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Intra Spinous Spacer

Interspinous means the spacers are placed between two spinous processes. Those are the bumps you feel along your back. They are knobs of bone that extend out from the vertebral bodies.

Spinal stenosis is a narrowing of the spinal canal, the opening formed by the vertebral arches. This is where the spinal cord travels from the brain to the base of the spine. Lumbar spinal stenosis is a common problem in older adults (age over 65). Low back pain and/or leg pain/discomfort are the first signs of this problem. Flexion bending forward relieves the pain, so patients adopt a bent posture called the shopping cart sign.

Because symptomatic spinal stenosis can be very disabling, surgeons are looking for ways to help support and stabilize the spine. Keeping the vertebrae from bending backwards (a direction that makes the symptoms worse) is the goal. These interspinous spacers may be helpful when more

conservative (nonoperative) care doesn't improve symptoms. They can be used in frail, elderly adults who aren't well enough to have surgery.

Only one spacer on the market has been approved by the Food and Drug Administration. That's the X-Stop. Three others are being studied with the intent to seek FDA approval. They are the Interspinous U (also called Coflex, the DIAM, and the Wallis system. They all work to limit spinal extension.

The placement varies slightly based on the shape and design of the device. The manufacturer of some of these spacers says they can be used for more than just spinal stenosis. Scoliosis, compression fractures, herniated discs, spinal instability for any reason, and degenerative disc disease are some of the conditions listed.

As seen in the Figure  the spinous processes are located in the very back of the spinal column near the skin surface. In fact, by passing the hand down the center of the low back one is usually able to feel several small prominences. These are the spinous processes. The near proximity of the spinous processes to the skin allows for the implantation of interspinous process spacers with minimal operative intervention and spinal morbidity (unwanted aftereffects of the surgery).







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