Deciding on X-STOP Surgery for Spinal Stenosis

X-Stop Video

The X-STOP (Interspinous Process Decompression System) is a spinal implant designed to treat patients who are 50 or older suffering from pain or cramping in the legs (neurogenic intermittent claudication) caused by lumbar spinal stenosis. The device is made of titanium (a metal), and recently a titanium/PEEK* (metal/plastic) combination device was introduced. The X-STOP procedure was developed as an alternative to traditional open laminectomy, which is a more extensive surgical procedure.

In addition to the clinical guidelines, there are a number of considerations to help patients decide about the X-STOP as a treatment option for their lumbar stenosis:

• This procedure can be done under local anesthesia and the patient is often allowed to go home the same day. Thus, it may be an option for some elderly patients who are not suitable for general anesthesia.
• If the X-STOP fails to provide sufficient pain relief, the patient still has the option of having a laminectomy spinal surgery.
• For some patients, however, the idea of having to potentially have two surgeries (an X-STOP and then a laminectomy) may be undesirable, and thus certain patients may prefer to just go ahead and have the laminectomy.
• The X-STOP procedure is more invasive than an epidural injection, but less invasive than open laminectomy with a fusion surgery.
• The size of the skin incision and muscle dissection required for the X-STOP procedure is equivalent to that required for a minimally invasive laminectomy.
• Compared to a traditional laminectomy, however, the X-STOP procedure is significantly less destructive to the supporting structural tissues (the bone and ligaments).
• While average costs for X-STOP are less than for laminectomy surgery, the costs are still significant (e.g. $15,000 to $20,000). Medicare and most insurance carriers typically cover this procedure.
• The X-STOP device addresses the symptoms of spinal stenosis in the lumbar spine, but unlike laminectomy it does not remove parts of the wall of the spinal canal. The X-STOP implantation procedure is therefore considered an indirect decompression.
• Some patients with lumbar spinal stenosis have multiple-level spinal stenosis and/or elements of spinal instability (e.g. degenerative spondylolisthesis) and thus are not good candidates for use of the X-STOP.
• The device forces a patient’s lumbar spine into further kyphosis, which some physicians believe may add further stress to the lower back.
• While it is minimally invasive stenosis surgery, it is still surgery and as such presents certain potential risks and complications
• At the time of this article, there are a limited number of clinical studies, based on relatively small study populations, that have evaluated the effectiveness of the X-STOP.
• The procedure works best in patients who have pain relief when bending (leaning) forward.

• Article written By:
• Rafael Levin, MD

February 26, 2009

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