Ask Dr. Roach: A spinal spacer is one option to treat critical spinal stenosis
DEAR DR. ROACH >> My husband is 84 years old and has critical stenosis in his back. He is also diabetic (his A1C level is 8.8% with insulin), has high blood pressure that is under control, and takes amiodarone for his heart. He received an epidural for back pain, but it did not help. He is now doing physical therapy, but gets very little relief before the pain comes back. The orthopedic doctor has recommended a spinal spacer for the stenosis.
Can you tell me what you know about this procedure? Is the procedure recommended for someone with his health, or are there any other options? He is hurting.
Dear J.B. >> Spinal stenosis is a condition where the spinal canal or a nerve root is compressed by bone and connective tissue in the back, often as a result of degenerative joint or disk disease. When medications and physical therapy have not been adequate, surgical repair is considered.
The standard surgical treatment for spinal stenosis is a laminectomy, sometimes with fusion of the bones in the affected area. In a person like your husband who is in his 80s with some medical issues, a less-invasive option is a spinal spacer, which uses a titanium device to relieve the compression between the two vertebrae.
In a study, the device was shown to relieve symptoms in just over half of the study’s subjects, and when successful, the benefit lasted at least two to four years. However, it didn’t work in everyone, and there were risks: infection, dislocation, disk herniation, bleeding and fractures. Fortunately, these complications were uncommon.
The procedure is so new that there is not yet published data to compare the results with standard surgery. But if the surgeon feels that standard surgery is too risky for your husband, this may be an option, although it is certainly not 100% effective nor free of risk.
DEAR DR. ROACH >> My secretary’s grandson plays college football. He just suffered an episode three days ago, and his CK level is at 197,000 U/L. The doctors are having a hard time getting his kidneys functioning and his levels down. We are in Tennessee. What doctor or hospital is the expert for this? We need to get this kid seen quickly and get him healthy. He’s also an NFL draft prospect as a sophomore in college. I’m not sure if he will ever be able to play again, but we still want him healthy.
Dear Anon. >> I’m so sorry to hear. This is not an uncommon injury, and critical care physicians are experts in this condition, although they may consult a kidney specialist(nephrologist). If there isn’t an obvious reason for the muscle damage, a neurologist (particularly one with special expertise in neuromuscular disorders) may be helpful.
Contact Dr. Roach at ToYourGoodHealth@med.cornell.edu.