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What is an Interspinous Spacer?

An interspinous spacer is a small medical device used to treat lumbar spinal stenosis, a condition characterized by the narrowing of the spinal canal and compression of nerve roots. An interspinous spacer is implanted between two spinous processes (the bony projections on the back of the vertebrae). It works by gently spreading apart the spinous processes, increasing the space in the spinal canal and foramina (the openings where nerves exit the spine), which alleviates nerve compression.

The procedure to implant an interspinous spacer is less invasive than traditional spinal surgeries, often performed under local anesthesia. Unlike fusion surgery, interspinous spacers allow for some degree of spinal movement, maintaining natural biomechanics. The device can be removed if necessary, making it a flexible treatment option.

Indications for Interspinous Spacer

The interspinous spacer placement procedure is typically recommended as a minimally invasive option for the treatment of lumbar spinal stenosis often caused by age-related changes like ligament thickening, disc bulges, or bone spurs. The procedure helps to relieve pressure on spinal nerves, which reduces pain, numbness, and weakness, especially in the lower back and legs offering an alternative for patients who wish to avoid fusion.

Preparation for Interspinous Spacer

Preparation for interspinous spacer placement typically involves the following steps:

  • A comprehensive medical evaluation, including a review of your medical history, physical examination, and imaging studies (MRI, CT, or X-ray) to confirm the diagnosis and plan the procedure.
  • Discuss all medications and supplements you are taking with your doctor.
  • You may need to stop taking certain medications, such as blood thinners or NSAIDs several days before the procedure to reduce the risk of bleeding.
  • Avoid smoking or alcohol in the days leading up to the procedure, as these can hinder healing.
  • You should not eat or drink anything for at least 6-8 hours before surgery.
  • Arrange for transportation to and from the hospital, as you may not be able to drive after the procedure.

Procedure for Interspinous Spacer Placement

The procedure for placing an interspinous spacer is minimally invasive and typically involves the following steps:

  • The patient is positioned face-down on the operating table.
  • Local, regional, or general anesthesia is administered based on the patient's needs and the surgeon's preference.
  • A small incision (approximately 1-2 inches) is made in the midline of the lower back over the affected spinal level.
  • Muscles and soft tissues are gently separated to expose the spinous processes.
  • The interspinous space is measured, and the appropriate size spacer is selected.
  • The device is inserted between the spinous processes using specialized instruments, ensuring it fits securely and decompresses the spinal canal.
  • The spacer is locked into place, providing immediate spacing and stabilization.
  • The incision is closed using sutures or staples, and a sterile dressing is applied.

Post-Procedure Care

After interspinous spacer placement, patients typically experience a short recovery period, as the procedure is minimally invasive. Most are encouraged to walk and engage in light activities on the same day to promote circulation and prevent stiffness. Pain is usually mild and managed with over-the-counter or prescribed analgesics. The surgical site should be kept clean and dry, with follow-up visits scheduled to monitor healing and spacer positioning. Patients are advised to avoid heavy lifting, bending, or twisting for several weeks to allow proper healing. Physical therapy may be recommended to strengthen the core and back muscles, enhancing spinal stability and reducing the recurrence of symptoms. Full recovery and a return to normal activities usually occur within six to eight weeks, depending on the individual’s health and adherence to post-procedure guidelines.

Benefits

Benefits of the interspinous spacer placement procedure include:

  • Smaller incision
  • Minimal tissue damage, blood loss, and scarring
  • Helps preserve natural spine motion
  • Reversible
  • Lower risk profile
  • Shorter recovery compared to other spinal surgeries

Risks and Complications

While interspinous spacer placement is generally considered safe, like any surgical procedure, it carries potential risks and complications, such as:

  • Pain or discomfort
  • Infection
  • Bleeding or hematoma
  • Device migration or displacement
  • Device failure
  • Nerve irritation or damage
  • Dural tears
  • Failure to relieve symptoms