerve are cut away; in some cases part of the disc between the vertebrae is also cut away. Usually, it becomes necessary to fuse the whole affected segment with metal rods, thus sacrificing motion.

“Conventional laminotomy and facetectomy are long, deep surgical procedures, with heavy bleeding, which sometimes are not recommended for older people with additional health problems, who are precisely the ones who have stenosis. The technology that has been developed for preventing these surgeries and for carrying out the newer and less invasive procedures is a great step forward,” adds Dr. Katzman.

According to the American Academy of Orthopaedic Surgeons, the best way to avoid lumbar spinal stenosis is to stay as physically fit as possible. Regular exercise can improve endurance and maintain the strength of the muscles that support the spine. Avoiding excess weight gain can decrease the load that the lumbar spine has to carry. Patients should also avoid smoking. Both the smoke and the nicotine cause the spine to degenerate faster than normal.

Nonsurgical treatments, which are considered conservative, include physical therapy, anti-inflammatory medications, epidural steroid injections, and bracing (corset). The same Academy explains that “all of these nonsurgical treatments are aimed at decreasing inflammation and providing relief of symptoms. However, nonsurgical treatment will not improve the narrowing of the spinal canal.”