The only surgical course for those suffering from moderate lumbar spinal stenosis used to be open back surgery. But two years ago, a new option entered the physician's arsenal. "The success rate has been overwhelmingly positive," says Brad Goodman, MD, a physiatrist with Alabama Ortho Spine and Sports in Birmingham.
Goodman was the first physician in the U.S. to perform the Superion Indirect Decompression System (IDS) procedure and still remains the only one performing it in Alabama.
Lumbar spinal stenosis (LSS) usually results with aging. The spinal canal narrows, infringing on the nerves causing pain, numbness, tingling and/or weakness in the back and legs. The distress intensifies with standing and walking and dramatically improves when sitting or bending over. The trademark stance for someone seeking relief from LSS makes them look like they are hunched over pushing a shopping cart.
Though not a cure-all for all the leg and back pain caused by LSS, the impact of this procedure has been notable. Of the 60 patients treated by Goodman using the Superion IDS, 80 percent were functioning at a much higher level, including around 50 percent reduction in pain. Less than five have gone on to have traditional surgery so far
In the clinical trial in 2,000 patients worldwide, results showed leg pain improvement equal to or better than found in the traditional surgical options. Four years after their surgery, 90 percent of those trial patients reported continued satisfaction.
"What's really important is that these people have a problem with which the only solution used to be major back surgery," Goodman says. "But they found relief with something far less invasive."
The Superion IDS process requires only an inch-long incision and is handled as an out-patient procedure. "It's even less invasive than other minimally invasive procedures, like laparoscopy," Goodman says.
A small tube is then inserted between the spinous processes. Then the implant is deployed. "It looks like a little bullet, and it has wings that are opened with a screwdriver once it is in place," Goodman says. The process takes less than an hour and requires no bone or tissue loss.
The titanium implant works like a little jack or shoehorn, so when the patient stands erect, it blocks that level of the spine from being able to fully extend backward. "By blocking extensions, it puts that level in a little bit of flexion which is what happens when a patient seeking relief sits or bends forward. It decompresses the back," Goodman says.
Recovery is much like with an epidural block. Patients are given very light sedation for the procedure and are sent home an hour or two later with a few staples to be removed a week later. "Generally speaking, patients are pretty much able to do basic activities the next day," Goodman says.
Some patients feel so well that they have actually caused a small fracture in their back from being so active. "Because they feel so good afterwards," Goodman says. The fracture can negate the implant's positive effect and leave the patient back where they started. Research has not yet explored whether or not the Superion IDS method can be performed again in these conditions.
Small fractures of the spinous processes can also occur during placement. "This procedure is done in mostly older people, so their bones can be more brittle and soft," Goodman says. "But these fractures are a rare issue. They occur in less than five percent of the procedures.
"The result can displace the implant. But that doesn't necessarily affect the outcome. Most of those patients will still find relief. The ones who don't, aren't doing any worse."
The ideal patient for the Superion IDS has a significant amount of stenosis, been treated with non-surgical options for at least six months, and not had back surgery at that same lumbar level of the spine. "Four levels are potentially treatable with this procedure, but it is only approved for up to two levels," Goodman says. "That doesn't mean it wouldn't work for more, but it hasn't gotten the approval at this time."
Goodman points out that there is no downside to this procedure, relativity speaking, because Superion IDS patients can still opt for the more invasive decompression or spinal fusion surgeries. "The procedure doesn't burn any bridges," he says. "It doesn't work in reverse, though. You can't go back from open back surgery. In that case, the anatomy you need to put this device in has been removed."