Lumbar Stenosis – Potential Interventions

Transcript

There were some other intervention surgically that have been tried and are currently, let’s say being thought about. And one of those is to take those patients and sort of prop them forward so that they have more room. Originally the surgery was described being done under local. The vast majority of practitioners who do it actually do it under general and these are called inner spinus spacers and they have a variety of sort of unusual names. The good news is is that some patients are made better by it. The most recent data has suggested though that finally requiring definitive operation occurs and maybe as high as 20 or 30% of the patients and the data isn’t really very solid because it’s just not there yet. And these things haven’t been around for 20 or 30 years and it takes a long time sometimes in medicine for the thing to get sorted out as to what’s the best treatment. And then there are a variety of other treatments, but most of those fall into the realm of less than 1% in terms of ever being used by practitioners. The good news about decompressive laminectomy is, is that probably if you look at the patients who undergo decompressive laminectomy at the end of a year, 95% of those patients will tell you that it was worthwhile and they probably have the surgery again. If you wait 10 years, that falls off to about 85% and so there’s about a 1% per year plus or minus attrition rate of people out of the original hundred percent who say that they wouldn’t have it again. One of the big myths is is that one spine surgery sort of predisposes you to this awesome cascade of more and more and more, and that particularly in the lumbar spine isn’t necessarily true for the pathologies, for the things that we’ve talked about today. And so that should not be a fear. It’s something to think about that you might have to have a second surgery, but generally the odds should fall in the 5 to 7 to 10% range depending upon whose paper you read of having a second surgery, if you have a first surgery for any of the things that we’ve talked about today.