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Spacer Insertion May Offer Less Invasive Option for Lumbar Problems

Implanting a small spacer between lumbar vertebrae during a procedure called interspinous process decompression may be an effective and minimally invasive way to treat spinal// stenosis, according to a new report.

The report is published by ECRI, an independent nonprofit health services research agency that produces systematic reviews on medical devices, drugs, biotechnologies, procedures, and health services.

Spinal stenosis is a narrowing of the openings in the vertebrae that contain the spinal cord and nerve roots. The condition, usually caused by age-related degeneration of the spinal disks and osteoarthritis of the spine, may “pinch” the nerves, resulting in pain or cramping in the legs, buttocks or groin that is aggravated by standing or walking.

The position of the spine typically affects the symptoms: leaning forward reduces the pain, while leaning backward makes it worse. Treatment generally starts conservatively, with physical therapy and pain relievers, and can include epidural steroid injections. Severe cases may require surgery to decompress the spinal cord, which can include fusing two or more of the vertebrae together.

Spacer insertion has a potential role as a less costly alternative to conventional operative procedures when conservative treatments have failed or in situations in which patients are unwilling to consider more invasive surgery. One spacer, X Stop, has been approved by the Food and Drug Administration for use in patients age 50 and older with confirmed lumbar spinal stenosis. XStop was the only spacer addressed in the ECRI report; however, other versions of the spacer are under review.

According to the ECRI analysis, only one randomized controlled trial of the procedure has been reported. A total of 191 patients at nine centers were randomly assigned to undergo either the spacer procedure or to be treated nonoperatively. Results from this study suggest that for some patients,
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