In my practice, I frequently get asked about when the X-STOP procedure for treatment of lumbar spinal stenosis should be considered as a treatment option.
Based on the mechanism by which the X-stop device operates, and based on my personal surgical experience, in my opinion the highest predictability for clinical success using the X-stop device exists in patients who fit the following criteria:
- Complain primarily of lower extremity neurogenic claudication symptoms (e.g. leg pain, heaviness, fatigue, tingling) rather than back pain alone.
- Have symptoms that are generally brought on by back extension (bending backward), prolonged standing and walking.
- Get significant reproducible relief of their leg pain (and or numbness, heaviness and tingling sensation) with rest while sitting, and with forward bending (such as when leaning forward against a shopping cart or walker.)
- Have significant stenosis on imaging studies (MRI and CT scans) classified as mild to moderate, moderate, or even moderate to severe in some cases, but generally not so advanced to be classified as severe stenosis.
- Have stenosis primarily due to soft tissue compression resulting from disc bulging and/or excess ligament, rather than primarily bony stenosis (resulting from bone spurs and enlarged facet joints).
- Have some mobility within the stenotic motion segment (i.e., do not have a completely collapsed disc space or functionally fused facet joint).
- Do not have hyper-mobility or frank instability within the stenotic motion segment. These patients may require a stabilization procedure such as fusion in addition to a decompression (lumbar laminectomy).
- Have a single level, or at the most two levels, of spinal stenosis.
- Do not have clinically significant stenosis at the L5-S1 level, the bottom segment of the lumbar spine. This is the lowest spinal motion segment and, due to anatomical constraints, this level cannot be treated using the X-stop device.
- Do not have advanced loss of bone (advanced osteoporosis).
With any surgery, the goal is to make sure that the procedure will be effective in treating the individual patient’s symptoms and clinical presentation. While all of the above have not been conclusively demonstrated in medical studies, this is what I have found to be most effective in treating patients with the X-STOP.