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X-Stop = Some Facts

John BluntJJohn Blunt Posts: 116
edited 06/11/2012 - 8:34 AM in Spinal Stenosis
There are many postings here about the X-STOP. Some have good results with this form of product but most people who post here have varying results and problems.


The X-STOP is an Interspinous Process Decompression (IPD[R]) Systema and consists of a titanium alloy implant that was approved by the Federal Drug Administration in November 2005 as the first and only implant at that time, that offered non-fusion treatment to improve symptom severity and physical function for SOME patients with Lower Lumbar Spinal Stenosis. The X-STOP provided an interim alternative procedure to certain Lower Lumbar Spinal Stenosis sufferers, before the consideration of surgery.
Inserted through a small incision, the X STOP is placed between two bones called spinous processes of the symptomatic vertebra in the low back. The X STOP is designed to limit extension of the lumbar spine, and keep open the canal in the lower spine that carries nerves to the legs, thereby relieving symptoms of LSS.The X-STOP can be surgically implanted in a minimally invasive procedure that is typically performed with local anesthesia in less than an hour. As it is not fixed to any bony structures, the X STOP procedure does not result in fusion and is completely reversible without compromising any therapeutic alternatives, including laminectomy

LSS- lumbar Spinal Stenosis is a degenerative narrowing of the spinal canal, nerve root canals and/or intervertebral foramina caused by bone and/or ligament hypertrophy in local, segmental or generalized regions. Alternative treatments include, medical management, epidural steroid injections and decompression laminectomy with or without fusion.


In theory the X-Stop is an excellent invention, provided that it is used in patients that are really good candidates for this procedure. Good candidates can only be identified by the doctor providing the opportunity of this procedure.
My personal experience in this respect has been very interesting. I suffered for some years with chronic radicular pain through my buttocks and into both my legs from Spinal Stenosis. I went through the same steps as many of you here taking pain killers and then epidural shots and then Caudal epidural shots. I reached a point where I was considering surgery and I heard about the X-STOP. WOW! I thought, this is it, no invasive surgery, a local anesthetic with an implant and I can go home a new man.

I did lots of research before going any further and I eventually went to several Ortho and Neuro Surgeons who professed to be experts in the implantation of the X-STOP.

Some of them told me that I was a good candidate and some even said that I could have two implanted at different levels. I however decided to do more research as I was not happy with the actual number of X-STOP procedures that any of them had really carried out.

Eventually I found a fellowship trained Ortho Surgeon who gave me the real truth. He said that he had done over 100 X-STOP procedures and in his judgement, I was most certainly not a candidate for even one X-STOP let alone two. That made me think extremely carefully about the professionalism of those that I had seen earlier and this opinion also brought their judgement and their priorities into question too.

I subsequently went to a second Fellowship Trained Ortho Surgeon and he also said that I waas not a candidate for X-STOP.


From what I can gather personally, X-STOP is an excellent solution those who are a proper bona fide suitable candidate for the procedure. However the operative words are "SUITABLE CANDIDATE" and that has to be determined by the individual doctor. I fully appreciate that if the X-STOP fails it is removable and will leave the implanted site unscathed and exactly as it was prior to the implant being placed and I also understand that even in suitable candidates there may be failures. However, the doctors judgement on whether the candidate is really suitable to even try this form of procedure is paramount. The sad part is that most people totally rely on the judgement of one doctor and most of us are in so much pain that we will do anything to get out of it and if it means that we have the opportunity of avoiding invasive surgery we will go for it hook line and sinker if we are told that it can work.

My personal dilemma is how many doctors suggest this procedure for the wrong reasons, knowing that they will be paid to put the implant in and then paid again to remove it in favor of either decompression surgery or fusion. Clearly, morals and ethics come into question here and as usual malpractice or just bad judgement is always an extremely difficult thing to prove afterwards.

SO THEREFORE as I have said many times before, we have to be responsible for ourselves and as we only get one body and one spine we cannot make decisions to traet them in a flippant manner. Pain is a difficult thing to bear as we here all know and we are all very vulnerable because of it, but we do all need to be so very careful about the decisions that we make and we also need to do the research before we commit to being treated.

The only consolation to those who have had X-Stop implants that did not work is that they can have them removed as quickly as they were inserted without any bone damage.

I sincerely hope that this "in good faith: post is as informative as it is meant to be.



  • I mentioned X-Stop to my Ortho Surgeon. Along with Axial-If and other things. Short of just doing fusion. He said no way would he do an X-Stop on me. He was also pretty much set against X-Stop period. Felt it did not fully stabilize the spine, only partial stabilization. Never went further with the idea.
  • Hi John,
    An interesting and informative post. Here in the U.K. things are different from your experiences in that we have a National Health Service so our treatment is free and therefore there is no financial incentive for any surgeon to offer a patient unsuitable or unnecessary surgery. In fact the opposite is probably true as such surgery would cause an unnecessary drain on the limited budget within the NHS.
    Here the possibility of getting a second,third or more opinions is difficult as there are few surgeons in any one region who have performed this procedure. Even if it were possible to see say 3-4 surgeons and they all said that a patient is a suitable candidate why would you not believe them and if the fifth and sixth said that the patient was not suitable why should they believe them as opposed to the other four surgeons?
    Also what is the definition of a suitable candidate. Is there an independently drawn up list of factors that reveal whether a patient is suitable or not and if there is a list is it available for patients to see?
    I undertook some extensive research before my operation 15 months ago but discovered there were few papers that revealed the success rate as the procedure was still considered to be in it's infancy. What I did discover was that the success rate ( based on patients who had a slight improvement to a good improvement)appeared to suggest it was on par with a laminectomy which is a more invasive procedure.
    My surgeon has been performing the X-stop procedure for more than 3 years and on average performs this procedure at least twice a week so I should have confidence in him. However from the posts in this forum it does appear that the X-stop is not the panacea it has been hyped up to be.
    As you said it is a reversable procedure and less invasive than the alternatives so it makes it an attractive proposition as a first option when considering surgery.
    Hopefully it will not be long before there is more clinical evidence available that will reveal whether this procedure is as effective as is claimed. As I have mentioned in another thread a doctor I spoke to in India told me that they do not recommend this procedure there as they have found that they are likely to have to perform laminectomys or fusion ops at a later date on patients who have had the X-stop procedure so they do not consider it cost efficient and that it provides only temporary relief in some patients.
    I may be offered the possibility of a second X-stop in the near future and while I will ask my surgeon relevant questions in order to assess the likely outcome. However his judgement will be based on having performed several hundred procedures which should give me confidence that he is acting in my best interests. At the end of the day it is about trust in your surgeon.
  • I am aware of the system in the UK and how that works. I am an ex-pat Brit born in London. I have lived in the USA for many years and I my experiences here are somewhat different to those in the UK. Both ethical and moral standards can and do vary here and having had the personal experiences of the American system it is only fair to share them with others who may wish to have the benefit of those personal experiences.

    Nevertheless, not everyone is as fortunate as you have been to find a doctor who is clearly well qualified in his judgement capability, well done you!. Sadly that is not the case everywhere. The surgeon who did my procedure has done many successful X-STOPS and as he told me there is still the odd failure due to very many different reasons, some not necessarily to do with the implant directly. I am sure, if the truth be known that your surgeon has had his failures too, but perhaps you may not be aware of those.

    As I said in my first post, the decision to declare a patient a suitable candidate for X-Stop is a judgement call of the individual doctor and not only can there be a moral and ethical issue, there can also be the issue of his judgement which is a somewhat grey and arguable area. Even if there are ever a set of medical standards published for X-STOP, there will still be a grey area of specific individual judgement applied by the practitioner and that is subjective too. The medical profession always protect themselves whether it is in the UK or anywhere else and I am a testimony to that fact from a previous bad UK surgical experience.

    I am however absolutely thrilled and delighted that you are completely happy with your X-Stop to the extent that you are looking at doing yet another one.

    I would however mention that this wonderful website is a great comfort and source of informed and realistic opinion to many who come here. The informative world of "SPINE HEALTH" covers much more than just the UK and therefore people who come here for help, want to be informed of what can go on out there in the medical jungles of the world, so that they can make the right decisions. If everyone was a happy as you with their spine treatment then perhaps Spine health would not even need to exist.

    Thank goodness there are some doctors out there who can apply better judgement than others. It is just up to the individual to find one of them and enjoy the confidence level that you have most fortunately found.

    John B
  • I appreciate that doctors attitudes, ethics and morals vary around the world and sometimes they might make wrong judgement calls as to what they recommend. I a also grateful for this forum as it made me think long and hard before having the X-stop procedure as it revealed that it was not as successful as the literature appeared to make out.
    One of my concerns is that there does not appear to be enough independent research about this procedure to help people make an informed decision about the op. As I mentioned in another thread most of us who write here have had negative results to the X-stop procedure so it might appear the device is useless. This may be due to those who have had a successful outcome not returning to this forum to pass on their experiences.
    Personally I am not really looking forward to the possibility of another X-stop procedure but being in permanent pain and limited ability to walk far means I will have it done in the hope it helps me.
  • X=STOP Data is indeed rather rare at this time and that is a fact. I would think that part of the reason for that is that they are not dealing with a precise science with respect to how it is being used. There are possibly many doctors who may be using it in circumstances that perhaps other doctors would not and vice-versa. The situation with each person is almost as different as fingerprints and it must be really difficult to produce reliable data under those conditions. I think that it is early days yet for really reliable data for many reasons, and it will be interesting to see if the device passes the test of time. I hope that it does as I sincerely believe that it may be the way of the future in very specific circumstances that are really yet to be determined. The real question will be, is it a permanent cure for pain or just a stop gap before surgery, in cases of worsening stenosis.

    I of course sincerely wish you the best of luck with your second device.

    John B
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