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March 19, 2008 > X-Stopping the Pain

X-Stopping the Pain

Dealing with pain was nothing new to Dr. Robert Black. A Fremont ophthalmologist on the Washington Hospital Medical Staff who has been treating patients in the Tri-City area for more than 40 years, Dr. Black suffered chronic back pain for many years, seeking relief through physical therapy. He finally realized, though, that physical therapy was not enough.

"It came to a point where it became difficult to stand on a hard floor, and my overall movement was severely limited," Dr. Black says. "After looking at my MRI and consulting with Dr. Desmond Erasmus, we both agreed that my best option would be to undergo the minimally invasive X-Stop procedure."

Dr. Erasmus, a neurosurgeon and the medical director of the Minimally Invasive Spine Program at Washington Hospital, diagnosed Dr. Black's problem as spinal stenosis. "Spinal stenosis is a form of osteoarthritis," he explains. "It is a degenerative condition that creeps up on you as you age, and it is most common in people after age 60, although it can happen earlier. With spinal stenosis, the ligaments and facet joints between the vertebrae in the spine become thick and cause a narrowing of the spinal canal, impinging on the nerves."

Dr. Erasmus notes that people who have spinal stenosis generally experience pain while standing or walking, with weakness and a sensation of heaviness or even numbness in the legs. "These patients, though, are usually comfortable when they are sitting," he says. "They might also walk in a bent-over posture to relieve the pressure on their nerves."

The X-Stop device is a titanium implant that is placed between the spinous processes - the bony projections at the back of the vertebrae - just underneath the skin. The implant effectively spreads the vertebrae apart and widens the spinal canal, thereby relieving the patient's symptoms.

Before the introduction of the X-Stop device, extensive surgery was the only effective treatment for spinal stenosis. Traditional laminectomy surgery for spinal stenosis involves the use of a long incision, moving the muscle away from the spine and removing supporting structures to free up the compressed nerves. Recovery from such surgery can take up to six months.

"That technique often destabilized the spine," Dr. Erasmus says. "Implanting the X-Stop device, on the other hand, is very minimally invasive and requires a smaller incision."

The X-Stop procedure for a single implant is performed in about an hour, with only local anesthesia and mild sedation, as opposed to the riskier general anesthesia required for laminectomy surgery. Patients who receive an X-Stop implant generally can go home later the same day or after an overnight stay in the hospital. They can go back to their regular activities within a few days, except for heavy lifting or strenuous exercise. After about two months, most patients can resume all activities.

"In a few instances, we might need to combine the X-Stop implant with a surgical procedure if the calcium deposits on the patient's facet joint are severe, in order to avoid having the X-Stop improperly seated," Dr. Erasmus notes. "Also, in perhaps five percent of cases, the implant may fail to solve the problem, in which case we can still perform a surgical laminectomy to remove the calcium buildup around the spinal nerves. But the X-Stop works perfectly for the vast majority of patients."

Since July 2006, Dr. Erasmus and his colleagues at the Spine Center have performed the X-Stop implant procedure on more than 30 patients, in some cases with multiple implants.

Dr. Black comments: "The X-Stop has become an established procedure, and there was less risk of complications than with traditional laminectomy surgery. In fact, the procedure is completely reversible, which helped to ease my concerns as well."

Since undergoing the procedure about a year ago, Dr. Black has seen his quality of life improve dramatically. He recently traveled to the jungles of the Amazon River in South America, and he says that his life has returned to normal.

"The great thing is that I don't have to consciously think about my back and whether I can handle certain activities," he says. "I enjoy hiking and other outdoor activities, and now I'm doing everything that I want to do."

For more information about the X-Stop procedure or to schedule a consultation, please call (888) 737-3394 and ask to speak to a physician in the Spine Program.

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