Why is a Coflex or X-Stop Used for Spinal Stenosis Surgery | Podcast Ep. 133

Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. This week we are going to talk about the X Stop and Coflex devices. This is probably something you've seen on imaging or on an imaging report. And I wanted to break down what are the differences between these two spine devices, what are they used for and how it can impact your practice. So this week is all research, all clinical and it's going to be something that can add value to your practice immediately. Also, as we kick things off, I wanted to give a huge thank you to everybody that's been tuning in and listening to this podcast. Last week was the first week that we reached over 10,000. 10,000 chiropractors. 10,000 listens or downloads in a single week. So that is again I've said it before and I will say it again, it is humbling. I am just so grateful that this podcast has resonated with so many people and is really my hope is provide some clinical guidance, provide some marketing advice, provide some research expertise that you can bring directly into your practice. So about think. Thank you a ton for listening. My one big ask. If you have not yet left feedback, left a rating or review on itunes, please click over and do that as soon as possible. That helps us reach more and more chiropractors. And you know, I was happy when it was 100 in a week. So 10,000 absolutely is just. Is just humbling and pretty awesome. So thank you for tuning in and thank you for listening. Listening. With that being said, this week we are hitting a topic that is going to resonate with you and your patients and it is about the Coflex and the X Stop devices. So there's no question that you've probably looked at a picture, an image or read a report and seen some of that nomenclature, X Stop or Coflex. So I wanted to break down what those devices are, where they sit within the spine, what are they used for, the differences between them and how it impacts your practice to make sure that you are up to speed on them. So the X Stop and the Coflex device are commonly used as alternatives to a fusion based procedure. So the way that they are sold essentially is that it provides stability without all of the nuts and bolts, the screws, the common architecture of a fusion, but it still is an implanted device that gives some stability. Those things are true. These devices sit on the posterior architecture of the spine. Each of them is inserted and can be inserted in a minimally invasive fashion. That's also appealing To a lot of people, many of these devices, each of these devices can really be done and performed depending upon what else is being done, in less than an hour's time for sure, in an outpatient setting. So that's what gets a lot of people interested in them. But both are used predominantly for the treatment and care of spinal stenosis. So when either of the devices is implanted or installed, it prevents extreme extension of the lumbar spine. So it prevents true extension. And we know extension closes down the spinal canal and increases the symptomatology in people with spinal stenosis. That's why that forward flexed posture leaning over the grocery cart feels so good for them and is it physically opens up the canal. So each of these devices limits the amount of extension that the person can perform because they're installed in the posterior architecture. And speaking of that, they both go into different spots. If you look at an image, if you look at a picture, sometimes it can be difficult to tell the difference between the two. But here is a glaring difference to keep in mind. This is a big difference. An X stop device is an intraspinous device. So it is rather superficial in comparison to the Coflex. An X stop device sits between the spinous processes. That is where it is engaged. That's where it hangs out. That's where it is meant to sit and live. A Coflex device is a deeper piece. It is an intralaminar device. So it goes beyond the spinous process and, and sits and performs its stability function between the lamina of those vertebral segments. Either of these devices can be done at one or two levels. Typically they're done at a single level. Additionally, L5S1 is out of the question. These are usually seen at 4, 5 or L3. L4, so either 3, 4 or 4, 5 most common placements. 5, 1, not a good placement because S1 obviously does not have a spinous process, nor does it really have a true lamina that the Coflex could grab onto. So again, to repeat that the X stop device sits in between the spinous processes. The Coflex device goes deeper and sits as an intralaminar device. Both limit extension and both are designed to provide some modicum of relief for spinal stenosis. Now, where each of those devices sits, spinous or lamina is very, very important for this reason. This is something that you have to keep in mind when speaking with your patients about them. An X stop device. When an X stop device is removed, there is essentially no burned bridges. So they are Rather simple from a surgical perspective to remove. And when it is removed, you still typically there are exceptions to every rule, but typically the broad gamut of interventions are still available for that individual. That's kind of esoteric way of saying, let me go to the flip side of that coin, a Coflex device being deeper when a Coflex device is removed, they're a little bit more difficult to remove. But because they sit within the intralaminar space, it is a majority, a vast majority, nearly every time that if a Colex device is removed, the only option from there on is a fusion. So there is somewhat of a burned bridge factor with your Coflex device. A Coflex sitting deeper when it is removed, a lot of stuff goes with it or has been taken out when it was implanted. Therefore, typically when a Coflex is removed, a fusion is performed right there and then failure of an X Stop device can be removed and you can go a variety of different directions. Now, Clint, that makes it sound like X Stop might be a better device if there's more options on the table if and when it fails. In my experience, my clinical experience, again working in outpatient surgical setting, working in a hospital based, full orthopedic setting, but I will say I saw better results overall with a Coflex device than an X Stop. I am not a big fan of an X Stop device in terms of true result, but the advantage of it is that it does allow a wide gamut of intervention if in the event it needs to be removed. Now, with all this being said about both the X Stop and the Coflex, this is why it is exceptionally important as we talk about each and every week, to bridge the gap and build relationships with other healthcare providers in your community. The ideal world is to never get to that point. Fusion is obviously the last thing anybody wants or needs to have done. There are certain instances where it's the only choice. Thankfully they are few and far between. And quite frankly, inserting any sort of substance, any architecture into the spine changes the biomechanics purposefully. In this case, each of these prevent full extension. Well, when you alter the biomechanics of the spine, there's no question in my mind that you advance the degenerative changes. The weight of gravity impacts a body differently when there's not a full range of motion available. That's important because as the dynamics of the body change, as the center of gravity changes, as the ability to move through a range of motion changes, it can negatively impact the surrounding joints. That is why bridging the gap? Talking about the case studies, talking about the early research that has showcased the great results that chiropractic has received with patients suffering from spinal stenosis is so important because the ideal world is a patient never gets to the point where they need their spine altered from that day forward without being able to go back. And regardless of what device you put in that is the brass tacks of what happens. There is a permanent change in the biomechanics, even if it's removed down the road. So as you go out there, this week was really about giving you the knowledge to understand those two devices a little bit better and the differences between the two. But secondarily, it is also to reemphasize the point that chiropractic, in my opinion, is probably the best option for people suffering from spinal stenosis in terms of providing that relief. They might have bone spurs, they might have ligamentum flavum hypertrophy. There can be a congenitally small canal. There can be a variety of things that contribute to spinal stenosis, many things which chiropractic, maybe on a picture is not going to change. But that doesn't take away the fact that this is about symptomatic relief. This is about function. And if somebody's canal is a little tight, but they're able to function at the level that they'd like to enjoy their life and have a high quality of life, then that is a huge win. And that is exactly what we do each and every week as chiropractors in our community. If you have any questions about Coflex or Xstop, feel free to shoot me an email. Jeffeevidencebasedchiropractor.com Again, 10,000 listens last week. We're going to continue to deliver the goods each and every week. If you have any questions or you have any topics that you would like to have addressed on any upcoming episodes, shoot me an email. Jeff the evidencebasedchiropractor.com I'd be happy to talk about it. I hope you have a great week in practice and I will talk to you soon.

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