Percutaneous therapies for spinal stenosis
Spinal stenosis refers to abnormal narrowing in the spinal canal, meaning that the space around the spinal cord narrows and presses on nerve tissue. When this occurs in the lower part of the back, it is referred to as lumbar spinal stenosis.
Because a standing position can narrow this area, you may feel better when you are not standing upright, such as when you sit down or cycle. Neurogenic intermittent claudication describes cramping or weakness in the legs caused by inflammation of a nerve and is due to degenerative lumbar spinal stenosis.
Percutaneous therapies (delivered through the skin) for spinal stenosis involve implanting tools designed to widen the affected area of the spine, called interspinous spacers, using fluoroscopic or CT guidance.
How does the procedure work?
The procedure is performed under local anaesthesia and mild sedation. The procedure is known as lumbar decompression surgery and it aims to widen (decompress) the spinal canal. You will be asked to lie on your stomach with your feet slightly raised.
The procedure is done under imaging. A trocar is inserted into the skin, allowing access to the area to be treated. More trocars of slightly wider sizes are inserted over each other. This allows for a wider opening through which the procedure can be carried out. The spacers will then be inserted, and should not be positioned too deeply or too superficially.
Why perform it?
You may be recommended for this treatment if you are suffering from degenerative lumbar stenosis and neurogenic intermittent claudication or progressive pain in your lower back which is made worse by standing upright and improved by sitting down, and if your symptoms have not improved after conservative treatments (medical and physical therapy).
Percutaneous treatments for spinal stenosis aim to widen the affected area in addition to acting as a shock absorber, which reduces the load on the facet joints. As the degeneration of disc joints is a common cause of back pain, redistributing the load on the joints should help ease the pain.
What are the risks?
The risks of this procedure include a delayed fracture to your spine and the possible dislocation of the implants.