X-stop procedure helps relieve pain as a result of spinal stenosis

Nov 20 2007

A new minimally invasive procedure is hitting its mark with certain types of low back and leg pain sufferers, significantly reducing their pain and disability.

Called X-stop, the procedure is designed to help relieve pain symptoms as a result of spinal stenosis, a condition effecting more than 400,000 Americans, most over the age of 60.

According to Paul Maurer, M.D., associate professor of Neurosurgery at the University of Rochester Medical Center, the simple, straightforward nature of the X-stop device and the procedure itself make it a great option for patients suffering with spinal stenosis.

“X-stop is really an exciting breakthrough, for it gives us a chance to cure or greatly diminish pain associated with spinal stenosis once conservative treatments have failed,” Maurer said. “The procedure can be done in a about a half hour, does not require the removal of any bone or soft tissue, and in some cases, the patient can even go home the same day.”

Spinal stenosis is a narrowing of the spinal canal in the lower back. The degenerative condition occurs gradually as we age as a result of the “wear and tear” on the spine from everyday activities. This narrowing can squeeze and irritate the nerves that branch out from the spinal cord, causing back pain, leg pain, general weakness, and a loss of balance.

Mild and moderate pain symptoms can be controlled with pain medicines, exercise, physical therapy and even a corticosteroid shot that reduces inflammation. However, for about 20 percent of spinal stenosis sufferers, a laminectomy is the only option that effectively relieves significant leg pain. During this surgical procedure, part of the vertebrae is removed to create space for nerves, relieving pressure on the spinal cord or the spinal nerve roots. Patients stay in the hospital between two and three days, and often face two or three months of recovery time.

X-stop, on the other hand, provides a simple way to permanently wedge open the narrowed spinal canal. The tiny titanium device is shaped like a bird with two sets of wings, and is designed to fit between spinal processes, the small bony protrusions that jut out from the spinal column toward the back. A surgeon makes a small and relatively superficial incision, and carefully places the X-stop in the effected area. The “wings” secure the implant between the spinal processes, so that X-stop remains in place without attaching to the bone or ligaments in the back.

“This truly is a minimally invasive procedure, with most patients having a full recovery in less than one week,” said Jason Schwalb, M.D., assistant professor of Neurosurgery at the Medical Center .

Schwalb cautioned that not everyone with spinal stenosis is a candidate for X-stop. Having performed dozens of these procedures, he said that those patients whose spinal stenosis is limited to one or two vertebrae have the best outcomes. And patients who do experience relief after the X-stop procedure can safely proceed to a laminectomy if needed.

“You really can't lose with X-stop,” Maurer added. “If you're a candidate, the 20-minute procedure has the potential to relieve the pain. For those who continue to have problems and don't improve, we can always do the standard operation.”

In addition to Maurer and Schwalb, the X-stop procedure also is performed by Rafael Allende, M.D. The three physicians are all members of Rochester Neurosurgery Partners, an initiative of the University of Rochester.