Minimally Invasive Cervical Foraminotomy and Minimally Invasive X-Stop IPD Procedure

Minimally Invasive Cervical Foraminotomy (MICF)
This is a minimally invasive surgical decompression procedure that enlarges the space in which a spinal nerve root exits the cervical spinal canal (intervertebral foramen). This narrowing can be caused by a herniated disc, bone spurs, or thickened ligaments or joints, which may result in painful pinched nerves. The procedure is performed from the back (posterior) with the patient on his or her stomach.

A 1- to 2-cm incision is made on the symptomatic side of the neck. Using an operating microscope and x-ray guidance, the muscles are gradually dilated and a tubular retractor inserted to allow access to the cervical spine. Bone or disc material and/or thickened ligaments are then removed to decompress and relieve pressure on the spinal cord and/or nerves. The tubular retractor is removed, allowing the dilated muscles to come back together, and the incision is closed. This procedure typically takes about 2 hours to perform.

Outcome
A multi-center retrospective chart review of 73 patients who had MICF showed the following results within a 40-month follow-up period:

At 40 months, 21% of patients had radicular symptoms with 11% reporting recurrence of pre-surgery symptoms and 9% with radicular symptoms of a different pattern. Nine of the 73 patients required cervical fusion within the 40-month period.

Minimally Invasive X-STOP IPD Procedure
This is a MIS procedure performed in patients with symptomatic, painful lumbar spinal stenosis. An implant, called the X-STOP IPD Implant is placed between two bones called spinous processes in the back of the spine.

The goal is to help keep the space between the spinous processes open, thus alleviating the painful pinched nerves that can result from lumbar spinal stenosis. The device can be implanted at one or two levels of the lumbar spine. This procedure is performed while the patient is on his or her side so that the spine is in a bent position during insertion of the implant.

Utilizing x-ray guidance, the implant is inserted through a small incision in the skin of the back. Once the implant is in place, the incision is closed. This procedure typically takes about 45 minutes to 1 ½ hours to perform.

Patients with the following criteria may be suitable candidates for this procedure:

• Age 50 and older with a radiological diagnosis of lumbar spinal stenosis
• Moderately impaired ability to function, with pain relief when bending forward

Patients with any of the following criteria are NOT suitable candidates for this procedure:

• Allergic to titanium or titanium alloy
• Spinal anatomy that prevents implantation of the device or would cause the device to be unstable in the body
• Cauda equina syndrome, a spinal nerve compression that causes bowel or bladder dysfunction
• Bone fractures or severe osteoporosis

Outcome
The X-STOP IPD System was tested in a controlled two-year research study on 100 patients in nine hospitals across the US. Outcome was compared to 91 patients who were treated through conservative, non-surgical methods. Clinical results beyond two years post surgery were not measured.

• About 50% of the surgical patients experienced a degree of pain relief and ability to increase their activity levels that was sufficient to be considered a successful outcome at two years post surgery.
• During the study, 6% of patients experienced a dissatisfactory treatment outcome and opted for a laminectomy (removal of part of the vertebra in the spine), at which time the X-STOP IPD device was removed.
• The implant dislodged in one patient after a fall, and the implant was later removed.
• A revision operation was required in three patients.

American Association of Neurological Surgeons
Neurosurgerytoday.org
Minimally Invasive Spine Surgery, January 2009

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