The 5 Most Innovative Treatments for Spinal Stenosis

Living with spinal stenosis can feel like navigating a maze of discomfort, where simple movements become daily challenges. But there’s a silver lining: medical science is opening new doors if you’re seeking relief. 

Spinal stenosis is characterized by the narrowing of spaces in the spine, leading to pain and sometimes weakness, numbness, and imbalance in a person’s arms and/or legs. This occurs when the nerves traversing the spine become compressed, an issue that can significantly impact daily life.

This article will provide a clear picture of spinal stenosis, exploring its causes, variations, and why it occurs. Most importantly, we’ll highlight five innovative treatments that offer new hope to people with this condition. By the end of this piece, you’ll have a deeper understanding of spinal stenosis and be equipped with knowledge about cutting-edge options that could potentially improve your quality of life.  

What is Spinal Stenosis?

The spinal canal, a vital passageway within the spine, can occasionally narrow, placing pressure on the essential neural and vascular structures it contains.¹ This condition is called spinal stenosis, which can significantly affect a person’s quality of life by compressing these critical structures. The narrowing impacts the nerves responsible for lower back pain and those extending into the legs. This may cause neurogenic claudication, a type of discomfort or cramping in the legs that occurs when walking or standing and improves upon sitting.²³ It can also affect the nerves crucial for maintaining balance.⁴

Spinal stenosis often begins with changes in the spine that leads to increased instability. These changes can result in hypermobility in certain spinal joints and a significant overgrowth of the facet joints, located at the back of the spine, primary contributors to lumbar spinal stenosis symptoms. 

Understanding Spinal Stenosis

Understanding spinal stenosis and what might increase the risk of developing it is essential for effectively diagnosing and managing the condition. Spinal stenosis most commonly affects the lower back and neck. Its causes are generally categorized into two main types: acquired and congenital.

Acquired spinal stenosis (often referred to as degenerative spinal stenosis) is the more common form and typically develops due to “wear and tear” changes in the spine as you age. As a common treatment for spinal stenosis in elderly patients, doctors first assess these age-related changes, which can include bulging discs, arthritic joints, and thickened ligaments. These conditions can protrude into the spinal canal and narrow the space available for the spinal cord and nerve roots. 

Congenital spinal stenosis is present from birth and involves a naturally narrow spinal canal. While congenital stenosis alone may not cause symptoms, it can make the spinal cord and nerve roots more vulnerable to acquired stenosis later in life. Only about 9 percent of spinal stenosis cases are due to congenital causes.⁵

Common Causes

Spinal stenosis doesn’t just appear out of nowhere—it’s often the result of gradual changes in your spine’s structure. These include: 

• Intervertebral discs, which is the wearing down of the cushions between the bones in your spine
• Enlargement of facet joints, which are the joints that connect the bones of your spine 
• Thickening of the ligamentum flavum, a ligament that connects the vertebrae in the spine
• Growth of bony bumps called osteophytes
• Bulging or protruding spinal discs
• Spondylolisthesis, a condition in which one vertebra slips over the one below it

Genetic factors, such as certain variations in collagen (a protein that helps give your body structure), can also play a role in developing spinal stenosis. Underlying conditions such as diabetes and issues with collagen production—along with physical stress or pressure on the spine—have also been linked to the onset and worsening of the condition.^{6 7 8}

Types of Spinal Stenosis

Spinal stenosis can manifest in various forms, depending on the location and nature of the narrowing of the spinal canal. Understanding these types is crucial for accurate diagnosis and effective treatment.

Cervical Spinal Stenosis

Cervical spinal stenosis occurs in the upper region of the spine or neck. This type is often caused by degenerative changes such as bone spurs, herniated discs, or bulging discs that impact the spinal canal in the cervical region. In cervical stenosis, the spinal canal is inadequately sized to accommodate the spinal cord and nerve roots. This may irritate the nerves as they leave the spinal canal or harm the spinal cord.⁹

Lumbar Spinal Stenosis

One of the most prevalent spine disorders is lumbar spinal stenosis, which is defined as an abnormal or atypical narrowing of the spinal canal. While there are several potential causes, the most common is arthritic degeneration of the spine’s joints or herniated discs, which leads to ligament and joint swelling inside the spinal canal. The spinal canal’s nerve roots experience abnormal pressure, leading to back and leg pain—sometimes in both legs. Other common symptoms include weakness, tingling, and numbness in the legs and feet.¹⁰  

Thoracic Spinal Stenosis

Thoracic spinal stenosis occurs when the space in the middle of your back becomes smaller, which can press on the spinal cord or nerves. This rare condition is usually caused by the thickening of ligaments or the joints between the bones in the spine. The main symptom is pain, and in more severe cases, it can lead to nerve-related issues. The only treatment option is surgery to relieve the pressure, sometimes using special tools to support the spine.¹⁰

Foraminal Stenosis

Foraminal stenosis occurs when the openings between the bones in your spine, called intervertebral foramina, become narrow. This narrowing can press on the nerves that pass through these openings, leading to pain that may affect one or both sides of the body. This pain, known as radiculopathy, can occur alone or alongside other serious conditions affecting the nerves like cauda equina syndrome, which impacts the bundle of nerves at the spinal cord’s end. The most common symptom of foraminal stenosis is pain on one side of the body. About 75 percent of these cases occur at the lumbosacral joint in the lower back.¹²

Central Canal Stenosis

The central canal is the space inside the arch of each spinal bone, extending from one level of the spine to the next. It ends where the root canal begins. Central canal stenosis occurs when the spinal cord is compressed within the central canal. It can lead to pain and dysfunction anywhere in the body below where the compressions occur and is most commonly found in the lumbar or cervical spine. Causes include bony overgrowth, thickened ligaments, and herniated or bulging discs.¹³

Far Lateral Stenosis

Far lateral stenosis is a condition where the narrowing of the spine bone extends beyond the neural foramina openings, the small openings located between the vertebrae. This may occur due to bone spurs, slipped discs, enlarged joints, or conditions like Bertolotti’s syndrome. It can also occur alongside foraminal stenosis, making the condition more complex. Far lateral disc herniations, which bulge out to the side, make up 7-12 percent of cases. People with these herniations often experience severe pain and neurological issues like weakness, reflex changes, and sensory problems. While non-surgical treatments help in 10 percent of cases, surgery is usually needed. Endoscopic surgery is particularly helpful for far lateral stenosis. ¹⁴

Tandem Stenosis

Some people may have both foraminal and central canal stenosis at the same time, a condition called tandem stenosis. This can happen at different levels of the spine, including the neck (cervical), middle back (thoracic), and lower back (lumbar). Tandem stenosis shows a mix of symptoms due to the narrowing in multiple spine areas. These symptoms include both upper and lower motor neuron signs, neurogenic claudication (pain and cramping in the legs due to nerve compression), and gait disturbances. Individuals might experience a combination of neurological issues like weakness, reflex changes, and sensory problems in both the upper and lower extremities. 

Depending on the affected regions, there are four subtypes of tandem stenosis: cervico-lumbar, cervico-thoracic, thoraco-lumbar, and cervico-thoraco-lumbar. The chances of having tandem stenosis vary with these types, and it mainly occurs due to wear and tear in the spine and abnormal bone growth. People with naturally narrow spinal canals or thickened ligaments are more likely to develop this condition.¹⁵ 

The 5 Most Innovative Treatments for Spinal Stenosis

Advanced therapies offer renewed hope and are transforming outcomes for people with spinal stenosis. These promising treatments highlight progress in reducing recovery times, minimizing tissue trauma, and enhancing overall success rates. 

Innovations in Laminectomy

Laminectomy removes the lamina, part of the vertebra covering the spinal canal, to relieve pressure on the spinal cord or nerves. Recent innovations include minimally invasive techniques, such as endoscopic unilateral laminectomy and microscopic surgery, notably unilateral laminotomy for bilateral decompression (ULBD). 

Research in BMJ shows minimally invasive techniques provide clinical results comparable to open laminectomy but with better outcomes one year after surgery. According to the Journal of Neurological Surgery and Scientific Reports, these methods lead to fewer complications and faster returns to daily activities.

Microscopic surgery uses an operative microscope for precision, while traditional surgeries typically require larger incisions, leading to more trauma and longer recovery times.

Endoscopic techniques use a uniportal or dual portal system for better visualization. This offers targeted nerve pressure relief with less tissue trauma and quicker recovery. Patients can return to light-duty work within 24-48 hours.

“The benefits are quite significant between micro-invasive and traditional open approach decompression surgery, with higher success rates,” notes Hany Demian, MD, CEO of the BioSpine Institute in Florida. “It is less time under general anesthesia, which means less complications, less blood loss, less time at the hospital, less downtime, [and] less scarring.”

Advantages and Disadvantages

Navigating the world of spinal surgery options can feel daunting, but innovations in laminectomy offer several compelling advantages that may enhance your recovery journey. These advanced techniques promise not only effective outcomes but also a smoother return to your daily activities. Some of these advantages include:

• Improved precision in neural decompression
• Reduced tissue trauma
• Faster recovery times
• Superior outcomes (85.1 percent success rate) of newer techniques like ULBD compared to conventional laminectomy (65.7 percent recovery)⁵⁸
• Smaller incisions
• Less blood loss
• Reduced postoperative pain
• Enhanced patient satisfaction
• A quicker return to daily activities  
• Better spinal stability
• Reduced risk of postoperative complications²²

While new laminectomy techniques offer benefits, they also face hurdles. These include the need for special training and tools, which can limit their availability. Doctors learning these methods may have a temporary dip in performance as they gain experience. Additionally, experts are still discussing whether these new approaches are worth their cost compared to standard treatments.

VertiFlex™ Superion™

Exploring treatment options for lumbar spinal stenosis can be overwhelming, but several minimally invasive alternatives have emerged. Various interspinous spacer devices are available, including the Coflex from Paradigm Spine, which features a U-shaped titanium implant, and the X-Stop from Medtronic, which was one of the first FDA-approved spacers. The Minuteman, a fusion spacer by Spinal Simplicity, offers a unique expandable design.

Among these options, the VertiFlex Superion has gained prominence. The Superion interspinous spacer, placed between vertebrae to maintain spacing, has shown favorable results in addressing moderate LSS. The device alleviates symptoms like pain, numbness, and leg cramping by widening the spinal canal and increasing disc height.

Studies in the Journal of Investigative Surgery comparing the Superion device to traditional decompressive surgery have found it to be a viable alternative with similar clinical effectiveness and potentially fewer complications. According to the journal Expert Review of Medical Devices, the Superion improves radicular symptoms by limiting spinal extension and reducing pressure on neural and vascular elements.

Advantages and Disadvantages

One key advantage of the VertiFlex Superion device is its minimally invasive nature, requiring only small incisions. This approach reduces tissue damage, blood loss, and recovery times compared to traditional surgeries. Patients often experience shorter hospital stays, quicker return to activities, and reduced need for pain medications.

However, like any medical intervention, the Superion has risks. Studies have noted rare complications such as device dislodgement, spinous process fractures, and infection. Some patients may need additional surgery if complete pain relief isn’t achieved.

TOPS System

The Total Posterior Solution (TOPS) system is an innovative approach in spinal surgery that provides an alternative to traditional treatments. Unlike a laminectomy or spinal fusion, the TOPS System maintains motion while addressing stenosis.

This system implants a device that acts as a posterior arthroplasty, enabling controlled spine movement while decompressing neural elements that send and receive signals throughout the body.

Studies in Scientific Reports show TOPS System effectiveness in cases where spinal stenosis results from degenerative changes in facet joints or ligamentum flavum. By targeting these areas while maintaining spinal motion, the TOPS System offers relief for patients with these underlying stenosis issues.

Advantages and Disadvantages

The TOPS System, an innovative approach to spinal treatment, offers multiple advantages for patients seeking practical solutions for spinal issues. Some benefits include:

• Controlled movement at the affected level of the spine
• A reduction in adjacent segment degeneration, a common issue after spinal fusion surgeries
• Decreased stress on the surrounding spinal segments
• Reduced need for additional surgeries [31]

However, there are limitations. Compared to more established procedures, there is less long-term data available. While initial studies show promising results in pain relief and functional outcomes, more research is needed to confirm its durability and long-term effectiveness. The system may also be more expensive than traditional treatments, limiting accessibility for some patients. [31]

Stem Cell Therapy

Stem cell therapy is an innovative approach in regenerative medicine that shows promise for treating various conditions, including spinal stenosis. Unlike traditional treatments, stem cell therapy aims to address the root cause by promoting tissue regeneration.

Research in the Journal of Biomedical Science has highlighted stem cell therapy’s potential. The treatment involves transplanting stem cells into damaged areas to relieve spinal nerve compression and aid tissue repair.

Studies in Stem Cells International have demonstrated effectiveness in preclinical and clinical settings for spinal cord injuries, showing functional recovery in experimental models.

Advantages and Disadvantages

One advantage of stem cell therapy for spinal stenosis is its regenerative potential. Stem cell therapy can also: 

• Alleviate symptoms such as pain and loss of function [41]
• Reduce the risks associated with traditional surgeries [42]  
• Secrete substances with neuroprotective properties to preserve neural tissue and support regeneration [42] 

Despite its benefits, stem cell therapy for spinal stenosis faces challenges. One drawback is the limited clinical evidence supporting its effectiveness and safety, specifically for spinal stenosis. While early studies show promise, more research is needed to determine the long-term outcomes and safety of stem cell therapy for this condition in clinical settings. [43] Additionally, the cost of stem cell therapy may be prohibitive for some patients, limiting access to this treatment option.

Acupotomy

Acupotomy uses a small, needle-like instrument to target specific points and collaterals, which is the network of secondary pathways that can be targeted to alleviate pain. Unlike traditional treatments, acupotomy focuses on releasing tension in the soft tissues surrounding the spinal canal to address spinal stenosis.

This approach is often combined with acupuncture to enhance its effectiveness, particularly in cases of lumbar spinal stenosis and other musculoskeletal disorders.

Studies in the Journal of Pharmacopuncture show minimally invasive acupotomy relieves symptoms by addressing tissue adhesions, reducing inflammation, and improving pain thresholds.

Research in Medicine highlights acupotomy’s ability to target specific issues that contribute to spinal stenosis, such as joint thickening, ligamentum flavum, disc herniation, and degenerative spondylolisthesis, offering a comprehensive approach to addressing underlying causes.

Advantages and Disadvantages of Acupotomy

One of the advantages of acupotomy is its ability to target specific areas with precision, allowing for more effective treatment compared to generalized approaches. Additionally, acupotomy relaxes muscular spasms, relieves compressed nerves and vessels, and promotes the resolution of chronic adhesions, particularly beneficial in spinal stenosis where these issues contribute to symptoms.

Furthermore, acupotomy has been reported to have a quick recovery time and be more effective at pain relief compared to conventional acupuncture treatments.

However, as an invasive procedure, acupotomy may carry risks, such as pain at the treatment site, hematoma formation, or nerve injuries. Thorough assessment and monitoring of patients undergoing acupotomy is crucial to ensure safety and effectiveness.

Frequently Asked Questions (FAQs)

What is the best treatment for spinal stenosis at L4-L5-S1? 

The optimal treatment can vary based on your needs. Surgical interventions, like decompression surgery (removing bone parts to alleviate nerve pressure), have shown positive results in managing stenosis at these levels.  When considering surgery, your surgeon will assess the impact of spinal fusion on nearby discs to ensure the best outcomes.

What is the most successful treatment for spinal stenosis?

Surgical decompression is recognized as an effective treatment for spinal stenosis. This procedure carefully removes enough bone and soft tissue to relieve pressure while preserving enough to maintain stability. Studies show that surgical interventions, including laminectomy, spinal fusion, and minimally invasive techniques, offer better outcomes than non-surgical treatments for managing pain from spinal stenosis. 

Conclusion

Advancements in medical technology and procedures offer new hope to those affected by spinal stenosis. The five pioneering treatments highlighted in this article can transform your recovery outcomes and enhance your quality of life. Each treatment presents unique and promising advantages while posing particular challenges that require careful consideration when discussing options with your health provider. 

To embark on this journey toward improved health, contact Commons Clinic, where you can start a new path to pain relief. With online scheduling, you can book virtual consultations on the same day, find the nearest Commons Clinic, and arrange an in-person consultation for the following day. Your Commons physician like Neil Bhamb, MD—our MD reviewer for this article— will be ready to assess your health, review your treatment choices, and develop an individualized plan that perfectly aligns with what is best for you.

Sources

Zhang, Y., Wei, F., Liu, Z., Zhou, C., Du, M., Quan, J., … & Wang, Y. (2022). Comparison of posterior decompression techniques and conventional laminectomy for lumbar spinal stenosis. Frontiers in Surgery, 9. https://doi.org/10.3389/fsurg.2022.997973

Bagley, C., MacAllister, M., Dosselman, L., Moreno, J., Aoun, S., & Ahmadieh, T. (2019). Current concepts and recent advances in understanding and managing lumbar spine stenosis. F1000research, 8, 137. https://doi.org/10.12688/f1000research.16082.1

Eck, C., Spina, N., & Lee, J. (2016). A novel mri classification system for congenital functional lumbar spinal stenosis predicts the risk for tandem cervical spinal stenosis. European Spine Journal, 26(2), 368-373. https://doi.org/10.1007/s00586-016-4657-3

Bajwa, N., Toy, J., & Ahn, N. (2013). Is congenital bony stenosis of the cervical spine associated with congenital bony stenosis of the thoracic spine? an anatomic study of 1072 human cadaveric specimens. Journal of Spinal Disorders & Techniques, 26(1), E1-E5. https://doi.org/10.1097/bsd.0b013e3182694320

Cohen, P. and Dorros, S. (2022). Lumbar stenosis spinal surgery-associated cerebrospinal fluid leak without headache: an autobiographical case report. Cureus. https://doi.org/10.7759/cureus.25253

“Spinal Stenosis.” Neurosurgery, neurosurgery.wustl.edu/items/spinal-stenosis/

Beckworth, W., McCarty, E., Garcia-Corrada, J., & Holbrook, J. (2017). Epidural lipomatosis and associated spinal stenosis—the impact of weight loss: a case report. American Journal of Lifestyle Medicine, 11(6), 511-514. https://doi.org/10.1177/1559827616686764

Shemesh, S. (2023). Diabetes mellitus and poor glycemic control are associated with a higher risk of lumbar spinal stenosis. Spine. https://doi.org/10.1097/brs.0000000000004900

Tan, X., Guo, Y., Liu, Y., Liu, C., & Pei, L. (2021). Symptomatic spinal cord compression: an uncommon symptom in pseudohypoparathyroidism. Annals of the New York Academy of Sciences, 1503(1), 38-47. https://doi.org/10.1111/nyas.14584

“Cervical Stenosis | Neurosurgery.” Neurosurgery, 2015, med.virginia.edu/neurosurgery/services/spine-surgery/cervical-stenosis/

“Lumbar Stenosis – Neurosurgery.” Neurosurgery, 3 Aug. 2023, med.virginia.edu/neurosurgery/services/spine-surgery/lumbar-stenosis/. Accessed 21 Aug. 2024.

Dützmann, S., et al. “[Thoracic Spinal Stenosis : Etiology, Pathogenesis, and Treatment].” Der Orthopade, vol. 48, no. 10, 1 Oct. 2019, pp. 844–848, pubmed.ncbi.nlm.nih.gov/31041462/, https://doi.org/10.1007/s00132-019-03731-8

Takahashi, Kohei, et al. “Foraminal Stenosis at L5–S1 as an Overlooked Pathology of Bilateral Radiculopathy: A Case Series.” Journal of Orthopaedic Case Reports, vol. 12, no. 6, 1 Jan. 2022, pp. 13–18, https://doi.org/10.13107/jocr.2022.v12.i06.2846

Porter, Richard W. “Central Spinal Stenosis: Classification and Pathogenesis.” Acta Orthopaedica Scandinavica, vol. 64, no. sup251, Jan. 1993, pp. 64–66, https://doi.org/10.3109/17453679309160121

Epstein, NE. “Foraminal and Far Lateral Lumbar Disc Herniations: Surgical Alternatives and Outcome Measures.” Spinal Cord, vol. 40, no. 10, 18 Sept. 2002, pp. 491–500, https://doi.org/10.1038/sj.sc.3101319. Accessed 24 Oct. 2019.

Bai, Qiushi, et al. “Current Understanding of Tandem Spinal Stenosis: Epidemiology, Diagnosis, and Surgical Strategy.” EFORT Open Reviews, vol. 7, no. 8, 1 Aug. 2022, pp. 587–598, eor.bioscientifica.com/view/journals/eor/7/8/EOR-22-0016.xml, https://doi.org/10.1530/EOR-22-0016

Lee, B., Moon, S., Suk, K., Kim, H., Yang, J., & Lee, H. (2020). Lumbar spinal stenosis: pathophysiology and treatment principle: a narrative review. Asian Spine Journal, 14(5), 682-693. https://doi.org/10.31616/asj.2020.0472

Phan, K., Teng, I., Schultz, K., & Mobbs, R. (2017). Treatment of lumbar spinal stenosis by microscopic unilateral laminectomy for bilateral decompression: a technical note. Orthopaedic Surgery, 9(2), 241-246. https://doi.org/10.1111/os.12335

Kaptan, H., Kasımcan, Ö., Ozyoruk, S., & Yılmaz, M. (2022). Microscopic unilateral approach for bilateral decompression of lumbar spinal stenosis. Archives of Iranian Medicine, 25(11), 742-747. https://doi.org/10.34172/aim.2022.117

Eun, D., Lee, Y., Park, J., Suk, K., Kim, H., Moon, S., … & Park, S. (2023). A comparative analysis of bi-portal endoscopic spine surgery and unilateral laminotomy for bilateral decompression in multilevel lumbar stenosis patients. Journal of Clinical Medicine, 12(3), 1033. https://doi.org/10.3390/jcm12031033

Zhang, L., Miao, H., Wang, Y., Chen, A., Zhang, T., & Liu, X. (2015). Limited unilateral decompression and pedicle screw fixation with fusion for lumbar spinal stenosis with unilateral radiculopathy: a retrospective analysis of 25 cases. Journal of Korean Neurosurgical Society, 58(1), 65. https://doi.org/10.3340/jkns.2015.58.1.65

Ebrahim, M., Alshura, S., & Hassan, M. (2020). Surgical treatment of lumbar spinal canal stenosis by laminectomy and posterolateral fusion. International Journal of Medical Arts, 0(0), 0-0. https://doi.org/10.21608/ijma.2020.21393.1062

Burnett, M., Stein, S., & Bartels, R. (2010). Cost-effectiveness of current treatment strategies for lumbar spinal stenosis: nonsurgical care, laminectomy, and x-stop. Journal of Neurosurgery Spine, 13(1), 39-46. https://doi.org/10.3171/2010.3.spine09552

Park, J., Park, H., Park, S., Choi, J., Kim, H., & Yeom, J. (2022). Learning curve for microscopic unilateral laminectomy for bilateral decompression surgery using the cumulative summation test for learning curve. Medicine, 101(40), e31069. https://doi.org/10.1097/md.0000000000031069

Nerland, U., Jakola, A., Solheim, O., Weber, C., Rao, V., Lønne, G., … & Gulati, S. (2015). Minimally invasive decompression versus open laminectomy for central stenosis of the lumbar spine: pragmatic comparative effectiveness study. BMJ, 350(apr01 1), h1603-h1603. https://doi.org/10.1136/bmj.h1603

Chang, F., Zhang, T., Gao, G., Ding, S., Su, Y., Li, L., … & Chen, Y. (2017). Comparison of the minimally invasive and conventional open surgery approach in the treatment of lumbar stenosis: a systematic review and a meta-analysis. Annals of the Academy of Medicine Singapore, 46(4), 124-137. https://doi.org/10.47102/annals-acadmedsg.v46n4p124

Ijaz, M. (2023). Unilateral laminotomy vs. conventional laminectomy: which is better for degenerative lumbar spinal stenosis?. Pakistan Journal of Neurological Surgery, 27(2), 178-186. https://doi.org/10.36552/pjns.v27i2.855

Toyoda, H., Hoshino, M., Ohyama, S., Terai, H., Suzuki, A., Yamada, K., … & Nakamura, H. (2019). Impact of sarcopenia on clinical outcomes of minimally invasive lumbar decompression surgery. Scientific Reports, 9(1). https://doi.org/10.1038/s41598-019-53053-0

Song, J., Samuel, A., Shahi, P., Fourman, M., Shinn, D., Dalal, S., … & Qureshi, S. (2023). The impact of preoperative sagittal imbalance on long-term postoperative outcomes following minimally invasive laminectomy. HSS Journal ®, 20(2), 222-229. https://doi.org/10.1177/15563316231162851

Hartman, J., Granville, M., & Jacobson, R. (2019). The use of vertiflex® interspinous spacer device in patients with lumbar spinal stenosis and concurrent medical comorbidities. Cureus. https://doi.org/10.7759/cureus.5374

Miller, L. and Block, J. (2012). Interspinous spacer implant in patients with lumbar spinal stenosis: preliminary results of a multicenter, randomized, controlled trial. Pain Research and Treatment, 2012, 1-10. https://doi.org/10.1155/2012/823509

Peng, H., Tang, G., Zhuang, X., Lu, S., Bai, Y., & Xu, L. (2019). Minimally invasive spine surgery decreases postoperative pain and inflammation for patients with lumbar spinal stenosis. Experimental and Therapeutic Medicine. https://doi.org/10.3892/etm.2019.7917

Nunley, P., Deer, T., Benyamin, R., Staats, P., & Block, J. (2018). Interspinous process decompression is associated with a reduction in opioid analgesia in patients with lumbar spinal stenosis. Journal of Pain Research, Volume 11, 2943-2948. https://doi.org/10.2147/jpr.s182322

Aggarwal, N. and Chow, R. (2021). Real world adverse events of interspinous spacers using manufacturer and user facility device experience data. Anesthesia and Pain Medicine, 16(2), 177-183. https://doi.org/10.17085/apm.20093

Wu, A., Zhou, Y., Li, Q., Wu, X., Jin, Y., Luo, P., … & Wang, X. (2014). Interspinous spacer versus traditional decompressive surgery for lumbar spinal stenosis: a systematic review and meta-analysis. Plos One, 9(5), e97142. https://doi.org/10.1371/journal.pone.0097142

Hong, P., Liu, Y., & Li, H. (2014). Comparison of the efficacy and safety between interspinous process distraction device and open decompression surgery in treating lumbar spinal stenosis: a meta analysis. Journal of Investigative Surgery, 28(1), 40-49. https://doi.org/10.3109/08941939.2014.932474

Loguidice, V., Bini, W., Shabat, S., Miller, L., & Block, J. (2011). Rationale, design and clinical performance of the superion®interspinous spacer: a minimally invasive implant for treatment of lumbar spinal stenosis. Expert Review of Medical Devices, 8(4), 419-426. https://doi.org/10.1586/erd.11.24

Staats, P., Hagedorn, J., Reece, D., Strand, N., & Poree, L. (2023). Percutaneous image‐guided lumbar decompression and interspinous spacers for the treatment of lumbar spinal stenosis: a 2‐year medicare claims benchmark study. Pain Practice, 23(7), 776-784. https://doi.org/10.1111/papr.13256

Nunley, P., Patel, V., Orndorff, D., Lavelle, W., Block, J., & Geisler, F. (2017). Five-year durability of stand-alone interspinous process decompression for lumbar spinal stenosis. Clinical Interventions in Aging, Volume 12, 1409-1417. https://doi.org/10.2147/cia.s143503

Jiang, H., Moro, A., Liu, Y., Wang, J., Meng, D., Zhan, X., … & Wei, Q. (2020). Two gwas-identified variants are associated with lumbar spinal stenosis and gasdermin-c expression in chinese population. Scientific Reports, 10(1). https://doi.org/10.1038/s41598-020-78249-7

Cho, Y., Ko, I., Kim, S., Lee, S., Shin, M., Kim, C., … & Kim, K. (2014). Oral mucosa stem cells alleviates spinal cord injury-induced neurogenic bladder symptoms in rats. Journal of Biomedical Science, 21(1). https://doi.org/10.1186/1423-0127-21-43

Kim, H. and Park, J. (2017). Usage of human mesenchymal stem cells in cell-based therapy: advantages and disadvantages. Development & Reproduction, 21(1), 1-10. https://doi.org/10.12717/dr.2017.21.1.001

Donnelly, E., Lamanna, J., & Boulis, N. (2012). Stem cell therapy for the spinal cord. Stem Cell Research & Therapy, 3(4). https://doi.org/10.1186/scrt115

Schneider, M., Ammendolia, C., Murphy, D., Glick, R., Piva, S., Tudorascu, D., … & Morton, S. (2014). Comparison of non-surgical treatment methods for patients with lumbar spinal stenosis: protocol for a randomized controlled trial. Chiropractic & Manual Therapies, 22(1). https://doi.org/10.1186/2045-709x-22-19

Sabapathy, V., Tharion, G., & Kumar, S. (2015). Cell therapy augments functional recovery subsequent to spinal cord injury under experimental conditions. Stem Cells International, 2015, 1-12. https://doi.org/10.1155/2015/132172

Kobayashi, Y., Shigyo, M., Platoshyn, O., Marsala, S., Kato, T., Takamura, N., … & Marsala, M. (2023). Expandable sendai-virus-reprogrammed human ipsc-neuronal precursors: in vivo post-grafting safety characterization in rats and adult pig. Cell Transplantation, 32, 096368972211070. https://doi.org/10.1177/09636897221107009

Sun, Y., An, Y., Fan, X., Shi, Y., Li, D., Liu, Y., … & Yu, C. (2023). A protocol for a single-centered, pragmatic, randomized, controlled, parallel trial comparing comprehensive nonsurgical therapy options for individuals with lumbar spinal stenosis. Journal of Pain Research, Volume 16, 773-784. https://doi.org/10.2147/jpr.s398897

Lee, J., Lee, H., Woo, S., Park, Y., Han, J., Choi, G., … & Han, C. (2023). Effectiveness and safety of acupotomy on lumbar spinal stenosis: a pragmatic, pilot, randomized controlled trial. Journal of Pain Research, Volume 16, 659-668. https://doi.org/10.2147/jpr.s399132

Kim, J., Lee, J., Lee, C., Lee, Y., & Lee, H. (2020). Effects of acupotomy on a dorsal wrist ganglion cyst with ultrasonography: a case report with a 7-month follow-up. Journal of Acupuncture Research, 37(4), 285-289. https://doi.org/10.13045/jar.2020.00276

Jun, H., Yoon, S., Roh, M., Kim, S., Lee, J., Lee, J., … & Leem, J. (2021). Quality assessment and implications for further study of acupotomy: case reports using the case report guidelines and the joanna briggs institute critical appraisal checklist. Journal of Acupuncture Research, 38(2), 122-133. https://doi.org/10.13045/jar.2021.00024

Kim, E., Kim, S., Kim, H., Jeong, J., Jung, S., Han, C., … & Kim, Y. (2017). Effectiveness and safety of acupotomy for lumbar disc herniation: a study protocol for a randomized, assessor-blinded, controlled pilot trial. Integrative Medicine Research, 6(3), 310-316. https://doi.org/10.1016/j.imr.2017.07.005

Yuk, D., Sung, I., Song, D., Kim, M., & Hong, K. (2013). Clinical study of lumbar spine stenosis treated by using acupotomy combined with oriental medical treatments. Journal of Pharmacopuncture, 16(3), 46-51. https://doi.org/10.3831/kpi.2013.16.017

Shen, Y., Li, T., Cai, T., Zhong, J., Guo, J., & Shen, H. (2019). Acupotomy for nerve entrapment syndrome. Medicine, 98(50), e18327. https://doi.org/10.1097/md.0000000000018327

Farooq, M. (2023). Clinical outcomes of three level interlaminar endoscopic decompression surgery in the treatment of multilevel lumber spinal stenosis. Pakistan Journal of Neurological Surgery, 27(3), 177-183. https://doi.org/10.36552/pjns.v27i3.881

Chang, J., Kim, H., Oh, Y., & Hwang, J. (2020). Correlation of the lumbar dural sac dimension with the spread of spinal anesthesia in elderly female patients: a prospective observational study. Acta Anaesthesiologica Scandinavica, 65(1), 116-122. https://doi.org/10.1111/aas.13698

Ghezelbash, F. (2024). Development and validation of a subject-specific integrated finite element musculoskeletal model of human trunk with ergonomic and clinical applications.. https://doi.org/10.1101/2024.01.06.574467

Malik, K. (2023). Pain management interventions in lumbar spinal stenosis: a literature review. Cureus. https://doi.org/10.7759/cureus.44116

Brøgger, H., Maribo, T., Christensen, R., & Schiøttz-Christensen, B. (2018). Comparative effectiveness and prognostic factors for outcome of surgical and non-surgical management of lumbar spinal stenosis in an elderly population: protocol for an observational study. BMJ Open, 8(12), e024949. https://doi.org/10.1136/bmjopen-2018-024949