CSC offers new minimally invasive iO-Flex technology for lumbar stenosis

Written by Michael J. Musacchio, Jr., M.D.

Michael J. Musacchio, Jr. M.D.At Center for Spine Care, we are continually evaluating new technology and assessing whether new techniques or devices help us to offer the most advanced, cutting-edge options for our patients with conditions and ailments of the spine. We diligently investigate and assess these new devices to be certain that they are effective and safe before incorporating them into the operating room. Often this involves working with new technology in training labs, and corroborating with industry manufacturers to ensure the validity of these therapies. Data and evidence through stringent clinical trials are crucial to popular acceptance of new technology so that there is limited risk to patients.

iO-Flex logoOne such device that we have found to be a great advancement in minimally invasive technologies is the iO-Flex® device by Baxano, Inc. (San Jose, CA). iO-Flex® is a MicroBlade Shaver® that directly removes ligament and bone to relieve spinal stenosis through a minimally invasive approach. It works much like a flexible nail file that has a rough shaving service and a smooth back surface that shaves away bone and ligament while preventing injury to the nerves and blood vessels.

iO-Flex MicroBlade Shaver

iO-Flex® System MicroBlade Shaver®

The design rationale for this device is to address stenosis in the portion of the spine called the foramen, which are the bone tunnels through which the nerves exit the spinal column. Foraminal stenosis often involves the facet joints themselves and traditional methods of decompressing the foramen run the risk of injuring and potentially destabilizing the facet joint. The integrity of the facet joint is crucial maintain biomechanical stability of the spine, as an unstable spine can cause significant pain and dysfunction. Surgical decompression of the foramen with traditional methods can lead to either not getting an adequate decompression of the foramen in order to avoid disturbing the joint, or over-decompression leading to instability of the spine and possible need for fusion.

iO-Flex System

iO-Flex System

With iO-Flex®, we now have a device that allows us to decompress the foramen from an inside-out approach, with controlled back-and-forth motion to essentially directly shave away the stenotic bone and ligament. This results in decompression of the foramen and relief of nerve compression while preserving the joint and ultimately the stability of the spine.

3 areas of Stenosis

3 areas of Stenosis

Patients with lumbar stenosis are potential candidates for this procedure. Stenosis is the process by which nerves are compressed by progressive changes of wear and tear on the spine resulting in bone spurring, ligament thickening, and disc bulging. This narrowing may then result in low back and leg pain and weakness. Stenosis is the most common surgical condition of the spine in patients over the age of 55, but can begin developing as early as the patient’s 30’s. Specifically, patients with leg or back pain due to degenerative disease of the spine with stenosis in the foramen are typical candidates for this procedure. The iO-Flex® is used as an adjunct to our usual minimally invasive laminectomy and decompression procedure, so it fits seamlessly into our normal surgical routine.

At Center for Spine Care, we have been using the iO-Flex® device over the last year or so and have had excellent results in carefully selected patients. The iO-Flex® device is one of many advanced, minimally invasive technologies we use at CSC to better care for our patients with spinal conditions in a safe and effective way.

Michael J. Musacchio, Jr., M.D. is a Center for Spine Care minimally invasive neurosurgeon specializing in the spine.
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To learn more about Center for Spine Care, visit our website!

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Frequently Asked Questions: What are facet blocks?

Like any joint in the body, facet joints may cause pain if they are irritated or inflamed. The facet joint block is a procedure where a local anesthetic medication (like the dentist uses to numb your mouth) with steroid is injected into the facet joint. The lidocaine numbs the area around the facet joint and the steroid helps reduce inflammation. If the pain resolves or is significantly reduced, the doctor or physician assistant may assume that the facet joint is a problem or at least part of the problem.

Facet blocks may be repeated. When the joint becomes irritated a third time, a rhizotomy procedure is recommended. This procedure cauterizes the tiny sensory nerve that innervates this facet region. The nerve may grow back in 6-18 months, and this procedure may be repeated. One may expect long term relief from a rhizotomy procedure if the facet blocks have effectively reduced pain.

Learn more about facet joints:

Pathophysiology

More Frequently Asked Questions:

What is degenerative disk disease?
What is sciatica?
What is a bulging/ruptured/herniated disk?
What is radiculopathy/nerve impingement?
What is spinal stenosis?
What is the difference between x-rays, MRI, and CT scan?
What is an EMG or NCS?
What is physical therapy?
What is an epidural?

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To learn more about Center for Spine Care, visit our website!

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Frequently Asked Questions: What is an epidural?

An epidural is a potent steroid injection that helps decrease the inflammation of compressed spinal nerves to relieve pain in the back, neck, arms or legs. Cortisone is injected into the spinal canal for pain relief from conditions such as herniated disks, spinal stenosis, or radiculopathy. Some patients may need only one injection, but occasionally more than one injection is needed to provide significant pain relief. Frequently, these are done using a transforaminal approach to selectively isolate a specific nerve root. Along with electrodiagnostics, this can help identify a specific nerve root as the pain generator.

Cortisone is a steroid that is produced naturally in the body. Synthetically-produced cortisone can also be injected into soft tissues and joints to help decrease inflammation. While cortisone is not a pain reliever, pain may diminish as a result of reduced inflammation. In orthopaedics, cortisone injections are commonly used as a treatment for chronic conditions such as bursitis, tendonitis, and arthritis.

Learn more about epidurals / injections:

Do injections really work or are they just masking my pain?

More Frequently Asked Questions:

What is degenerative disk disease?
What is sciatica?
What is a bulging/ruptured/herniated disk?
What is radiculopathy/nerve impingement?
What is spinal stenosis?
What is the difference between x-rays, MRI, and CT scan?
What is an EMG or NCS?
What is physical therapy?

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To learn more about Center for Spine Care, visit our website!

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Frequently Asked Questions: What is physical therapy?

Physical therapy is the treatment of musculoskeletal and neurological injuries to promote a return to function and independent living. Physical therapy incorporates both exercise and functional training. Exercise restores motion and strength while functional training facilitates a return to daily activities, work, or sport.

More Frequently Asked Questions:

What is degenerative disk disease?
What is sciatica?
What is a bulging/ruptured/herniated disk?
What is radiculopathy/nerve impingement?
What is spinal stenosis?
What is the difference between x-rays, MRI, and CT scan?
What is an EMG or NCS?

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To learn more about Center for Spine Care, visit our website!

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CSC’s John Peloza, M.D. & Michael J. Musacchio, Jr., M.D., FAANS first in the country since FDA approval to use coflex, the first and only motion-preserving treatment approved for degenerative spinal stenosis

John Peloza, M.D. and Michael J. Musacchio, Jr., M.D., FAANS are the first in the United States since FDA approval to use the coflex® Interlaminar Technology, a motion preserving, minimally invasive treatment for people with degenerative spinal stenosis. The first case was done November 5, 2012 at the Institute for Minimally Invasive Surgery in Dallas.

For patients with lumbar stenosis or spondylolisthesis, which are both very painful conditions, this is a welcome and much awaited treatment. Stenosis is a painful condition caused by narrowing of the spinal canal, which puts pressure on the nerves causing pain in the groin, buttocks and down the leg. Spondylolisthesis is when one vertebra slips forward over the vertebra below it. Most often, this happens in the lower back  because that part of the spine bears excess weight and absorbs significant directional pressures.

The coflex device is used in conjunction with decompression treatment and provides stabilization to the spine and a unique “flexion” design that helps provide patients with more mobility. Until now, the standard treatment has been spinal fusion which can limit movement.

coflexCSC Medical Director Dr. John Peloza, a pioneer of minimally invasive treatments for the spine, says the coflex device offers an exciting new way to treat patients with stenosis and spondylolisthesis. “Our goal at CSC is always to get patients back to their normal lives as quickly as possible,” he says. “The minimally invasive co-flex achieves this with shorter operating times and hospital stays, quicker recovery time, faster pain relief, greater mobility at the treatment level, as well as natural movement at adjacent levels. For most patients, we can do the procedure in an ambulatory surgery center.”

CSC’s Dr. Michael J. Musacchio, also a pioneer in minimally invasive spine treatments, is looking forward to treating many patients with the co-flex. “We do not offer patients with back or neck pain  a ‘one size fits all’ approach to treatment,” he says. “We are involved in numerous clinical research studies in helping develop the most modern technologies that provide relief.  The coflex  is an exciting new treatment and we are proud to be the first in the country to use it.”

Both CSC physicians will be training surgeons across the country on how to use the new device. “I’m looking forward to training colleagues across the country on this modern technology so that they too can help patients heal quickly from debilitating back pain.”

Since 1996, the Center for Spine Care has been on the forefront of many of the most modern, minimally-invasive technologies currently used to treat patients with back or neck pain. Utilizing these technologies as well as clinical research data provided on all of their treatments and procedures, CSC is able to diagnose and offer patients options based on this evidence based research.

For more information, go to www.centerforspinecare.com

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To learn more about Center for Spine Care, visit our website!

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Frequently Asked Questions: What is an EMG or NCS?

Electrodiagnostic studies include electromyography (EMG); nerve conduction studies (NCS); and evoked potentials (EP). Like imaging studies, these studies cannot confirm the presence or absence of pain. They are most useful in evaluating a patient when pain is present with an observed neurological deficit.

Electromyography (EMG) is the most commonly used test to assess the function of the nerve roots leaving the spine. The test is done by inserting tiny electrodes into the muscles of the arm or leg. By looking for abnormal electrical signals in the muscles, the EMG reveals nerve irritation, or pinching of the nerve, as it leaves the spinal canal.

Think of how you test the wiring on a lamp. If you place a working bulb into the lamp, and the bulb lights up, you assume that the wiring is okay. However, what if the bulb does not light up? You may safely assume that something is probably wrong with the wiring, like the lamp is unplugged, or a short circuit has occurred. By relating the muscles to the light bulb in the lamp, the EMG is able to determine the condition of the nerves that supply those muscles, like the wiring on the lamp. If the EMG machine finds that the muscles (the light bulb) are not working properly, the doctor may assume that the nerves (the wiring) must be irritated or pinched somewhere.

Learn more about EMG/NCS:

EMG/NCS

More Frequently Asked Questions:

What is degenerative disk disease?
What is sciatica?
What is a bulging/ruptured/herniated disk?
What is radiculopathy/nerve impingement?
What is spinal stenosis?
What is the difference between x-rays, MRI, and CT scan?
What is physical therapy?

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To learn more about Center for Spine Care, visit our website!

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Frequently Asked Questions: What is the difference between x-rays, MRI, and CT scan?

X-rays are a type of radiation, and when they pass through the body, dense objects such as bone block the radiation and appear white on the x-ray film, while less dense tissues appear gray and are difficult to see. X-rays are typically used to diagnose and assess bone degeneration or disease, fractures and dislocations, infections, or tumors.

MRI, or magnetic resonance imaging, combines a powerful magnet with radio waves (instead of x-rays) and a computer to manipulate magnetic elements of internal organs and tissue to create highly detailed images of structures in the body. Images are viewed as cross sections or “slices” of the body part being scanned. There is no radiation involved as with x-rays. MRI scans are frequently used to diagnose bone, joint, and soft tissue problems.

A computed tomography (CT) scan (also known as CAT scan) is similar to an MRI in the detail and quality of image it produces, yet the CT scan is actually a sophisticated, powerful x-ray that takes 360-degree pictures of internal organs, the spine, and vertebrae. By combining x-rays and a computer, a CT scan, like an MRI, produces cross-sectional views of the body part being scanned. In many cases, a contrast dye is injected into the blood to make the structures more visible. CT scans show the bones of the spine very well, so they are useful in diagnosing conditions affecting the vertebrae and other bones of the spine.

Learn more about x-rays, MRI, and CT scan:

Imaging Studies

More Frequently Asked Questions:

What is degenerative disk disease?
What is sciatica?
What is a bulging/ruptured/herniated disk?
What is radiculopathy/nerve impingement?
What is spinal stenosis?
What is an EMG or NCS?
What is physical therapy?

.

To learn more about Center for Spine Care, visit our website!

Posted in Frequently Asked Questions | Leave a comment