VertiFlex/Xstop/Mild?

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Timeoutofmind

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Anyone recommend any of these treatments as reasonable/effective at this current point in time?

Saw a healthy, active, pleasant 60 year old with severe single level lumbar stenosis with a lot of ligamantum flavum hypertrophy today...had been offered decompression/fusion...not doing well with conservative tx. Got me thinking...

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Unless he's got a significant and/or mobile spondy I'd rec, if it was my family, to get another opinion for a simple decompression without fusion. IMO a Young and healthy patient should get this problem truly fixed, not a gizmo.


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Unless he's got a significant and/or mobile spondy I'd rec, if it was my family, to get another opinion for a simple decompression without fusion. IMO a Young and healthy patient should get this problem truly fixed, not a gizmo.


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Sorry forgot to clarify...grade 1 listhesis. Stable in flex/ex

I guess it makes some since they would want to fuse her given the listhesis? Although with a grade one seems that a decompression should still be adequate without a fusion?
 
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The literature review refutes need for fusion with a stable spondylolisthesis. Decompression only. The other options don't seem reasonable or effective.
 
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the younger spine surgeons usually can decompress without fusion for a stable grade 1 degenerative spondy. the "classic" teaching is that you need to fuse these, so the older surgeons (or more greedy ones) fuse as well. if they have a concomitant spondylolysis, then a fusion is necessary
 
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the younger spine surgeons usually can decompress without fusion for a stable grade 1 degenerative spondy. the "classic" teaching is that you need to fuse these, so the older surgeons (or more greedy ones) fuse as well. if they have a concomitant spondylolysis, then a fusion is necessary
Prob depends how much facet arthropathy is contributing to the stenosis, and how much of the facets they have to take to clear out the canal. If they take enough, prob have to fuse for stability purposes
 
Prob depends how much facet arthropathy is contributing to the stenosis, and how much of the facets they have to take to clear out the canal. If they take enough, prob have to fuse for stability purposes

True, but ssdoc makes a good point. If this was my mother, I'd ensure she had 2 and 3rd opinions with two other younger spine surgeons.
 
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Necro bump I’m aware

What is the group’s experience with Vertiflex?

In terms of my personal preference, I do not offer these to patients who are younger and healthier and could tolerate a decompression +/- fusion. Therefore I reserve them for people who are medically sicker and will not tolerate an invasive procedure. In short, I’ve view them as an agent for people in their mid to high 80s to low 90s.

With that being said, I’m not overzealous with this procedure. I get no cut of the facilities fees. I try to avoid the severe stenosis since it is off label. Most of my patients are on no opioids or a very small amount.

However, I have been disappointed in it lately. I have seen multiple spinous process fractures despite the literature suggesting otherwise and reassuring DEXA scans and not oversizing the implant. In addition, I have seen device failures during implant. Despite the literature suggesting otherwise my explant rate is higher than advertised.

I have talked to spine surgeons and I know that the ones that I have spoken to do not believe in this therapy much.

Perhaps since I am putting these in older patients I will not get the proverbial home run. However, I’d like to see some improvement walking the dog and picking up the mail.

Perhaps I’ve just had a string of bad outcomes lately and I am putting too much weight on the small sample size.
 
The literature review refutes need for fusion with a stable spondylolisthesis. Decompression only. The other options don't seem reasonable or effective.

Necro bump as well.

I’ve coached patients into insisting their surgeon try just lamis with a stable spondylolisthesis and the vast majority did just fine without the fusion.
 
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Vertiflex works great. Most are very aged because this procedure is limited to traditional Medicare here. I have done around 250. I am pretty confident less than 10% have been explanted or revised. I have only revised a couple to a fusion spacer. I removed one a couple days after placing as I placed a 16mm and caused a radiculopathy from an adjacent nerve.

Spinous process fracture is fairly asymptomatic and doesn’t typically require removal of the device or any intervention.

Have I seen some of them a little wonky when I go back and do a RFA? Sure. But that is expected. They aren’t secured with anything other than the vertebral columns own spring pressure and the pressure of the surrounding tissue/surgical scarring. If they are still between the spinous processes, even a little rotated, they are still limiting extension at that segment and thus doing their job. I place mostly 12mm spacers, quite a few 14mm, and rarely 10mm. I don’t use the sizer. I use my eyeballs and the objective knowledge of how big the rasp and final dilator are.

I am pretty confident that my most satisfied patients have been vertiflex patients and they continue to spread good word of mouth. It is such a tiny wack and very well tolerated. It doesn’t make anyone worse and doesn’t cause any adjacent segment disease or same level listhesis.
 
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Vertiflex works great. Most are very aged because this procedure is limited to traditional Medicare here. I have done around 250. I am pretty confident less than 10% have been explanted or revised. I have only revised a couple to a fusion spacer. I removed one a couple days after placing as I placed a 16mm and caused a radiculopathy from an adjacent nerve.

Spinous process fracture is fairly asymptomatic and doesn’t typically require removal of the device or any intervention.

Have I seen some of them a little wonky when I go back and do a RFA? Sure. But that is expected. They aren’t secured with anything other than the vertebral columns own spring pressure and the pressure of the surrounding tissue/surgical scarring. If they are still between the spinous processes, even a little rotated, they are still limiting extension at that segment and thus doing their job. I place mostly 12mm spacers, quite a few 14mm, and rarely 10mm. I don’t use the sizer. I use my eyeballs and the objective knowledge of how big the rasp and final dilator are.

I am pretty confident that my most satisfied patients have been vertiflex patients and they continue to spread good word of mouth. It is such a tiny wack and very well tolerated. It doesn’t make anyone worse and doesn’t cause any adjacent segment disease or same level listhesis.
If leg pain. This is a home run.

I used to LOVE this procedure. fast and safe. Problem was advantage plans....

I guess that's why MinuteMan came to be..
 
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Advantage plans and also a $375 pro fee with a 90 day global. You forget to use modifier -79? Your cervical mbbs/rfa aren’t going to get paid and you just lost $2000.
 
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