Historically, age-related spinal degeneration has been difficult to treat, but highly effective, minimally invasive techniques now exist that are ideal for use in ambulatory surgery centers.
During a June session at Becker's 18th Annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference, sponsored by Surgalign, Jeffrey J. Larson, MD, founder and medical director of Coeur d'Alene Spine and Brain in Idaho, discussed different interlaminar stabilization treatment options for aging patients.
Five key takeaways:
- Lumbar spinal stenosis is debilitating for many. This condition often causes back pain with radiculopathy and neurogenic claudication. Radiculopathy results in unilateral or bilateral pain, numbness or weakness. With neurogenic claudication, patients relieve the stenosis by bending forward to create flexion. This allows them to walk. If patients walk upright, tightening in the spine prevents them from ambulating for long periods of time.
- Coflex is a motion-preserving option for treating moderate to severe lumbar spinal stenosis. Coflex received FDA approval in 2012. The titanium device is inserted into the interlaminar space and secured to spinous processes. Coflex offers several benefits: It restores and maintains foraminal height, it prevents subsistence and restenosis, it offloads and protects the posterior disk and facet joint, and it preserves motion at the level operated on while potentially protecting motion at adjacent levels.
"Coflex isn't a stepping stone to fusion," Dr. Larson said. "Studies have shown that it's an alternative to fusion for a subset of patients. It makes decompression more durable."
- Researchers and professional organizations recognize the superiority of Coflex over decompression and fusion. A European study found that two years after surgery, 58.4 percent of patients who received decompression with Coflex saw improvements in the Oswestry Disability Index, had no injections, experienced no device or procedure-related adverse events, and underwent no additional operations compared to 41.7 percent of patients who underwent decompression alone.
An IDE study conducted in the United States found that two years after surgery, Coflex patients had improved their walking distance more than five times compared to before treatment. In addition, Coflex patients had 2.4 times more improvement in walking distance measurements compared to decompression alone. The North American Spine Society and the International Society for the Advancement of Spine Surgery have both given support coverage to Coflex.
- The ideal candidates for Coflex are older, active individuals. Coflex is a good match for active patients over 62 years old with moderate to severe lumbar spinal stenosis with an ODI score greater than 40, a Visual Analogue Scale score greater than 50, and up to grade 1 spondylolisthesis. Medicare has approved Coflex for surgery center and hospital settings.
- CoFix provides an alternative to traditional fusion procedures. CoFix is based on the Coflex interlaminar stabilization technology. The minimally invasive, posterior, interlaminar supplemental fixation device is used as an adjunct to lumbar fusion with the ability to promote fusion via bone graft.
"This is a good alternative fixation option for backing up an ALIF, LLIF and TLIF in the ASC setting. Compared to pedicle screws, CoFix reduces the anatomic trauma and surgical risks for patients," Dr. Larson said.
Sources: 5-year Follow-up of a Prospective, Randomized, Controlled Trial; Decompression with and without interlaminar stabilization
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