Forward bending or sitting leads to rapid pain relief. LSS is seen frequently in clinical practice. 3 to 4% of all patients consulting a general physician with pain in the lower back region have LSS. Nearly 15% of the patients who see a specialist for lower back pain have LSS [4]. Annual incidence rates http://www.selleckchem.com/products/Enzastaurin.html of 5/100,000 have been reported [5]. In the United States, the cost of NIC to society from medical treatment and loss of productive work hours reaches tens of billions of dollars annually [6]. Nonoperative therapy is initially considered with oral nonsteroidal anti-inflammatory drugs (NSAIDs), other analgetics, and physical therapy. This regimen can be intensified by adding epidural pain treatment (steroids, opioids, and local anesthetics).

In a third of all cases, this therapy decreases symptoms sufficiently that operative treatment can be avoided. In the remaining two-thirds, surgical intervention is necessary [7]. For LSS patients over 65 years undergoing surgery, open decompression is most frequently performed [1, 8, 9]. One problem associated with decompression procedures is trauma to the osteoligamentous structures, which vares in severity depending on the extent of surgery performed. A relatively new and less invasive therapeutic alternative is insertion of an interspinous process decompression device (IPD). These implants are inserted between the spinal processes and are expected to result in improved symptoms. The use of interspinous implants has grown markedly over the past few years.

Biomechanical studies have shown that IPDs significantly reduce intradiscal pressure as well as facet load, and they prevent narrowing of the spinal canal and neural foramina [10, 11]. Previous studies have shown benefits with the use of implanted devices (e.g., X-Stop) versus conservative therapy, especially with regards to the quality of life [6, 12]. For some patients with LSS, IPDs may be a viable alternative to open decompression [13]. IPDs may be used either as ��stand alone�� implants or to augment open decompression by preventing instability [14]. The main principle behind their design is the limitation of dynamic extension in the affected segment [13]. Radiologic studies have demonstrated that the use of interspinous devices affects spinal alignment as well as the dimensions of the spinal canal and neural foramina [15�C17].

In addition, insertion of an IPD can be accomplished percutaneously through a 1.5cm incision. This method is used for implantation of the Aperius PercLID device designed by Medtronic, Inc. This device has been on the market since 2006 and is CE certified. The inner core and outer shell of the implant are made of titanium (Ti-6Al-4V) with unfoldable fins. The Batimastat Aperius PercLID is suitable for patients with degenerative lumbar spinal stenosis and can be implanted at the levels L1�CL5.