IPD for Treatment of Degenerative Lumbar Spine Stenosis
If thoracic spine pain becomes so severe that it disrupts daily life or is accompanied by swelling, tenderness, or redness, it’s important to seek medical attention.
At Complete Orthopedics, our expert thoracic spine specialists are adept at treating thoracic spine pain through both surgical and non-surgical means. We examine symptoms, diagnose the condition, and recommend suitable treatments, including surgery if necessary.
Serving New York City and Long Island, we partner with six hospitals to offer cutting-edge thoracic spine surgery and comprehensive orthopedic care. You can schedule a consultation with our orthopedic surgeons online or by phone.
Learn about the common causes of thoracic spine pain and the treatment options available, including when surgery might be the best choice.
Overview
Degenerative Lumbar Spine Stenosis (DLSS) is a condition that predominantly occurs as a result of aging. This condition involves the narrowing of the central spinal canal and intervertebral foramen due to degenerative changes in the facet joints, ligamentum flavum, posterior longitudinal ligament, and intervertebral discs. These changes can lead to various symptoms including neurogenic claudication, radicular syndromes, and back pain.
DLSS is a condition that occurs as a result of aging, whereby the narrowing of the central canal and intervertebral foramen is caused by changes in the facet joints, ligamentum flavum, posterior longitudinal ligament, and intervertebral disc.
Neurogenic claudication is commonly linked to narrowing of the central canal, while radicular syndromes usually occur with stenosis of the lateral recess and intervertebral foramen. Additionally, back pain is typically present.
Degenerative listhesis may also be present, with or without instability. These clinical characteristics can be assessed individually or as a whole, resulting in a diverse group of patients with varying presentations.
Although there are no well-defined diagnostic and classification criteria, DLSS with symptoms is a prevalent condition. Radiologic evidence of DLSS has been found in 19% to 47% of cases. DLSS is presently the primary reason for spinal surgery in patients who are over 65 years old.
If non-surgical interventions such as physical therapy, spine injections, and conventional or neuropathic pain medicine do not succeed in relieving pain and improving functionality for the patient, they may consider undergoing surgical treatment as a viable alternative. When radicular pain and/or neurogenic claudication are the main symptoms, decompression appears to be especially advantageous.
The conventional surgical method involves performing a broad decompression, which may be combined with arthrodesis. Several potential adverse outcomes could include postoperative pain, dural tear, blood loss, infection, and immobilization.
According to the literature, the use of an interspinous process device (IPD) may increase the central canal area by as much as 18%.IPDs are presented as a less invasive surgical option, but their safety, effectiveness, and cost-effectiveness are still under investigation. IPDs have been evaluated against conservative treatment or traditional surgery, but there is a general apprehension about potential bias risks and small sample sizes in these studies.
Non-Surgical Treatments
Non-surgical interventions for DLSS include physical therapy, spinal injections, and medications (both conventional and neuropathic pain medicine). These treatments aim to relieve pain and improve functionality. However, when these measures fail, surgical treatment becomes a viable alternative.
Surgical Treatments
Conventional Decompression Surgery
The traditional surgical method for DLSS involves performing a broad decompression of the affected spinal segments, which may be combined with arthrodesis (spinal fusion). Potential adverse outcomes of this surgery include postoperative pain, dural tears, blood loss, infection, and immobilization.
Interspinous Process Devices (IPDs)
Interspinous Process Devices (IPDs) represent a less invasive surgical option for DLSS. According to the literature, the use of IPDs may increase the central canal area by up to 18%. However, the safety, effectiveness, and cost-effectiveness of IPDs are still under investigation.
Comparative Effectiveness of IPDs
IPD vs Non-Surgical Treatments
Studies comparing IPDs to non-surgical treatments (such as physical therapy, spinal injections, and medications) have shown that patients with IPD implants experience significantly greater improvements. However, treatment failures, requiring subsequent laminectomy or reoperation, are more common in the non-surgical treatment group. Patients with IPD implants also report a better quality of life, especially regarding physical activity, although adverse events are more prevalent in this group.
IPD vs Decompressive Surgery
The IPD group had a higher overall reoperation rate. When considering healthcare costs, social costs, and cost-utility, the likelihood of IPDs being more cost-effective than decompressive surgery was well below 50%.
The cost of IPDs was substantially greater and did not result in an improved quality of life in comparison to surgical decompression. The higher expenses associated with IPDs were due to the cost of the implant and the increased rate of reoperation.
IPD has a noticeably lower rate of treatment failure, and superior pain relief and improved functional outcomes. However, the incidence of complications was observed to be higher in the IPD group when compared to conservative treatment and decompressive surgery. The cost-effectiveness analysis supported the conventional approach.
Conclusion
Degenerative Lumbar Spine Stenosis is a complex condition with various treatment options. While non-surgical treatments are often the first line of defense, surgical options, including conventional decompression surgery and IPDs, are considered when conservative measures fail. Each treatment option has its advantages and drawbacks, and the choice of treatment should be individualized based on the patient’s specific condition, symptoms, and overall health. Ongoing research and clinical trials will continue to refine the best practices for managing DLSS.
Do you have more questions?
Common symptoms include neurogenic claudication (pain and discomfort in the lower extremities during walking or standing), radicular pain (nerve root pain), and back pain. Symptoms may also include numbness, tingling, and weakness in the legs.
DLSS is a condition that occurs due to aging, involving the narrowing of the spinal canal and intervertebral foramen. This narrowing is caused by degenerative changes in the spine’s facet joints, ligamentum flavum, posterior longitudinal ligament, and intervertebral discs.
What non-surgical treatments are available for DLSS?
Non-surgical treatments include physical therapy, spinal injections, and medications (anti-inflammatory drugs, analgesics, and neuropathic pain medications).
When should surgery be considered for DLSS?
Surgery is considered when non-surgical treatments fail to relieve pain and improve functionality, or if there is significant neurological impairment or spinal instability.
What is a laminectomy?
A laminectomy is a surgical procedure that involves removing part of the vertebra called the lamina to relieve pressure on the spinal cord or nerves.
What are the surgical options for treating DLSS?
Surgical options include conventional decompression surgery (laminectomy or laminotomy), which may be combined with spinal fusion (arthrodesis), and the use of interspinous process devices (IPDs).
What are interspinous process devices (IPDs)?
IPDs are implants placed between the spinous processes of the vertebrae to maintain spinal spacing and relieve pressure on the spinal cord and nerves. They are considered a less invasive alternative to traditional decompression surgery.
What are the risks associated with IPD implantation?
Risks include device migration, infection, dural tears, and the need for additional surgery due to complications or treatment failure.
How effective are IPDs compared to conventional surgery?
IPDs can provide short-term relief and improved functionality, but they are associated with higher complication and reoperation rates compared to conventional decompression surgery.
Is there a difference in recovery time between IPD implantation and conventional surgery?
Recovery time can vary, but IPD implantation generally has a shorter recovery period compared to traditional decompression surgery. However, this advantage may be offset by higher reoperation rates.
What are the potential complications of decompression surgery?
Complications can include postoperative pain, dural tears, infection, blood loss, and, in rare cases, neurological damage.
Can DLSS recur after surgery?
Yes, there is a possibility of recurrence of symptoms or development of stenosis at other spinal levels after surgery.
How long does it take to recover from decompression surgery?
Recovery can take several weeks to months, depending on the patient’s overall health, the extent of the surgery, and adherence to postoperative rehabilitation.
What factors influence the decision between choosing IPDs or conventional surgery?
Factors include the patient’s age, overall health, severity of stenosis, presence of spinal instability, and previous treatments or surgeries.
Are there any long-term benefits of IPD over conventional surgery?
Long-term benefits of IPDs are still being investigated. While they may offer short-term improvements, higher reoperation rates and complications can impact long-term outcomes.
How long does it take to recover from decompression surgery?
Recovery can take several weeks to months, depending on the patient’s overall health, the extent of the surgery, and adherence to postoperative rehabilitation.
What factors influence the decision between choosing IPDs or conventional surgery?
Factors include the patient’s age, overall health, severity of stenosis, presence of spinal instability, and previous treatments or surgeries.
What are the costs associated with IPD compared to conventional surgery?
IPDs are generally more expensive due to the cost of the implant and the higher rate of reoperations, making conventional surgery more cost-effective in many cases.
Are there any long-term benefits of IPD over conventional surgery?
Long-term benefits of IPDs are still being investigated. While they may offer short-term improvements, higher reoperation rates and complications can impact long-term outcomes.
Can lifestyle changes help manage DLSS symptoms?
Yes, maintaining a healthy weight, regular exercise, good posture, and avoiding activities that strain the spine can help manage symptoms.
Is there a role for chiropractic care or acupuncture in treating DLSS?
Some patients find relief with chiropractic care or acupuncture, but these treatments should be used in conjunction with conventional medical advice and not as a substitute for surgical interventions when indicated.
What advancements are being made in the treatment of DLSS?
Advancements include minimally invasive surgical techniques, new implant designs, and better diagnostic imaging to tailor treatments more precisely to individual patient needs.
What is the prognosis for patients with DLSS after surgery?
The prognosis is generally good, with many patients experiencing significant pain relief and improved function. However, individual outcomes can vary based on the severity of the condition and overall health.
How can I prepare for DLSS surgery?
Preparing for surgery involves preoperative assessments, optimizing any medical conditions, discussing the surgical plan with your surgeon, and understanding the postoperative rehabilitation process.
Can DLSS lead to permanent disability if left untreated?
If severe stenosis and nerve compression are left untreated, it can lead to permanent neurological damage and disability. Early intervention can prevent such outcomes.
Are there any dietary supplements or medications that can help with DLSS?
While there are no specific supplements for DLSS, maintaining overall bone and joint health with a balanced diet, adequate calcium, vitamin D, and appropriate pain management medications can support treatment. Always consult with a healthcare provider before starting any new supplement or medication.
How does DLSS affect daily activities?
DLSS can limit mobility, cause pain during walking or standing, and interfere with daily activities and quality of life. Effective treatment aims to alleviate these limitations.
I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.
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