InterLaminar Decompression and Instrumentation

InterLaminar Decompression and Instrumentation

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Hi my name is Dr. John Shim, and I want to discuss the lumbar Co flex interlaminar stabilization surgery. By now you have already tried non-surgical treatments, and have decided to move forward with surgery. Lumbar Coflex interlaminar stabilization is offered because your pain patterns match the spinal stenosis findings on your diagnostic studies. Spinal stenosis means narrowing and pinching of the nerve tissues in the spine. Because surgery will remove some of the important stabilizers of the spine. the coflex interlaminar stabilization procedure along with bilateral lumbar laminotomy decompressions are recommended. Let me show you a typical lumbar MRI of spinal stenosis. This is the sagittal view. It's a side view of your back. For most patients, there are some normal disc levels, but with spinal stenosis, you can see the narrowing of the canal by a combination of bone spurring, ligament enlargements, and disc bulging. The axial view, or the cross-sectional view will provide another angle to visualize spinal stenosis. When compared to a more normal level, you can see the triangular shape of the canal, and the narrowing of the space that is occupied by the nerves that are extending from the spinal cord into the lower body. Of course, I'm simplifying the process. For the surgeon, there are many nuances that need to be considered. Experience does help when planning the operation. Still, the exposure is relatively the same. For a single level, a 4 centimeter incision is made in the midline, spanning across the area of bone removal. Muscles are gently retracted to allow visualization of the boney covering or lamina and the ligament that covers over the spinal canal. Some bone in the middle will need to be removed to allow access. The posterior spinal ligament is removed. Tools including burs, kerrison punches and curettes aid in the removal of the covering bone and ligament. The nerve sack is identified, and protected. Associated bone spurs are removed, and the nerves are given more room to exit the space called the formen. The spine is prepared to accept the coflex interlaminar device. Trial devices are used to measure the appropriate size the device. The device is then implanted to within a few millimeters of the thecal sac, and the fins of the device rest on the lamina of the upper and lower spinal levels. The fins are then compressed onto the posterior spinous processes, securing the device to the spinal bones. The incisions are then closed. If there are no issues, most patients can have the surgery performed on an outpatient basis. For the vast majority of patients, they can resume normal activities within a few weeks. This is the basic animation of the lumbar Co flex interlaminar stabilization operation. You should discuss your individual concerns with your surgeon. This is Dr. John Shim, and I hope this video helps you understand the basics of the lumbar Co flex interlaminar stabilization surgery. Thank you!

Spinal stenosis is a very common problem afflicting many people after the age of 60.  It should not be considered a disease,  but rather a normal process of aging.

The degenerative cascade is the process by which the disk degenerates or collapses.  Because of the collapse,  the facet joints of the posterior spine rub abnormally against each other,  causing the bone to enlarge.  For my older patients,  many of you will find that the joints of your fingers have enlarged over time.  That is the same process.  The bones rub against each other,  causing wear of the cartilage.  The bone responds to the pain on the cartilage by enlarging the surface area between the bones.  This enlargement is the development of the widening bones.  In the spine,  this enlarging of the bones will cause pressure on the nerves that travel through the spine.  That is the so called “bone spur”,  pinching the nerve.  In addition,  as the disks collapse,  the rims of the disk naturally bulge out.  Some of the bulging can cause some narrowing of the space for the nerve.    The final cause of spinal stenosis is secondary to the effects of the narrowing of the space by the disks.  There are ligaments called the ligamentum flavum that are normally stretched between the bones of the spine.  With narrowing of the disks,  these ligaments are no longer stretched or taut.  It will cause a shortening, and widening or hypertrophy of the ligament.  This widened ligament can also contribute to the narrowing of the space for the nerve.

Degenerative spinal stenosis is usually a combination of the bone spurs,  the narrowing of the disk,  and the widening of the ligaments covering the spinal nerve.

Traditional treatments for spinal stenosis included activities modification, NSAID medications and exercise.  Recent studies have not demonstrated a usefulness of epidural steroid injections for these patients,  though many still request the injection.

Surgical options depend on many factors,  and not all patients are candidates for surgery.  In general,  the main goal of surgery was to remove pressure on the nerves.  In certain situations,  there is an instability component that necessitates fusion along with removing pressure on the nerve.

In the past 10 years,  there has been more and more interests in so called interspinous ligament devices. The rationale is that a device designed to stretch the ligaments,  and restore some of the disk height may relieve the spinal stenosis pressure.  The devices have had some success,  but some patients will still require formal surgery to directly remove pressure on the nerve.

As these concepts evolved,  an interlaminar device called the Coflex,  from Paradigm spine has been studied for efficacy.  The concept is relatively simple.  A more traditional limited removal of bone and ligaments off the nerve is performed.  then a U shaped device is placed in between the spinous processes,  thus achieving some of the height restoration,  facet off loading,  and opening of the foramen.  In addition,  secondary to the more traditional laminectomy/laminotomy,  the surgeon has direct visualization of the nerves being relieved of pressure.

In my experience,  for the properly selected patient,  this is a very reasonable option for patients with localized spinal stenosis and with low grade instability.

The procedure can be done on an outpatient basis for select patients.   There is no fusion associated with this technique.

Citations

  • Röder C, Baumgärtner B, Berlemann U, Aghayev E. Superior outcomes of decompression with an interlaminar dynamic device versus decompression alone in patients with lumbar spinal stenosis and back pain: a cross registry study. Eur Spine J. 2015 Oct;24(10):2228-35. PubMed PMID: 26187621

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Author and Contributor to www.Spine-Health.com – July, 2015

www.Spine-Health.com/author/john-h-shim-md-facs

Chief of Surgery, Mease Countryside and Mease Dunedin Hospitals, Safety Harbor and Dunedin, Florida. 2014-2016.

Orthopaedic Section Chief Mease Countryside Hospital; Safety Harbor, Florida Mease Dunedin Hospital; Dunedin, Florida.2008-2013

Board Member Morton Plant Mease Research Council

Co-Director of Mease Neuro-Ortho Spine Center Mease Dunedin Hospital; Dunedin, Florida.

One of “6 Spine Physicians Ranked #1 on Google” – December 2016

Top Ten Most Liked Spine Surgeons on the Internet – July 2016

2016 Spine Surgeons to Know list – January 2016

2014 Spine Specialists to know list – September 2014

One of Ten Leaders of Certified Spine Programs – December 2011

 

The Best Orthopedics in Tampa

The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.
Outpatient Spine Surgery Considerations. www.Spine-Health.com. January 2016.

What is Spinal Stenosis? www.Spine-Health.com. October 2015.

Surgeon insights on the Changing Landscape of Orthopedic Care. OrthopedicToday. June 2014

Chapter 33: Interspinous Spacers. Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

Chapter 35: Minimally Invasive Percutaneous Lumbar Fusion Technique.Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

March 2010 Minimally Invasive Transforaminal Lumbar Interbody Fusion American Academy of Orthopaedic Surgeons Annual Meeting New Orleans, Louisiana February 2010

February 2010 A Review of Dynamic Stabilization in the Lumbar Spine Selby Spine Symposium; Park City, Utah

November 2009 Lumbar Spinal Stenosis Community Based Lecture; Tampa, Florida

September 2009 Instructor/Proctor Minimally Invasive Lumbar Cadaver Lab; Tampa, Florida

February 2009 New Spinal Technology: Cervical Disc Replacement and Interspinous Spacers. Selby Spine Symposium; Park City, Utah

February 2008 The Degenerative Spine: The Role of Dynamic Lumbar Stablization and Interspinous Spacers Selby Spine Symposium; Park City, Utah

October 2008 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

September 2007 Emerging Technology in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

October 2006 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

May 2005 The Role of Kyphoplasty in the Treatment of Vertebral Compression Fractures Mease Neurosciences Symposium; Clearwater, Florida
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