New procedure eliminates pain from spinal stenosis.

At 75, Michael* wasn’t ready to feel old. Yet, maddening back pain made it difficult for him to feel youthful and stay active. The pain from his back traveled all the way down his right leg, which affected his walking and put a stop to his morning exercise routine. Even standing was painful, and Michael found himself instead sitting in his chair doing nothing. When he tried to cook, he had to lean over his kitchen sink, which provided some relief from the agony in his back and leg.
“I really enjoy cooking for my family,” Michael shares. “It’s something I have always tried to do several days a week, but the pain I would get in my back when I stood too long at the stove forced me to stop cooking as much as I used to.”
Michael’s primary care physician suggested a few options to help ease his pain. But when a trial of conservative treatments, including heat and ice, physical therapy and pain medications, failed to deliver lasting results, Michael’s doctor recommended he visit Harold J. Cordner, MD. Dr. Cordner is board certified in pain management and anesthesiology, and practices at Florida Pain Management Associates in Sebastian and Vero Beach.
At Florida Pain Management Associates, all patients who come in with severe back and leg pain are given a careful evaluation that includes a thorough history and physical examination, as well as imaging studies such as x-rays and an MRI. After his evaluation, Dr. Cordner was able to confirm his initial suspicion; Michael was suffering from spinal stenosis.
The spine is made up of 24 small bones called vertebrae. The vertebrae are stacked one on top of the other with an open canal in the middle through which the spinal cord runs. On the back of the vertebrae are projections of bone called spinous processes. Between these sections of bone are openings called neural foramen, where the spinal nerves exit the spinal cord and travel to the rest of the body.
Spinal stenosis is the narrowing of the spinal canal and the neural foramen. Because these spaces become narrower, the nerves become crowded or pinched, causing symptoms.
“Generally, the symptoms are back pain with leg weakness or a feeling of heaviness or pain into the legs,” describes Dr. Cordner. “Sometimes, the patient just has back pain; other times, the pain radiates into the legs. The pain is typically worse with prolonged walking or standing, and is relieved as soon as the patient sits down or leans forward.”
Spinal stenosis is most often caused by the wear and tear of arthritis that occurs with aging. To make up for the degenerative changes caused by arthritis, the body sometimes grows new bone to help support the vertebrae. These new bone pieces are called bone spurs. They can narrow the openings for the spinal cord and nerves. Arthritis can also cause the ligaments in the spine to become larger, which can irritate the nerves and cause symptoms.

A New Option

Traditionally, treatment for spinal stenosis begins with nonsurgical steps, such as physical therapy, anti-inflammatory medications, chiropractic manipulation and steroid injections. When all nonsurgical efforts have failed, surgery is generally the next step.
“The treatment for spinal stenosis was often epidural steroid injections,” confirms Dr. Cordner. “If those did not help, patients would undergo a decompressive laminectomy. However, there are patients who are elderly or have other diseases or complicated medical illnesses who cannot get cleared for or are too sick to have surgery.”
During a laminectomy, the surgeon removes some of the bone, and any bone spurs and/or pieces of ligament that are compressing the nerves. Doing this opens up the space for the nerves and relieves pain. However, it requires one large or multiple smaller incisions and a lengthy recovery, and may fail.
Now, Dr. Cordner offers an alternative to laminectomy. It’s a new, minimally invasive procedure to treat patients with spinal stenosis who have back and leg pain that is relieved by bending forward or sitting.
“The procedure uses an implanted device that decompresses the spine,” states Dr. Cordner. “The device goes in and opens up, enlarging the space where the spinal nerves exit as well as the central canal.”

The device is the VertiFlex^® Superion^® InterSpinous Spacer System. The Superion spacer is an H-shaped implant made of a titanium alloy that fits between two adjacent bones in the lower back. It is designed to limit movement of the spine when the patient stands and walks, and to open up the nerve spaces, relieving symptoms. VertiFlex describes the Superion as a “Safe and effective alternative when conservative treatment has failed and laminectomy is too aggressive.”
“During the implant procedure, I make a small incision in the back and clear out some tissue between the spinous processes,” explains Dr. Cordner. “Then, I insert the device through a small tube about the size of a dime. As I engage it and screw it open, two arms emerge that push the spinous process bones apart, and that creates more room inside the spinal canal and the neuroforamen.
“The ideal candidate for this procedure is a patient who has spinal stenosis that is worse with standing or walking, and relieved with bending over a little bit. These are patients who are walking in the stores leaning over their shopping carts, which helps ease the pain.”
Such was the case with Michael, as he mentions he found relief when he would bend over, but not when he was standing up straight.
Implanting the Superion device is a simple, outpatient procedure with less tissue damage and blood loss than surgery, and a rapid recovery time.
There was a similar device in the past called the X-StopPK^®. However, there were drawbacks to it. In some cases, it moved out of its implanted position. With the Superion, there have been no reports of the devices moving out of position in the thousands of cases that have been performed to date.

There are four years of data to support the effectiveness of the Superion InterSpinous Spacer. According to studies, 48 months after having the procedure done, patients’ leg pain was reduced 79 percent, and patient satisfaction was 87 percent.
“Thus far, there have not been any patients whose condition deteriorated after the procedure, which certainly can happen with back surgery,” stresses Dr. Cordner.
“The Superion is the only FDA-approved, standalone device for the treatment of moderate lumbar spinal stenosis. Medicare has approved it as well, and I am the only physician in Indian River County certified to do this procedure.”

Nonsurgical Relief

For Michael, Dr. Cordner was the answer to a prayer, and the Superion spacer was a godsend. He became one of those patients in the “satisfied” category.
After having the device implanted, Michael’s pain is gone. He is now able to get out of his chair and take his morning exercise walks. He can cook without leaning over his sink, and he no longer feels the aching all the way down his leg.
“It’s been a miracle for me, it truly has,” Michael raves. “I am so thankful that I found Dr. Cordner. I feel better than ever, and I no longer have to live with pain!”
Michael is back to being active and feeling more youthful. And that’s affected his attitude about his age as well.
He remarks, “Seventy-five isn’t old at all!”

* Patient name witheld at their request.